Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVl ns u lation <br />6b2fu1Roof Sheathing lo,tW,9 tt\ <br />Shear Wall <br />Framinq <br />lnsu lation/Enerqv <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[\/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputv Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />frt <br />FINAL t0'9$'77)IW,ffIOA W6 <br />Certificate of Occupancv <br />Notes, Remarks, Etc. <br />?, <br />OWNER BUILDER DELCARATION <br />I hcrcby aflirm undcr Jrcnalry of Jrcrjury that I am excmpt liom lhc Grntracture' Liccns liw li,r thc following rcasD (Se.70-11.5 <br />Busilrcss arrl Prolbssion Gxrc): Any City or County which rcquircs o [rcrmil t(t c(rnslruct. altcr. improvc. dcm)lish or reFir any <br />structurc, ltrirr to its issuaer, als(, rcquircs Ihc applicant for such JErmit to tilc a sigrcd strtcnEnt lhat he or slrc is liccnsd pusuanl <br />lo tlrc pmvisions of thc Gnnractor's Liccnscd Law (Chaptcr 9. Commcncing wilh Seliur 7000 of Division -l of thc Busircss and <br />Prulbssiom Codc) or that hc or shc is cxcmpt thcreliom atrd thc hasis firr thc ollcgcd cxcmp{ion. Any violltion of Scctktn 7OJ 1.5 by any <br />lpplicatrr for tr pcmit subj@ts thc {pplicant k) a civil pcnalty of nd morc th{r livc hundtcd dollus (5500}. <br />Mu*r", ofihc prupcny, or my cmploycc$ with wa8rcs as llrctr slc compcnsation. will do ltrc wort uxt thc tlrutrc is not <br />/ rntcnrlcrl or offcrcd f(n salc (Se.?044, Busincss and Pnrfcssions Ctxlc: Thc G)ntrack['s Liccns Law il(rcs not apply to an owncr of <br />thcpn)Fny wlxrbuildsorimgn)vesthcrq)n,aulwh)d(Essuchm*himsclforhcrrclforth()ughhisorhcrowncmployccs, <br />providcd lhat such impn rcmnts rc frrt intcnlql orollbBl fu sab. Ii horcvcr, thc buillirg or impn)rcmnt is $)ld within ('nc ycu <br />ol'comphlirn, thc Owrcr Buillq will haw thc burdcn o[ Inrving that lrc or shc dil mt bui!.i or itrWovc lhc prcFrty for thc purJxrs of <br />uh). <br />_1, as owncr ol'thc profrcrty, amcxclusivcly contracting with licenscd contractors to conslruct thc projcct 1Scc. l0{"d, $usivlgss <br />and Pnrt'esskrn Code: Thc Contractor's Liccnsc [-aw dtrcs not apply to an owner of proJrcrty who builds or improvcs thcrcon, <br />and who contracts tirr such projc-cts with a Contractrlr(s) liccnscrl pursuant to thc Contractor's Liccttsc taw). <br />_l am ttttr.lcr & P.C. lirlthis rcas()n. <br />Policy Numbcr: Expires: <br />e L s <br />I hcrcby aft'irnr undcr ;rcnalty of Jrcr.iury onc of thc tirlkrwing dcclaratlons: <br />_l havc arxl will nuintain a Ccrtiticatc of Conscnt to Scll'-lnsurc firr workers'comJrcnsation, as pnlvirlcd lilr by Scctiott 37fi) of thc <br />Lahor Ctilc. lirr thc Jrcrlirrmancc of thc work lirr which thc pcrmit is issucd. <br />_l havc and will maintain workcrs' cornJrcnsation insurancc. as rcrluircd hy Scct ion 37fi) of thc l-abor Codc, tbr thc grcrtttrmancc of <br />thc work krr which this pcrmit is issucd, My wrx'kcrs' c()mlrcnsation insurarrcc carricr and Jxllicy number arc: <br />%!(k^\r rn^in rhc lrcrti)rmamc of thc work lor which this lErmit is issucd, I shall not cmpkty any lrcrsotr in any manncr <br />/so as to hccrrm suhjcct to lhc workqs' com1Ensation laws ()f Calilbmia, anrl agrcc lhat if I slouLl bocom suhjctl b thc <br />workcrs' comlrcnsation pmvisions of Scclion 3?U) of thc bhrr C(xlc, I stEll, l'orrhwith crrmply wilh thorc pnrvisions. <br />WARNING: Failurc to scurc w()rkcrs'comlEns.tion coveragc is unlawful. and shall subjet an mploycr to oiminal Jrcmltics and <br />eivil fincs up to orc hundrcd lh(rusand d(rllars (S100,fiX)). in addition b thc cost of comlEnsalion, damScs as Fovidcd Ior tlrc <br />Scction ]076 ol'thc Lahlr Crxlc, irttcrcst and attorncy's l'ccs. <br />Date: t /C> '6 7 -Z a l\ <br />\ <br />I hcrchy alllrm undcr Jrcnalty of Jrcrjury that I am licenscd under pnrvision of Chaptcr 9 (commencing with Scctiolt 7000) of Division -l <br />of thc Busincss and Prof'cssions Codc, and my liccnsc is in lull firrcc uxl cll'cct. <br />, <br />Licensc Class: Liccnsc Number: <br />Date: Contraclor: <br />W <br />I hcrchy allirm undcr lrcnaltyof Frjury that thcrc is a c(rnstructbn hnding agcncy for thc lErformaDcc ofthc work li]r which this Frmit is <br />issucrl (Scc. -1097, Civ. C.). <br />lrndcr's Namc: <br />Lcnder's Addrcss: <br />APILICANI.DECI.AEAIPN <br />I hcrd,y allim undcr IEnalIy of Frjury onc of thc following dcclarations: <br />Dcm)litt n Pcrmits-Asbc$tos N(trification Fcderal RcSulatiotrs (Titlc 40, Pan6) <br />-Rcquir.d <br />t ttcrof Notilicalbn <br />-l <br />cedily thal lhc lbdcral rcgulatioN rcganting asbcsbs rcm)val arc Bil .pplicablc to this prujet, <br />?4r rnnl havc rca'l rhis slplicrtion url state that thc ahrvc infomthn is corot. I a!re k) q)mply with rll City arxl County <br />ordimNcs atv.l St0tc kws rclaling to building construction, a!r.l hercby authorir rcJrcsntalives of this City and County to cnlcr uJxtn the <br />atxrvc mcntioncrl proJrcrty tirr <br />-d 7oApplicant or Agent <br />Pennilee nanre <br />ov nR-n -2n1q <br />a <br />a