Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />S!TE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hocby affm undr pclalty of pcrjury that I m exmpt from thc Contraclos' Licere tlw for the following rwn (Se.7031.5 <br />Busines md Profcssion Codc): Any City or County which requirc a pemh to coNtrucl, altq, imprcvc. dcmolish or rcpair my <br />structue. pnor to its issuacc, also rcquirc thc applicilt for such pctrrit to filc a signcd statmat thal h€ or slrc b licqscd plMt <br />to thc provisiom of thc Contractor's Liccnscd Law (Chspa 9. Commmcing with Setion 7000 of Division 3 of thc Buins 4d <br />Prcfsiom Cod€) or that hc or she is exempt thqefrom ud thc b6sis for the allcged cxmp(io[ Any violstion of Scrion 7031.5 by any <br />applicut for a pmil subjets thc applicant to a civil pcnalty of trot morc tha fivc hundrcd dollm ($500). <br />_1, s owna of thc property. or my cmployc with w8g6 s thcir $lc compcnsation. will do thc wd( ad thc struclrc is rcl <br />intqrded or offcrcd for slc (Sc.7044. BNins md Profeiom Codc: Thc Crntractor's Liccre lrw do6 not @ply to u ownq of <br />thc prcpsry *'ho builds or improvc tho@tr ud who do6 such wtt hiroclf or hwlf or thmugh his or hr om mploye, <br />provided that such inFovms rc not inandcd or offocd for glc. If. howdq. rhc building or improvqrcnt is sH whhin onc )qr <br />ofcompletioo, thc o\vn6 Buildq will have thc hrd6 of proving thd he or $e did rct hdld or inprovc thc prcpsty for thc purpo*of <br />ele). <br />-1, <br />r omq of the propqly, m qclBivcly contracting with licens€d contmctoc to @mtrucl thc projct (Sc. ?044, BEinG <br />ard Proftssbn Co&: Thc Contrctor's License Law do6 not applyto u own6 of propoty who builds or improvG thq6n, <br />md who ontrads for such projcls with 8 Contmcto(s) licas€d pu6uet to thc Contractor's Licre Law). <br />_ _! am exempt B.reas()n. <br />r'I hereby affrrm under penalty of perjury one followrng <br />_-_i have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />labor Code. for the perfonnance of the work for which the permit is issued. <br />_l have and will maintain workers' compensation insurance. as required by Scction 3700 of thc Labor Codc. for the performance of <br />the work for which this permit is issued. My workers' comperuation insurance carrier and policy number are: <br />Carrier: <br />Policy Number: <br />--l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner <br />so as to become subjert to thc workers'compensation laws of California. and agree that if I should becorne subjcct to the <br />workcrs' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply with thosc provisions. <br />WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an onployer to criminal pelrahies and <br />civil fines up to one hundred thousand dollars in addition to the cost of compensation. damages as provided for the <br />Section Code. interest( <br />I hereby alfirm under pcnalty of perjury that I am licensed undcr 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />[.icense Numbcr: <br />Dete: Contrector: <br />W <br />I hreby aflim undo porahy of pcrjury that thoc is 8 construction lqding ag6cy for thc pcfotimcc of thc wo.k for which this pflnit is <br />issued (Se. 3097. Civ. C.). <br />Lcnder's Name: <br />I-cnder's Ad&ess: <br />APPLICANT DECLARA'TION <br />I hercby affrrn under penalty of perjury cne of the following declarations: <br />Dcmolition Perrnits-Asbestos Notilication Federal Regulations (Title 40, Pafl6) <br />-.Required <br />Letter of Notification <br />- <br />I cstify that thc fcdqal rcgulatioN rcgading obstos moval rc not applicablc to this prcjet. <br />W ,nn I have ud this application ard state rhal rhc above infonnation is coret. I agc to @mply with all City md County <br />ordinancB ad Stste tiws rclati[g to building constructiorL ad hscby authorirc rcprBmtalive of this City md County to ats upon thc <br />above mentioned property for inspection purposes. <br />Applicant or <br />llernritee <br />\ <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bfloor/Ve nU I n s u latio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />/l --l <br />FINAL //ril ??o 24 %tr / <br />Certificate of Occu <br />Notes, Remarks. Etc. <br />t <br />? <br />,,,",d/g/Al?