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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/VenUl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framinq a,//rr,/,8 4,1'rrt 'E-r.,}f gA <br />lnsulation/Energy <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 />Engineer Final Report <br />Flood Zone Certif <br />ltt 9p?u) <br />FINAL Ll-o2-tE Slr eg <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />iil:'*'l'rffi [#[*i**i;*,,-*,*,[ii#fl fl"il <br />to thc pro!'isions ofthc Contracbr's Licensed Law (Chapler 9. ('onnnencing with Section 7000 ofDivision.l ofthe Busincss and <br />Professions Code) or that hc or shc is cxenrpl thercfrorn ard the basis for the allegcd cxenption. Any violation ofSeclion 70-3 1.5 h1 any <br />applicant for a pennit subjccts lhc applicanl lo a civil penalty ofnol nrorc than fir'e hundred tlollars ($500). <br />_ -l,iNorvnsofthepro;rfly.orrnyernploymrvithrvagaothcirvrlecompensalion.willdothc\rorkmdtheslructu'eisnot <br />incnded or oflqed for $lc (Se.70,14. Businss and llofmirms ('ode: Thc Conlractor's l-icense l,aw docs nol apply h an orvner of <br />thc prcpsly rvho builds or irnprovs thqqrn. ard rvho dos such wor,k hirnselfor hersclfor through his or ho orvn employes. <br />provided that such improvments ue not intmdql or ofloc{ for sle. l[ hoRss, lhe building or irnprovement is sold $ ilhin (\nc )iu <br />ofcoilrpldi(rn. the Orvner lluilds \vill havc lhe budo ofproving thal he or she did nd build or irnprol'e the prcpdy for the purpse of <br />ele). <br />l. 6 oMer ofthe propoty. an exclusively contracting rvith licmscd contracloG lo construcl lhe Fr(r(l (Se. 7044. Busins <br />dd I'rof6sfunCode:lheContractor'sl,icensel-awdo6nolapplylomownqofproperlyrvhobuildsorimprovcslhreon, <br />and \\'ho conlracts for such projtrts wilh a Contractor(s) licensed pulsuant to the Contractor's Licensc [,aw). <br />-l <br />tun exernpt unde Section-- <br />- <br />-. <br />B. & P.C. for this rc6on. <br />I)rte:()N nrr <br />D1]CLARA'TION <br />I hercby alfirm under poalty of 1ujury one of the follorvirrg dela alionsr <br />lhavemdwillmaintainaCeriificateofConsflttoSel[-lnsureforworkss'composation.m providedforbySetion]700ofthe <br />l,akrr Code, for the pqfomance of the work for rvhich the pemit is isued. <br />-l havc and u'ill mainlain workms' comFnsalion insurance. m requircd by Scclion l7O0 ofthe Labor Code, for lhe pdfomrance of <br />the w(ilk for which is My cornpflsation insurilce cmio md policy number de: <br />l'olicv Nuorlrr:3- /.Jg <br />I cdiry thal in the perfonnance ofthe work for which this pqrnit is issued. I shall not snploy any poson in any mmner <br />rc o kr trcome subjel to lhe workffi' compmsalion laws of Califomia, md agree that if I should become subj(t 1o the <br />workqs' compensalion provisions ofSeclion ,1700 ofthe Labor Code, I shall, fonhrvith comply rvith thos provisions. <br />WARNINC: Irailure to sure workos'cornpemattrn covemSe is unlawful. aild shall subj6l m mployo to oirninal pmltis and <br />civil fina up to one hundred thowod dollm ($100,000). in addition to cost ofcompensation. damages as provided for the <br />Setion of the tabor Code. intsGt md attomey's fees.-Ja - / <br />I hereby allirm undcr pcnaltyof perjury that I dn liccnsc{ uilder pro\1slon of Chaplq 9 (commncing Nith Sstbn 7000) of Divisitrr 3 <br />of thc Businos and I'rofcssions ('ode. atd my licmsc is in full force rurd c'[Irt. <br />Liceroe Clas:-[,icensc <br />l)alc:9b't a <br />I hreby aflirm undo gmally of perjury thal thse is a conslruction lmding agmcy for the pefommce of the rvork for which this tmnit k <br />issued (Sec. 3097. Civ. C.). <br />Lends's Name: _ <br />Lsds's Addrs: _ <br />APPLICANT DECLARA-IION <br />I lueby aflinn unde penalty of pejury one of the following delarations: <br />Demolition Psmits-Asb6tos Notification Fedqal R€gulations (Title 40. Pan6) <br />-Required <br />L€lter of Notilication <br />. <br />-l <br />cmiry lhat the fedual regulatiom regdding 6b6tos removalue not applicable to this preject. <br />#4["*ify ,fr, I have rqd this application dd state that the alnve infomation is const. I agr@ to comply with all City and Counry <br />\ordinancc md Statc Laws relating to building cogstruction. md hoeby authorizc rcprcmtativs of this City ild Count) lo fl16 ufnn rhe <br />'abovc rnmlioned propmy for imp<ion ormscf. <br />Appricant or Asnr s ,r,rru"", <br />'fff{4 <br />. on", 3' 3 O ^ / 1 <br />Pemirennme(prinr): <br />-'U' <br />7*c''< Wr '- <br />BUILDING. INSPECTOR RECORD <br />Cmio:-Fn,+r*r*^ <br />('ontrnctor:-