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t BUILDING. INSPECTOR RECORD <br />ID/SIG.SITE.WORK DATE COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loo r/VenUl ns u latio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulatio nlEnerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL <br />Certificate of Occupancv <br />Notes, Remarks, Etc. <br />OWNI'R <br />I hcrcby afftrm under pcnally of Frjury that I m excnq)t frem thc Contnclor' Lbensc lnw for the following rNn (Src.703l.t <br />Busincss and Prcfcssion fuc): Any City or County which rcquircs a Jrmit lo constMt, alter, improve. dcmlish or rcpoir my <br />slructuG pri)r to its issuffic, alre requiEs thc applicant for such pmit to file a signcd stalemnt that hc or slrc i$ liccnsd puBu.nt <br />to thc Fovisions of tlE Contrrctor's Licensed lrw (Chsptcr 9, Comrcing with Sction 7000 of Division 3 of the Busiress md <br />PrcfcssionsCodc)orthathcorshciscxctrrptthorcfromandthcbasisforthcallegedcxcmption. AnyviohtionofSectionT03l.5byany <br />applicail for a pcrmit subjsts thc applicmt to a civil pcully of not mrc thm five hundrcd dollus ($500). <br />-1. <br />as owrcr of the Fotrcdy, or my emplolccs with wagcs as their slc @mfEnsalion, willdo thc wok ard thc sttutrc is ml <br />iilqdcd or offered for slc (Se.7Ol4. Busincss and Prcfessions Codc: The Contraclor's Liccnc l:w &rcs mt apply to an owncr of <br />thc ImIEaty sho builds or inpmE tlE@tr ard wln dc sch mrk himelf or hcMlf or lhDugh his or her own cmployccs. <br />providql that such imfmwnts @ not iilqdcd orolfcrcd for slc. lf. homEr, thc boiBing or inpmrcmnt is sU slhin orc Fe <br />of con{rbtiotr thc Owrcr Buikhr will h6w thc htrdcn of pmving thar lE or dE dil mt boiH or hprow the prcIEty for tlrc purlDs of <br />sh). <br />_1. as owncr of thc propcrty. am cxclusivcly contracting with liccnscd contractors lo conslruct thc projcct 1Sec. 7U4, Business <br />and Pmfbssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owner of propcrty who builds or improves thcrcon, <br />and who contracts for such projects with a Contractor(s) liccnsed pursuant to thc Contractor's Liccnse Law). <br />-lanrcxenrptundcrSc.ction-.B.&P.C.forthisreason. <br />I ):rl r <br />WOITKIi ILS' COI\T PENSA'I'ION <br />DI,CI ,TRATION <br />I hcrcby uffirrn undcr Jrcnalty ol'Jrcrjury orte of thc lbllowing dcclarations. <br />_l havc and will maintain a Ccrtificate of Conscnt to Sclf-lnsurc lbr workcrs'cornpcnsation, as provided for by Scction 3700 of the <br />l.atxrr Crrdc, for the pcrformance of thc wort for which the pcrmit is issucd. <br />U4nuurand will maintain Codc. for thc pcrformance of <br />arc:thc work for which this <br />/ <br />Policy <br />_l certify that in the pcrforrnance of the work for which this permit is issued. I shall not cmploy any frcrson in any nurnncr <br />so os lo bccome subject to thc workcrs' compcnsation laws of California. and agrcc that if I should bcconr subict to thc <br />workcrs' compcnsation provisions of Scction 3700 of thc l-atnr Codc, I shall. forthwith comply with thosc provisions. <br />WARNING: Failure to sccurc workers'compcnsation coverage is unlawful. and shall subjcct an employcr to criminal penaltics and <br />civil fines up to onc hundrcd thousand dollars ($100.00t11. in addition to thc cost of con;lcnsation, danugcs as providcd for the <br />Sccliott intercst and attorncy's fccs.) <br />I hcrcby atfirm undcr pcnalty of Jrcrjury that I am licenscd of Chaptcr 9 with Scction 7000) of Division 3 <br />of thc Busincss and Prolbssions Codc, and rny liccnsc is in full forcc and cffcrt. <br />{!r l- <br />I-rccnsc <br />Date:/{ <br />CONSTT,UCTION I NNDING AGENCY <br />I hcrehy aflirm undcr Fmhy of Frjury Ih.l lhcrc is a concructkrn bnding agcrcy for thc pcrformcc of thc work for which this tHmil is <br />issucd (56. 3097. Civ. C.). <br />Lcndcr's Namc: <br />I-cndcr's Addrcss: <br />APPLICANT NBCLARATION <br />I lrcrcby alfirm undcr pcnalty of pcrjury one of thc following declarations: <br />Dcrnolition Permits-Asbcslos Notification Fcdcral Rcgulalions (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notilication <br />LI ccrtify that rhe federalrcgulations rcgarding asbcslos rennval are not applicablc to this projcct. <br />-Y r"nifythat I have rcad this apptication and srate thar <br />ordinanccs and State l.rws relating to building <br />atxlvc nrcntioncd propcrty for inspcction <br />Applicant or Agent <br />Pernritee nanle <br />Rev. 08-07 -201 5 <br />arxl <br />I r) <br />'//t-2t <br />/ <br />2 d2,"ontraclor:-