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BUILDING- INSPEC ECORD <br />SITE.WORK DATE ID/SIG cpMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenVl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing -\. <br />lnsulation/Enerqy I tA ^? QAA <br />Drywall il ul lul llYuuutr . Lz ttStY <br />Ext./lnt. Lath I <br />Brown Coat <br />Ivlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL /.bHW(LgY <br />Certificate of Occu pancy lrrl <br />Notes,, Remarks, Etg <br />)\rI <br />()WNI!R BUII,Di]R DEL(]ARA'I'IoN <br />I hoeby allirrn under penally ofpe{ury thal I an e\enlpt from lhe Contractors' l,icensc l,arv for the following reNn lss.70.'].5 <br />Businas and Profssion (odc): Any Cit)'or County $hich requires a ponit to construcl, alts. irnprove. derlolish or relair nny <br />slruclure.priorloits issuance.alsorequirGtheapplicantftrrsuch;nrnittofileasignedstatsuent thatheorsheislicenscd pursuant <br />lo the pro\ isiof,s of th€ (.ontractor's Licensed [-arr (Chapter 9. (\)mnrencing $ ilh Sslion 7000 of Division 3 of the Business and <br />ProfessionsCode)orlhatheorsheisexempllhrcfrornantllhcbasisfortheallegedexernplion. AnyviolationofSrctionT0.ll.5hl.rury <br />applicant for a pennit srbjects the applicant to a civil penaltl. ofnol nnre than fir'e hundrcd dollnrs ($500). t <br />I. as osner oflhc |()peny. or rny employe$ *ith $ags as lhcir sole cornpeilsatiN. will do lhc \uk ild the slnrtue is nol <br />inlflded orolltrcdformle(Se.7044.BusinssandPnrlessions(irdcr TheConlractor'sl,iccnscl-a\vdosnotapply1oanowncrof <br />lhe prcpoly rvho huilcls or iruprovs thqmn. and *ho tlos such wtrk himselfor lrersclfor lhnrugh his or hcr orvn cnrpkryccs. <br />ofconrpldi()n. llr Ow'ncr lluilclet s'ill have the hmlm ol poving tlral he or she clid nol build or inrprove the propqly for the plrgrsc of <br />slc). <br />I. ru o\r ns oflhe propsly. am exclusively conlracting with licensed contracl06 lo constnrct the proist (Src. 7044. Busines <br />and hofGsion('odc: IheConlmclor'sLicense[.a\\'do6nolapplvloano\!nqofpropeny\hobuildsorimpro\eslhqsn. <br />and s'ho conlraclsforsuchfrojslssilha('ontraclo(s)licensedpursuanltotheContraclor'st.iccnseLaN). <br />I art erernpt under Setir,n Il. & l'.( for lhis reason. <br />l)ate: osilcr: <br />n'onrnns' trrlt t'iins,r'r'rox <br />t)Ii( l,Att^l toN <br />Iheretrl. afiirnunrlo pcnnll\ol'psiurloneofthclirlkrs'inSrlcclarrtions: <br />lhavemd\villmaintaina('enificateofCorNflltoSclf-lnsureforNorkos-conrpensation.o providedforbySetionlT00ofthe <br />labor Code. for the poformance ofthe rvork for rvhich the pmnil is isned. <br />- I ha\e and uill mnintarn \rlrrkers cornpensation insurancc. c <br />lhe \rork for shich lhis pqrnit is isued. My s orkaSrrrnpmsat <br />carier: - fttf tuh) <br />PoricyNumb6: ?y32Hz <br />re<;uiled by Satitrn -1700 of lhe libor Code, for the pslirnnuce of <br />ion insurance canic md Jnlicy nurnber ae: <br />lirpircs:q9 [!-+o <br />I ceilify lhal in lhc performnnce ofthe rvork for rvhich lhis pcrnit is issued. I shall not cnrpkry any pemon in any rnnnner <br />$ d to bffoue subject k) the w'orkfrs' composal ion laws of Califrrmia. and agre that if I should becotne subjet to the <br />uorkrs'cornpcnsationprovisionsofSdion.lT00oflhcl{ltr('ode. Ishall.forthsithcomply*iththo*prorisions. <br />\YARNING; [ailurc kr wure w'orkere'cornlxnsation co\sage is unlawful. and shall subid an orpkryer to oiminal fEnalti6 and <br />civil frnes up to onc hundred thouund dollars ($100.000). in addition lhe cost of conrpcnsation. donages as provided for the <br />Seclion -1076 of,(bdc. inlersl and atk,nrc) s ltr:. <br />Applic{nl:__ <br />r)t,:( l.An,\'l toN <br />of the llusinss anrl llolcssions Code. and mv liccilsc is irr lirll firrce and effect <br />I-icense Classr <br />,,,"1o]o3\\L <br />l.iccnsc Numbcr:\ oRt<xG <br />( ontrnclor: <br />(:ONS'I'RU(]'I'ION LENDIN(; AGEN('I' <br />issued (Sec. .t097. ('iv. ('.). <br />l,cnder's Nanre: <br />Lendo's Addrqss: <br />APPLICANT DECLARATION <br />I hreby'affinn undcr penalty of perjury one ofthc follorting delarations: <br />Demolition Psmils-Asbeslos Nolification Fedsal Regulations (.l itle 40. Pan6) <br />-Raluircd l-cltcr of Nolifi calion <br />I colity lhal lhc fcdtral rcgulalions rcgarding asbcslos runoval are nol applicahlc lo lhis proiccl. <br />above mmtioned propeny for inspection purposs. <br />Applicflnt or Ageill Sigilatilrc: <br />I'ornlil* nsmr (priilt): <br />,,,," \ olrr\f 15 <br />I <br />Ll5 4n- Lt {L-