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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs -a <br />Forms/Steel/Holdowns <br />"12?l7J <br />D#-Y7 A',,+67 <br />Erection Pads lt -ta <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenUl ns u latio n <br />Roof Sheathino <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ltlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />I <br />FINAL l?( r lzo p4-{t&-/ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />* <br />OWNER BUILDER DELCA RATION <br />I hcrcby afl-trm undcr pcnalty of pcrjury that I am cxcmpt frorn thc Contractors' Liccnse law for thc following reason (Scc.7031.5 <br />Busincss aml Profcssion Code): Any City or County which rcquircs a pcrmit to construct, altcr. improve, dcmolish or rcpair any <br />structure. prior to its issuance, also requircs thc applicunt for such pcrrnit to filc a signcd slalernent that hc or shc is liccnscd pursuant <br />to thc plovisions of thc Contractor's Licenscd Law (Chaptcr 9, Commcncing with Section 7000 of Division 3 of the Busirrcss and <br />Profcssions Codc) or that hc or she is cxcmpt therefrom arxl thc basls for thc alleged cxcmption. Any violation of Scction 703 I .5 by any <br />applicant for a pcrmit subjccts thc applicant to a civil pcnalty of not morc than five hundrcd dollars ($500). <br />-1. <br />as owncr of thc propcrty. or my cmployecs with wagcs as their solc compcnsation, will do thc work altd thc structure ls rnt <br />intendcd or offcrcd for sale (Sec.7044, Busincss and Professions Code: The Contraclor's Liccnsc [:w does not apply to an owncr of <br />the propcrty who builds or improvcs thcreort and who does such work hirnself or hcrself or through his or her own employees, <br />providctl that such improvcnrcnts arc not intcndod or oft'crccl for sah. lf. howcver. thc buikling or inqrrovcnrcnt is sold within onc )aar <br />of comphtion. thc Owner Buildcr will havc thc burden of proving that hc or shc did not build or improve thc propcrty for thc purynsc of <br />salc). <br />-1. <br />as owncr of thc profrcrty. am cxclusively contracting with liccnsed contraclors to construct thc projcrt (Sec. JQ#, f,usinc55 <br />and ProtLssion Codc: The Contraclor's License Law does not apply to an owncr of propcrty who builds or intproves thcrcon. <br />and who contracts for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnsc [.aw). <br />-l <br />anr excnrpt undcr Section-, B. & P.C. for this rcason. <br />l):rlt': ( )*'ncr. <br />\YORKI'RS' CONI PF]NSATION <br />DECLARA'I]ON <br />I hcrcby aff irm undcr pcnalty of perjury onc of thc following declarations: <br />-_l have and will maintain a Ccrtificate of C<lnscnt to Sell'-lnsurc for workcrs' corryrcnsation, as providcd for by Section 3700 of the <br />L:bor C-odc, for thc perfornrance of the work for which thc pcrmit Ls issued. <br />_l havc and will nnintain workcrs'as by .Scction 3700 of thc Labor Codc. for thc pcrfornuncc of <br />thc work for which this 'rn''t'rrurnhcr arc: <br />L <br />i t /?-z (Policy <br />_l certily that in thc ;rcrfornnnce of thc work for which this permit is issucd, I shall not cmploy any pcrson in any rnnncr <br />so as to bccornc subjcct to thc workers' compcnsation laws of Califomia, and agrcc that if I should beconrc subject to thc <br />workers' conpcnsation provisions of Scction 3700 of thc Labor Code. I shall. forthwith comply with thosc provisions. <br />WARNING: Failure to rccure workcrs' cornpcnsation coverage is unlawful. and shall subjcct an employer to criminal grcnaltics and <br />in addition cost of conrlrcnsation. danurgcs as g5ovidcd for lhc <br />) <br />(comrrcncing with Scction 7Un) of Division 3I hcrcby aft'irrn undcr pnalty of pcrjury that I ant liccnscd <br />ol' lhe Business and Profcssions Code. and rny liccnse is in t'ull forcc arxl cfTect. <br />r bLicensc Nunrbcr:a <br />a <br />W <br />I hercby affirm urdcr Fnalty of Frjury that thcrc Ls I conEruclk n lcnding agcmy for the perforlMcc of the work for which lhis Frmit is <br />isscd (S€. 3097, Civ. C.). <br />lrndcr's Narrrc: <br />Lrndcr's Address: <br />APPLICANT DECI ARATION <br />I hcrctry affinn under pcnalty of pcrjury one of thc following declarations: <br />Dcnmlition Permits-Asbcstos Notification Fcdcral Regulations (Titlc 40. Part6) <br />-Rcquircd <br />Lcttcr of Notification <br />with all City and County <br />and County to cnter upon thc <br />above nrntioned property for <br />Applicant or Agent <br />Itermilee nanle <br />,^r" r(?Z?'k <br />ev. 08-07 -2015 <br />I <br />civil fincs up lo onc hundrcd thousand <br />Scction 3076 o[ ttrc Latrqr Code. intercst <br />,,,",'bz-?-7() <br />and attorney's fccs. <br />A;rplicrurl: t' <br />Contracto.,( <br />regarding asbcstos rertrovalarc not applicablc to this projcct.