Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hcrchy affirm undcr lEndlty of pcrjury lhat I am excmpt lirrm thc Conlrack)rs' Liccnsc law for thc lirlbwing rcnsotr (Scc.7OJ 1,5 <br />Busincss ant Profcssi<ln Crxlc): Any Cily or Counly which rcquircs a lErmil lo conslrucI. allct impnrve. dcmr)lish (rr rc[uir atry <br />structurc, lrior to its issuancc, alsr rcquircs thc applicant for such Jrrmit to lilc a siglcd stalcmnt that hc or shc k liccNcd pursu{nt <br />k) thc pfl)visions of thc Conlract(rr's Liccnsd tiw (Chaptcr 9, Comrcncing with Scction 7u)0 of Division -l of lhc Busincss and <br />Prufessions C'(xlc) ()r that hc (rr shc is crcmpt thcretiom and thc basis for the allcgcd cxcmpti(tn. Any violation of Setion 70J 1.5 by atry <br />applicant tbr a JErmit subjBls thc applicant to a civil pcmlty of nol morc than five hundrcd dollars ($5fi)). <br />_1. as owncr of thc propcrty, or nry cmployces with wagcs as lhcir solc compcnsation, will do thc work atil thc slrur'turc is not <br />intcndcd or oll'cre'd lilr salc (Scc.7(X4, Busincss and Pnlt'cssions Ctxlc: The Contractor's Liccnsc Law docs nol apply to an tlwncr ttf <br />the pK)pcrty who builds or improvcs thcrcon, and who drrcs such work himsclf or hcrscll'or thnrugh his or hcr own cmployccs, <br />providcd that such impnrvenrcnts arc not intcrxlcd or otl'crcd lbr sah. It. lxrwcvcr. thc huikling or impr<lvcmcnl is srtkl within onc ycar <br />ol'complction, lhe Owncr Buildcr will havc tlre burdcn o[proving that hc or she did not build or improvc the pnrpcrty lirr the pury)osc ol' <br />sah). <br />_1. as owncr ol'thc propctly, anr cxclusivcly contracting with liccnscd contraclors to construct thc pnrjcct (Sec. 7(X4, Busincss <br />and Pnrfbssirln Codc: Thc Contraclor's Liccnse Law drrcs not apply to an owncr of proJrcrty who builds or improvcs thcrcon, <br />and who contracts lirr such pnljccts with a Contractrlr(s) licorscd pursuant to thc Contraclor's Liccnsc Law). <br />-IanrcxcmptuntlcrScctitllt-'B'&P'C'fitrlhisrcastln. <br />}VORKERS' (:ONI PENSATION <br />DE(ILARATION <br />I hcrcby atTirm undcr pcnalty of Jrcr.iury onc of thc lirlkrwing dcclarations: <br />_l havc aml will maintain a Ccrtilicate of Conscnt to Sclt'-Insurc ttlr workers' comSrcnsation, as pnlvidcrl lilr by Scctittn 17fi) of thc <br />Latxrr Culc, lirr thc pcrklrmance2l'thc work tbr which thc pcrmit is issucd. <br />_l havc antl will maintain wrlrkcrs' comfrcnsatkln insurancc, as rcquircd by Scction 37fi) of the Lahor Codc, tilr thc pcrlirrmancc of <br />the work tilr which this Jrcrmit is issucd. My workers'insurancc carrier and Jxrlicy nunrhcr arc:- <br />F <br />l- t-?\Policy <br />i <br />_l ccrtify that in thc Jrcrkrrmancc of thc work lirr which this Jrcrmit is issucd, I shall not cmploy any pcrson in any manncr <br />so as lo bccomc subjcct to the workcrs' compcnsation laws of Calilirrnia, and agrec that if I should bccomc suhject to thc <br />workcrs' compcnsation provisions of Scction 3700 of thc l-^atxlr Crxlc. I shall. klrthwith comply with thosc provisions. <br />WARNING: I;ailurc to sccurc workcrs' <br />civil lincs up to onc hundrcrl thousand <br />compcnsation is unlawlul, and shall subjcct art to crirri.ral Jrcnaltics and <br />dollars ($ I in addition to tltc as providctl lor thc <br />Scction 1076 of intcrcst l'ces. <br />t- <br />I hcrcby allirrn undcr pcnalty of Jrcrjury that I am liccnscd pnrviskrn of Chaptcr 9 (comrrcncing with Scction 7U)()) ol'Division -] <br />of thc Busincss and Prof'cssions Codc, and my liccnsc is in tull tbrcc and cll'ect. <br />- <br />Liccnsc Nunrbcr: <br />I hercby aflrm undcr pcnalty of frcrjury that thcrc is a construction <br />issucd (Sec. 3097, Civ. C.). <br />[.cndcr's Namc: <br />agency Jrcrtormancc of thc work frrr which this Jrcrmit ls <br />lrndcr's Addrcss: <br />APPLICANT DECLARATION <br />I lrcrcby all-rm undcr pcnalty of ;rcrjury onc of thc ftrlklwing dcclarations: <br />Dcmolition Pcrmits-Asbestos Notification Fcdcral Rcgulations (Title 40, Part6) <br />_Rctluircd l,cttcr of Notilication <br />/etccrtilyhO" I'crlcratrcgulations rcgarding asbcsto.s rcmoval arc not applicablc to this pnrjcct. <br />_l ccrtity that I havc read this and statc that thc ahrvc inlilrmation is corrccl. I agrcc to comply with all City and County <br />ordinanccs and Statc laws rclating construction. and hcrcby authorizc rcprcscntativcs of this City and County to crttcr uJxrn thc <br />atxrve mcntioncd propcrty for <br />Appiicant or Agent <br />I'crnrilec nanrc <br />PUrrx)scs.A-\\- <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVI ns u Iatio n , <br />Roof Sheathing /o.l'slzrzD *dti\ <br />Shear Wall (,v <br />Framinq <br />lnsu lation/Enerqv <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[\Iasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />|t,rt; I / I <br />FINAL <br />of <br />Notes, Remarks, Etc. <br />Elorr nP.-n7 -2n 1 q