Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE IDiSIG.COMMENTS owNER BUTLDER ITELCARATION L..I hcrchy rli'rrm undcr pcnnlty ol pcrjury lhal I am c\cmpt from thc Conlraclors l-iecnsc Law tbr lhc li)llowing rca\rrn tsc(.7o.rn <br />Busincss and Prolass()D CG.lc): Any Cily or County which rcquircs a lrcrmil t) construct. altcr. inrprovc, dcn]llsh or rcpair rny <br />structnrc.priork)it\ i\suancc.alsorcquircslhcrpplicanlli)rsuchlratrrllofilcasiSncdstatcmcnt lhnihcorshcisliccnscJ pursuanl <br />k) thc provisions ol thc Contraektr s l-iecnscd [-aw (Chrpter 9, Conrnrcncing with Scclion 7000 ol Division .] ol thc Busincss and <br />ProllssionsCodc)orlhatlrcorshciscxcmptthcrcliotrllndthchasisli)rlhcallcgcdcxcmplion. Anyviolali(mofScetxnTOll.5hyany <br />rpplicintli)rrpemritsuhjcclslhc applic{nlk)acivilpcnxllyolnotntrrrcthanfiv!'hundrcddollars(S50{)). <br />_1. t\ owncr ol lhc ln)Fny, or my cnlpl(,yccs with waecs as thcir s()l(- conrpcnsati(rl. willdo thc work and llE struclurc is nol <br />idcndql oroll'crcdli)r$lc(Scc.7044.[]rsinessand['roltssionsCodc:'IhcConlrnck]r'\l,iccnscLrwdocsnotapply(ornowncrof <br />thcpr)Frly whobrihlsorimpnrvcslhcrcon,mdwhodrEssuchworkhirrscll'orhcr\cllorlhK)uShhisorhcrowncmpl()yccs. <br />providcd thal such imprl)vcmnls m ilil uilcndc.l rlr oll'crcd li)r salc. Il. howcver. lh! hurldirg or improvcrmnl is sold within unc ycd <br />ol conrpkni(nl. llN Owncr Buildcr will havc lhc hurdcn ol pn)ving Ihdt hc or \hc did n(il hurkl or improvc tlE pr)fErty li)r thc pur[x)* ol' <br />s{h). <br />_1, rs owncr ol lhc Ix)[L-f,y. anl cxe hrsively coDtrrel ing with liccnscd conlrack)rs t) conslnrct thc nn)icel (Scc. 7(X4. 8u\trrcss <br />atr, l\)lbssi)n Codc: 'l hc Contraclor's l,iccnsc [-aw docs not apply tr) an owncr ol propcrly who huild\ or improvcs lhcrcon. <br />and who contrtcls li)r such f()jccts wilh a Corilftckrls) liccnscd pur(urnl k) thc Contrack)r's I-iccnsc [-aw). <br />I anr cxcmpt undcr Sce ton-. B. & P.C. lirr this rcason. <br />WORKERS' COI\IPT]NSATION <br />DECLARATION <br />I hcrchy rllirm undcr pcnalty ol I^.r.itrry onc of thc li)llowing dcclarxtir)ns: <br />_l hrvc and will mainlain a Ccnilicatc ol Conscnt k) Scll:lnsurc li)r w{)rkcrs compensali(nl. as providcd fbr hy Sce tirrr .1700 of thc <br />t,ahrr (ixlc. lbrthe 1^-rti)rnlaDcc ol lhc work lilr which lhc pcrmit is rs\ucd. <br />_l hnyc and will malntain workcrs eompcnsati(rl insuranec, as rc.luirc.l hy Scclt)n -l7U) ol thc litx)r C()dc. for lhc [Erformancc of <br />thc work li)r whieh this pcrmit is issucd. My workcrs conrpcnsalion insurancc caricr uxl Jxrlicy numbcr uc: <br />Poltcy Nunrhcr: Erpires: <br />_l ccaili thrt i,l rhc pcrli,rmilncc ol lhc work lbr which this l^*rnril is isrucd. I shlll not cmploy rny lL-r\on in any nrdnncr <br />sl, ns k) hceomc ruhj{ct k) the workcrs'compcn$tion lnws ol'Crlifi)rnir. rnd agrcc thal il'l should hccomc suhject lo thc <br />workcr\'compcnsiti(mprolision\olSccli{rr-17U)ollhct-nlxrrCodc.lshnll.tbnhwilhconlplywilhlh(}scprovis()ns. <br />WARNING: Faihrr(- k) sccurc work.r\'compcnsalion covcra8c is unlawlitl. amJ shall ruhjcct !n cnrploycr h criDirrl J^-nallies and <br />civil lincs up k) onc hundrcd thouslnd dollars (Sl(X).(XD), in addili(r k) lhe co\l ol compcnsnli(n.as pro\,idcd for thc <br />Sccrx[ -1076 of thc lrtxrr Code. intcrcst and atk)rrcy s lics. <br />f <br />DECLARATION <br />I hcrchy altirm undcr lEnally of ltrjury lhat I am liccnsd !nder provis()n ofChaplcr I (commncing with Scction 7000) ol Division 3 <br />ol thc Busincss and Proltssions Crilc. arl my liccnrc is in full I{)rcc md cltcct. <br />Lre('n\c <br />'tq <br />CONSTRUCTTON LENDTNG AGENCY <br />I hcrchy allirm undcr FnElty of frcrjury thal thcrc is a construction lcndine aScncy for thc Frcrlirmahcc of lhc work li)r which this lrcmil is <br />issucJ (Scc. -1097. Civ. C.). <br />kndcr's Namc: <br />l,crricr's Addrcssr <br />A PPL IL^ANT DECLARATION <br />I lrrchy afiimr undcr pcnally ()f pcrjury onc ol thc tilllowinS declaral!)ns: <br />Dcnx)lition Pcrmils-Asbcsbs Nolificdlion Fcderal RcSulalions ('Iitlc 40. Put6) <br />-Rcquircd <br />lrltcr ol Ndilication <br />_l ccniti that thc I'cdcralrcgulali()ns rcgtrilin8 ashcsk)s rcmovdlnrc n(il tpplicahlc lo lhis pn*cl. <br />_l ccnily that I hnvc rcad (his applicatiotr md slate thrt thc atx)vc irtlbmution is cotrccl. I agree to conlply with all Cily and County <br />il*:::[ffi :::wrirui/i//."""".".':::"""";'i,";;;." <br />Pemrllee n[me (Drint): <br />Set Backs <br />Forms/Steel/Holdowns I Tlelto) L ul'qfi4l <br />Erection Pads I <br />I <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lVasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL -16/r,te{vt D <IL9 /znzo <br />Certif icate of Occupancy <br />Notes, Remarks, Etc lt <br />I0 - 30"(,4nt) <br />L/,I <br />I <br />q NNL \v\ Ii