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i BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Stee!/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Ve nVl nsu latio n <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsu Iation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />L{7 2 Its e a a'-\nr--.t I -- /ta d attJ <br />FINAL -luoI-(r frr ttr7,vCK)// .6 I <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I hcrcby 0llirm unrjer lrcnalty of Frjury that I am cxcmpt hom thc Cotrtrack)r' Liccnsc hw for thc folhwing rcas9n (Se.70-ll.! <br />Rusiucss and Prolbssion C(xlc): Any City or Counly which rcquircs a lErmil to construct, alter. improvc. dcmolish (rr rclBir any <br />struclurc, pri()r k) ils issuancc. al$o rcquircs thc applicanl lbr such lErmit kr Iilc a signed statemnl that hc or shc is licensd pmuant <br />to lhc pruvisions of lhc Contrack['s Licenscd Law (Chaptq 9, Commcncing uilh Setion 7fix) of Division 3 of thc Busincss and <br />Pnrlbssions Codc) ur that hc (rr shc is crcmpt thcrcliom atrd thc hasis for thc allcgcd cxcmption. Any violalion ofsection 70ll.5 by any <br />applicanl for a lErmit subjccls thc applicant to a civil pcnalty of rol morc than livc hundrcd dolhs (5500). <br />_I. as owncr of thc propcrty, or my cmployces with wagcs as lhcir solc compcnsation, will do the work arxl the slrur.*turc is not <br />intcndcrl rlr oll'ercd lirr salc (Sec.7(X4. Busincss antl Pnrfcssions Crxlc: Thc Contractor's License [:w does not apply to an owner of <br />thc pnrJrcrty who huilds or impnrvcs thcrcon. anl who docs such work himsclf or hcrself or through his or hcr own cmpklyces. <br />providcd that such improvcrncnts arc not intcrxlcd rlr ollcrcd lilr sah. It, txlwcvcr, thc buikling or improvcnrcnt is sokl within onc yciu <br />ol'comphtkln, thc Owncr Buillcr will havc thc burden ol'proving that hc or she did rxrt buikl or improve thc pruJn'ry lbr thc purposc of <br />sah). <br />_1. as owncr ol'thc propcrty. am cxclusivcly conlracting with licenscd contractors to construct the projcct (Scc. 7G14, Busittcss <br />aml Pnltbssiorr Codc: Thc Contractor's Liccnse Law drrcs not apply lo an owner of propcrty who builds or improves lhcreon, <br />anrl who contracls firr such projccts with a Conlraclor(s) liccnsctl pursuant to the Contractor's Liccnsc hw). <br />-IamcxcmptundcrScction-'B.&P'C.forthisrcason.Date: Owner: <br />wtxrcns' cotttprnls <br />DECLARATION <br />I hcrchy alfirm undcr Jrcnalty ol';rcrjury onc of thc krlklwing dcclarations: <br />_l havc and will maintain a Ccrtitjcate of Consclrt to Sclt'-lnsurc filr workcrs' comJrcnsation, as provided ftrr by Sectitln 17fi) of the <br />l:txrr CrxJc, lirr thc pcrfilrmancc of thc work frlr which thc Jrcrmit is issucd. <br />_l havc and will maintain workcrs'comSrcnsation insurancc, as rcquircd byScction 3700of the [aborCodc, <br />the work frrr which this Jrcrmit is issucd. My workcrs' compcnsation insurance carricr aml plicy numbcr are: <br />for thc pcrtbrmancc of <br />2 <br />Policy <br />-l <br />ccrtity that in thc pcrlirrnuncc ol'tlrc work lirr which this Jrcrmit is I shall not cmpkly any pcrson in any manncr I <br />so as to bccotttc suhjc-ct to thc workcrs'crlmpcnsatirtn laws agrcc that if I subject to the <br />workcrs' conrlrcnsatiott prcvisions o[ Scction ]7fi) of thc l.ahlr lirrthwith thosc prtlvisiotts, <br />}VAITNIN(]:Itt workcrs' compcnsation covcragc is and cmpklycr to criminal Jrcnaltics and <br />civil l-rncs up tlxrusand dollars ($l()0,fi)0), in to thc damagcs as prcvidcrl filr thc <br />Scctiort antl attorncy's l'ccs. <br />I hcrcby al'lirnt unrlcr pcnalty of prjury that I arn liccnscd 9 (commcncing with Section 7U)()) of Division -] <br />tlf thc Busincss anrl Prul'cssiorrs Codc, and my liccnsc is lirrcc c['t'cct, <br />Liccnsc <br />I hcreby allirnr undcr Jrcnalty ol';rcrjury that llrcrc is a <br />issucd (Scc. .1097, Civ. C.). <br />[-cndcr's Namc: <br />Jrcrtormance of the work lbr which this Jrcrmit Ls <br />l-endcr's Address: <br />APPLICANT DECLARATION <br />I trcrcby all'lrm undcr pcnalty of pcrjury onc ol'thc lirllowing dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rcquircd lrttcr ol Notilicatirxr <br />_l ccrtity that thc t'cdcralrcgulations to this project. <br />_l ccrtify that I have rcad this application is correct. I agrcc to comply with all <br />rlrtlinanccs antl Statc Laws rclating to building <br />atxlvc mcntioncd proprty lilr inspcction <br />Applicarrt or Agent <br />Penuilec nanrc <br />that thc <br />rcmoval arc <br />rcprcscrU4livcs of this City and to thc <br />Rarr nP.-n7-2nl q