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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DEL('ARAI'ION <br />I hercby allirm uncler pmalty ofpsiury thal I on exeinpt from lhe Conlracto6' License [,aw for thc follorving reson (Sec.70]1.5 <br />Businss and Profmion Codc): Any Cily or (bunty rvhich requira a ponit 10 construcl. alte. irnprove dmolish or reprir m1 <br />stnrchrre. pdor lo its issumcc. also reqtrirG thc applicant for such fEmil lo file a signed statoncnt thal he or she is licenscd pusuant <br />to the provisions ofthc Contrdclor's l,icensed [,arv (Chapls 9. Commencing rvilh Section 7000 of Division 3 ofthe l]usiness and <br />Profcssions('ode)orthatheorsheiscxetnptthscfromandlhebasisfortheallegederonption. AnyviolalionofSationT0.rl.5byani <br />applicantforapennitsubj(tsthe applicanttoacivilpenaltyofnolrnorelhanllvchundreddollds($500). <br />y' I.6 o\ursofth(propefly.ormyenrplo;muith$agsmtheirmlecornpersalion.\rilldolhe \\orkandthestrudueisnol <br />intcndcd oroflsedforsale(Sa.T044.RusinessMdProfcssionsCode: fheCoillraclor'sLicmseLawdosnotapplytooownqof <br />lheprcpdty whobuildsorirnprov6thtr@n,mdwhodo6suchwolkhimselforhoselforthroughhisorherownernployc6. <br />provided thal such irnprovmots ae nol inlodql oroflqcd for sle. lf. ho$'qo, the hrilding or improlanml is $ld within one )@ <br />ofcornpldion. the 0\vner Buildq rvill havc the burdm ofprovirrg tha he or she did not build or ilnfrove the prcpqty for the purpse of <br />salc). <br />l. o orvno oflhc propmy. am exclusively conlr acting wilh licensed conlraclore k) construcl the proiecl (Sec. 7(X4. Busincss <br />and llofesstn Codc: 'l he Contractor's l,icense l,arv docs not apllly lo an owner ofp[rperly rvho builds or improves thereon. <br />and rvho contracts for such projets rvilh a Corilracto(s) Iicensed pursuant b lhe ('onlraclor's l-icose [-a$'). <br />I arn cxcrnl)l undcr:iection . lt & P (. tirrthis rc,rr,rrrl! <br />Y'.*,,*"?,*,,*}J,.- ) i-l)alr itlrzlrqX-()N ner: <br />DECLAR,{TION <br />I hereby affirrn under lmalty of grjury one of thc follo$ irtg delnrations: <br />. lhaveandrvillmaintainaCetificalcofConscnlloSelf-lnsureforworkes compmsation.&s providcdforbySetion3T00ofthe <br />Latrr Code. for the pofomance of the u,ork for $hich lhe pflnit is issued. <br />Ihavcandw'illnraintainNorkers-conrpcnsalioninsurancc.as rcquiredbl. lieclionlT00oflhcl-abor(-ode.forlhepo'forilranceoI <br />tht'rorkforshichthispcnnilisissuctl.Myuukss cortpcnsalioniosurancccanierandgrlicyrrunrberoc: <br />('arrier: <br />11:licy Nuntber:[]rpires: <br />I certif)'lhal in thc pcrforillance oflhc $'ork for \r'hich this pcrnrit is issucd. I shall not cnrploy an:. prson in any manncr <br />so as to becoilre subjcct to thc workos'cornpensilion la\\'s ofcaliftrnria. and agre that il l shotrld tEornc subjftt to the <br />workq-s' conrpensalhn provisions ofSeclion 3700 ofthe t,atbr Codc. I shall. foflhrvith comply rvith thos provisions. <br />WARNINC: Faihrre h sue N'orkers'compelsation co\trage is unla$ful. and shall subj(t an onployr b oirninal fmaltia and <br />ci|il finauptoonchundredthousand<lollars($100.U)()).inadditiontolhecostofconrJrnsation.danagescprovidedforthe <br />Seclion 3076 <br />^"*. I t i'E[):]x.and allorney s <br />DECLARATION <br />I hoeby aflirm undo Jvralty of pcrjury that I m licmed undo provision of ('hapto 9 (commcncing with Sdion 7000) of l)ivision -1 <br />of the Business and Prcfssions Codc, md tny liccnsc is in full force md effect. <br />l,iccrse Class: <br />Dntc: _ <br />Liccnsc Nunrl*r: <br />( oillrtctor: <br />CONSTRUCTION LENDIN(; AGENCY <br />I hoeby affirm under ;rnally of pqjury lhat lhfle is a constnrction lmding agmcy for the psftrnnance ofthe rvork for $hich this permit is <br />issued (Sec. 3097, ('iv. C.). <br />Lendo s Narnc: <br />Lcndcr's Addrcss: <br />APPLI('ANl' DT]('LAR,\1'ION <br />I hda{\ allinr under pcnalty ofpcrjutr onc oflhc ftrllo$ ing dcclaralions: <br />t)cnrolition I'crnrils Asbestos Notification Fedcral Regulations ( I itle.l0. l'ar16) <br />Requir c(l t-cllcr oI Ndil]calion <br />I celili that thc ltdcral rcgulations rcgo{irtg asbstrs rcmor al ar c nol ilp|licahlc lo lhis p,oiecl <br />I cenif)-, lhal I har c rcad this applicalion md sl.le lhal lhc atFle infonnalion is con ccl. I agr(- lo comply \\'ith all ('ily and ('ount] <br />ordinancs anrl State l.a\vs relaling to building conslnrction, and hereby author izc represorlali!6 ofthis City and Counly lo mts upon the <br />abovc nrenlitNed prope(y for inspection DUmSeS- <br />)L/\pplic{trt or Agetrt Signature: <br />Perrrifeenanre(print): l <br />x <br />b,:ril,e-4 L <br />\z-t^^rtM-I)ater r \Irz 1zot"1 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <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 />I <br />FINAL <br />Certificate of Occu <br />Notes, Remarks Etc. <br />3 //{/2,)/r-&li I