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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.GOMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf Ioor/VenVl ns u latio n A t\,,'l /r/ <br />Roof Sheathing I ,(' lu aL/W,*r,1 rud6 q) <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drvwall <br />Ext./lnt. Lath <br />Brown Coat <br />[t/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />^- <br />FINAL /a-*{-4)e@u U66r <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARATION <br />I hcrcby alfirnr undcr pcnalty of perjury that I am cxenpt frorn the Contractors' Liccnse law for thc following rcason (Sec.7031.5 <br />Busincss and Prol'cssion Codc): Any City or County which requires a pcrnrit lo construct. altcr. improvc, dcmolish or reJnir any <br />structurc, prior to its issuancc, also rcquircs thc applicant for such permit to filc a signcd statement that hc or she is liccnscd pursuant <br />to thc pnovisions of thc Contractor's Liccnsed Law (Chaptcr 9, Commcncing with Scrction 7000 of Division 3 of thc Busirrcss and <br />Profcssions Code) or that hc or shc is excmpt therefrom arxl the basis for the allcgcd excrnption. Any violation of Scction 7031.5 by any <br />applicant for a pcrmit subjcrts the applicant to a civil pcnalty of not more than live hurxlred dollars (S500). <br />_1. as owncr of thc propcrty. or my crnployccs with wagcs as thcir solc cornJrcnsatiott. will do thc work and thc structurc is not <br />intcnded ur offcred for salc (Scc.7044. Busincss and Profcssions Codc: Thc Contractor's Liccnsc [,aw docs not apply to an owncr of <br />thc proFrty who builds or inrprovcs thcrcon and who docs such work hintsclf or hcrself or through his or her own cmployccs. <br />providcd that such improvenrcnts &rc not intendcd or offcrcxl for sah. lf. howcvcr. thc buikting or inprovcnrcnl is rcld within onc )rcar <br />of complction. thc Owrcr Buildcr will lurvc the burdcn of proving that hc or she did not buikl or irnprovc the propcrly for thc purpsc of <br />salc). <br />_1. as owner of thc proprty. am cxclusively contracting with licenscd contraclors to construct thc projc.ct (Scc. 7W. Business <br />and hotbssion Cocle: Thc Contractor's Licensc Law does not apply to an owncr of propcrty who builds or improvcs thcrcon, <br />and who conlracls tbr such pojecls with a Contractor(s) liccnscd pursuant to thc Conlraclor's Liccnse [aw). <br />-l <br />arn excrnpt undcr Scction-. B. & P.C. tbr thi.s reason. <br />Date:Owner: <br />WOnXFkY COrrtPnVSAnOX <br />DT'CI ARATION <br />I hcrcby allirm undcr pcnalty of Isjury one of the following dElsations: <br />-l <br />harc 8nd will mintain o Cc(ificatc of Consnt to Sclf-lnsurc for workcrs' compcns&tion, as lrcvided for by Scction 3700 of thc <br />tibor Codc. for thc pcrforme of thc work for whhh thc permit is issucd, <br />,fnuo "na <br />*itt *inlain worke$' mmpcnsation iruurarce. as rcquircd by Scctkrn 3?00 of the tibor Codc, for Ihe perfffic of' thc work for which this pcrmit is issrd. My workqs' @r[rcnstion insumnc cmicr ard policy numbcr rc: <br /><.[€, 14 R^N d <br />Policy <br />qZ <br />_l certify that in the pcrformarce of the work for which this Srerrnit is issued, I shall not employ any person in any nnnncr t <br />so us to bccomc subjcct <br />workcrs' cornpcrtsal ion <br />to the workers'compensation lawsof Calilbrnia, und agrcc thal if I should bcconre subjcct tothc <br />provisions of Scction 3700 of thc [:tnr Codc. I strall. <br />WARNING: Fhilurc to sccurc workcrs'contpcnsation covcragc is <br />civil fincs up to onc hundrcd thousand dollars ($1O0.0()()). in <br />Scction 3076 cf thc l-abor C-odc.lzlu intcrcst and atlorncy's fccs. <br />Ir"te: | | <br />I hcreby alfirrn undcr pcnalty of pcrjury that I am liccns:cd undcr Chapter 9 (comnrcncing with Scction 7000) of Division 3 <br />of thc Business and Prol'cssions Codc. iuxl rny liccnsc is in lull forcc axl cffect. <br />Liccnsc Nunrbcr:1,'o55\ <br />\IG <br />W <br />I hcrcby affrm undcr pcmlty of Frjury that thcrc is a congruction lendirg agcrcy for thc pcrfor|wc of thc work for which this Fmir is <br />isncd (Se. 3097, Civ. C.). <br />kndcr's Nam: <br />[.cndcr's Address: <br />APPLICANT NECLAR.ATION <br />I horby aftrnn undcr penalty of pcrjury onc of the folkrwing declarations: <br />Dcrrxrlition Pcnnits-Asbcstos Notification Fcderal Rcgulations (Titlc 40, Part6) <br />_Rcquircd l*ttcr of Notification <br />-l <br />ccrtily that thc fedcral rcgulations regarding asbcstos rcnxlvalare not applicablc to this projc.ct. <br />state that the with all City and County <br />arrd County to cntcr uJnn thc <br />abovc mcntioncd property for inspcction purfloscs. <br />Applicrmt or Agent <br />Itermitee name <br />hcrcby <br />l- <br />tr/z <br />0B-07-201 5 <br />- <br />Conlraclor:- <br />this <br />building <br />t- <br />a