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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE !D/SIG COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVl nsu latio n <br />Roof Sheathino <br />Shear Wall <br />Framinq lo'L,tr,7n bktr61 <br />lnsulation/Energy <br />Drywall LI 1/)hktrtr 7 <br />Ext./lnt. Lath t <br />Brown Coat <br />[t/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enoineer Final Report <br />Flood Zone Certif <br />1 A ,\-? /^ <br />FINAL Ir lv 'l/)I>kq'r <br />Certificate of Occupancy - <br />Notes, Remarks, Etc. .c.- <br />lol ? 71 7d. f o .l- --\fr#m <br />t I \) <br />OWNER BT'ILDER DELCARATION <br />I hcrcby affrm under Fndty of lErjury that i m cxerpt frcm the ContBcloN' Liccnse l:w for thc following rBsn (Ss.7031.5 <br />Busincss and Prcfcssion Codc): Any City or County uhich rcquircs a pcmit to @nstnrct. altq. imprcve, &mlish or rcpair uy' <br />structurc, frior lo its issuance, also rcquircs thc applicant for such Jrcrmit to filc o signcd ststcmnt tha] hc or she is licensd pursumt <br />to thc Jrevisions of the Contractor's Liccnsd Law (Chaptcr 9, Comrcing with Sction 7000 of Division 3 of the Busircss md <br />PrcfcssionsCodc)orthatheorslrciscxcmpttlmfromardthcb&sisforthcallcgcdcxcmption. AtryviolationofscctionT03l.5bysny <br />applicant for a Jrmit subjats thc applicant to a civil pcmlty of nol mrc the fivc hurdrcd dollus ($5fi)). <br />_1. as owtrcr of thc property. or my crnployccs with wagcs as their solc compcnsation. will do thc work and thc stnrcture Ls rrrt <br />intcndcd or olTercd for sale (Sec.7014. Busincss and hofessions Codc: Thc Contractor's Liccnse law docs not apply to an owner of <br />thc propcrty who builds or improvcs thcrcon, and who docs such work hirnsclf or hcrsclf or through his or hcr own employees, <br />providcd that such improvcnrnts arc not intcndcd or offercd for salc. lf, howcvcr. thc building or improvctrrcnt is sold within onc ycar <br />of complction. thc Owncr Builder will havc thc burdcn of proving that he or she did not buikl or improvc thc propcrty for the purpsc of <br />sab). <br />_1. as owncr of thc propcrty. am exclusively contracting with liccnscd contraclom lo construct thc pnl.icrt (Scc. 7W. Busincss <br />and Prrofcsskrn Codc: Thc Contraclor's Liccnse Law docs nol apply lo an owncr of propcrty who builds or improves thercon. <br />and who contracls for such projccts with a Contracto(s) licenscd pursuant to thc Contractor's Liccnsc L:w). <br />-l <br />arn cxcnlpl undcr Scction-. B. & P.C. for thls rcason. <br />Date:___( )rr lter. <br />WORKERS' COMPM{SATION <br />DT'CLARATION <br />I hercby affirrn undcr penalty of pcrjury onc of thc following dc'clarations: <br />_l havc and will maintain a Ccrrilicatc of Consent to Scll'-lnsurc for workcrs'compcnsation. as provided for bySection 37fi) of the <br />Labor Code, for lhc pcformancc of thc work for which thc pcrnrit is issucd. <br />_l have and will rnaintain workers' compcnsation insurarrcc. as by Scction 370O of the l-abor Code, for the performancc of <br />carricr ard plicy number arc:thc work lbr which this permit is issucd. My workers' <br />t .J \tv ) <br />Policy s lr /ror,l <br />_l certify that in the pcrfornrancc of the work for which this pcrrnit is issucd, I shall not employ any pcrson in any numncr <br />so as to bcconrc subjcct to thc workers' compcnsation laws of California. and agrcc thal if I should bcconrc subjecl to tlrc <br />workcrs' con{rcnsation provisions of Section 3700 of the L,:rtnr Code, I slrall. forthwith comply with thosc provisions. <br />WARNING: Failure to sccurc workcrs' compcnsation coveruge is unlawful. arxl shall subjcct an employcr to criminal pcnaltics and <br />t <br />civil fin('s up to onc hundrcd thousand dollars (S100.000). <br />Scction 307(r of thc Latnr Codc. intcrcst and attorncy's fces. <br />in addition to thc cosl of comfrcnsation. danutges lirr lhc <br />Dalc: \.sl ts l:o g r,t <br />I hcrcby allirrn undcr pcnalty of pcrjury that I am liccnscd 9 (comnrcncing with Scttion 7000) of Division 3 <br />of thc Busincss and hofcssions Code. and my liccrse is in full force ard cffcrct. <br />B q(l <br />Liccnse Nurnbcr: <br />W <br />t hercby aflirm undcr Fnalty of IErjury th.t th@ is a conslruction lending agcrcy for thc Frformcc of thc work for which lhis Imil is <br />issucd (Scc. 309?. Civ. C.). <br />lrnder's Namc: <br />lrndcr's Acldrcss: <br />APPI ICANT DECLARATION <br />I tracby aflirnr undcr pcnalty of Jrcrjury onc of thc following dcclarations: <br />Dcmolition Pcrnrits-Asbestos Notification Fcdcral Rcgulations (Title 40, Pan6) <br />-Rcqu <br />ircd [-cttcr of Notification <br />_l certily that thc federal rcgulations rcgarding asbcstos rcnxlvalare not applicable to this prolt'ct. <br />_l ccrtify that I havc rcad this application and state that thc atnvc infornvation is to comply with all City and County <br />ordinanccs and Statc [:ws rclating to building of this City and County lo entcr upon the <br />abovc rrntioncd property for <br />Applicant or Agent <br />Pernriler-. ntnrt <br />constructioru hcreby <br />o** to I tS/OO <br />Rev. 08-07 -201 5 <br />I <br />6vl <br />I <br />\ <br />Applicnnt: