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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor n
<br />Su bf loor/VenVl ns u latio n
<br />ffisheathing FttotY ll - I 7-vo 9,lf$Lr,I
<br />Shear Wall M t
<br />Framinq - [0 -207d W{,7t I
<br />lnsu lation/Energy 'J t\)
<br />Drywall
<br />Exillnt. Lath lt ,lrl LC D*+1
<br />Brown Coat II '4.)hA,**7
<br />Masonry I l
<br />-t,
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I I
<br />FINAL IL l0 a Dk*W
<br />Certificate of Occupancy I
<br />Notes, Remarks, Etc.
<br />aFLcDtL tw9ht^4r, L gfgL '.. ?Y I aualwD r}.O F bnry t/vtr
<br />,9',i/0 hu \/
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<br />OWNER BUILDER DELCARATION
<br />I hcrcby allirm undcr Fnalty of IErjury that I am cxcmpt hom thc G)ntractos' Liccns Law l(rr thc foll(twing rcavu (Se.7031,5
<br />Busilcss and Professi(rn Cfilc): Any City or County which rcquircs a fsmit to conslruct, altcr. improve. dcmrlish or rcJuir any
<br />structurc, ltrior lo its issu{ucc, slso rcquircs thc applicant lbr such IErmil to tilc a sigrcd strtcmnt that he or she is liccnsd pususnt
<br />to thc pmvisiotrs of lhc Contractor's Licenscd law (Chaptcr 9, Commcn-ing with Selion 7000 of Division J of lhc Busircss and
<br />PrulcssionsCodc)orthrthe(,rsheiscxemptthscliomatrdthchasisf(rrthcallcgcdcxcmption. AlyviolotionofsectionT03l.Sbyany
<br />applicaur for a [E]mit suhjccts lhc applicanl lo a civil pcnally of nd m)rc than five hundrcd dollars (Ssfi)).
<br />_1. as owncr of thc propcrty. or my cmployccs with wagcs as lhcir solc conrgrcnsation, will do thc work arxl thc struc'turc is nol
<br />ilrtcndcd or ofl'crcd frrr salc (Scc.7(X4, Busincss and Prol'cssions Crxlc: Thc Conlractor's Liccttsc Law docs not apply to an owncr of
<br />thc pnrpcrty wlxr builds or improvcs tlrcrcrrn. and wtxr drrcs such work himsclf or hcrsclf or through his or hcr own cmployccs,
<br />providctl that such improvcnrcnls arc mrt intcndcd or ot'lcrcd tilr sale. It, howcvcr, thc buikling or impnrvcnrent is sold within onc ycar
<br />ol'complction, thc Owncr Buildcr will have thc burdcn o[pnrving that hc or shc did not build or improvc thc property lor thc purJxlra of
<br />salc).
<br />_1. as owncr ol'thc property, am cxclusivcly conlracting with liccnsed contractors to construct thc prlject (Sec. 7044, Busincss
<br />and Pnrtbssion Code: 'l'he Contractor's Liccnse Law docs not apply to an owncr of proJrcrty who builds rtr improves thcrcttn,
<br />and who conlracls lilr such pnljccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc Law).
<br />-l
<br />am cxcmpt undcr Scction-, B. & P.C. tbr this rcason.
<br />}VORKERS' CONI PENSATION
<br />DE(]I,ARATION
<br />I hercby affirm under pcnalty of Jrcrjury onc of thc l'olbwing declarations:
<br />_l havc arxt will maintain a Certilicate of Conscnt to Sclt'-lnsurc firr workcrs' comJrcnsation, as providcd fbr by Scctiolt 3700 of thc
<br />l.atxrr Crxlc, for thc Jrcrlormancc of thc work ftrr which thc pcrmit is issucd.
<br />_l havc and will maintain workers' compcnsation insurance, as rcr;uircd by Scction 37fi) of thc Lahor Codc, for the pcrftrrmance of
<br />thc work lilr which this pcrmit is issuctl. My workcrs' compensation insurancc carricr and grlicy number arc:
<br />Policy Numbcr: Expires:
<br />-l
<br />ccnity thrt in lhc lrcrlirrmancc of thc work ft)r shich this Frmil is issucd. I sh{ll not cmpby any lErson in any manncr
<br />$ as to bccomc subjcct to thc workcrs' compcnsatio[ laws of Califbrnia, and a8re lhal if I should hocom subjet to thc
<br />uorkss' comFnsation prcvisions of Setion .1700 of thc Lfhrr Culc, I shsll, lbflhwilh c$mply with tho* pruvisions.
<br />WARNING: Failurc to surc workcrs'comlrcnsation covcngc is unlawful, and shall sub.pct an cmploycr lo criminal lrcmltbs and
<br />civil tincs up t(, orc hundrcd lhousand dollatr (S|00,UD), in addition to thc cosl of compcnsation, dam.Scs as providcd tor thc
<br />Scction 3076 of thc Latxlr Ctxlc, intcrcst and attorncy's t'ccs.
<br />I hcrc'by al'lirm undcr pcnalty of pcr.jury that I am liccnscd undcr pntvision 9 (commencing with Scction 7firu) of Division 3
<br />of thc Busincss and Prot'cssions Codc, antl my liccnsc is in full litrcc and etlcct.
<br />Liccnse Class: Liccnse
<br />J C0NSTRI.;('TION I.,F]N I)IN( ;,\(; F,NC]\'
<br />I hcrcby affirm under yrnalty ofperjury that rh@ is a constructbn hndinS agctrcy for thc performancc ofthe work for which lhis lEmil is
<br />issucd (Se. 309?, Civ. C.).
<br />lJnlcr's Namc:
<br />Lcndcr's Addrcss:
<br />APPLICANT DECLARATION
<br />I hcrcby atlrm undcr ;rcnalty of p-rjury onc of thc lirllowing rlcclarations:
<br />Dcmolition Permits-Astrcstos Notification Fcdcral Rcgulations (Titlc 40, Part6)
<br />_Requircd lrttcr of Notification
<br />_l ccrtity that thc l'ctlcral rcgulations rcgarding asbcstos rcmovalarc n()t applicablc to this projcct.
<br />_l ccrtily that I havc rcad this application arxl statc that with all City and County
<br />and County to cntcr uJxrn thcrlrdinanccs and Statc Laws rclating to huilding
<br />atxrvt: mcnlioncd proJrcrty lilr insJrcction purlx)scs.
<br />Applicant or Agcnt
<br />Pcnnitce n:une
<br />^*, N*12*2A
<br />Flarr nQ-n7-2n 1 q
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<br />,",., OcAt2*ACr
<br />/rrnirrll.
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