Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I lrcrcby alnrm undcr pcnalty of Jrcrjury that I am cxcmpt from thc Grntrackrs' Liccos tjw lirr thc followin8 rcasrn (Ss.703 1.5 <br />Busincss aul Prolcssion Crxlc): Any City or County which rcquircs a lErmit kr construcl. altcr, improvc. dcmrlish or rcpair any <br />slructurc. lrhr to its issuaNc, also rcquircs thc opllicant for such lEnnit to filc a signcd slatcrenl lhal he or she is liccnsd pwant <br />to lhc pr)visi()ns of thc Contractor's Liccnsd Law (Chaptcr 9. Commcncilg with Scction 7(X)0 of Division J of thc Busircss and <br />PR)fcssionsC'(xlc)([thalhcorshciscxcmFtthcrcfiommdth€basisforthcallcgcdcxcmption. A[yviohtionofsetirnT0Sl,5byrny <br />applicant for a Jrrmit subjccts the applicant kr a civil pcnalty of not fr)rc than fivc hundrcd dollds (SsU)). <br />_1, as owncr of thc propcrly, or nly cmployccs with wagcs as thcir solc comfrcnsalion. will do thc work arxl lhc str ',,r*ture is not <br />irrtcndctl or oUbrcd tbr salc (Sc'c.7(X4, Busincss and Pnrt'cssions Crxlc: 'fhe Contractor's Liccnsc Law docs not apply to an owner of <br />thc pnrpcrty wlxr huilds or improvcs thcrcon. aml who docs such work himself or hcrscll'or thnrugh his or hcr own cnlployccs, <br />prcvidctl thal such impnlvernctrts arc rrot irrtcndcd or oltbrcd firr salc. Il. howcvcr, tlrc building or improvcrncnt is sold within onc ycar <br />o[comphtkln. thc Owncr Buiklcr will havc thc burdcn of pnlving that hc or shc did mrt build or improvc thc pnlpcrty tirr thc purp.rsc of <br />sale). <br />_1, as owncr of thc property. amcxclusivcly contracting with liccnscd contractors to construct thc project (Sec. 7044, Busincss <br />and Prul'essitm Codc: Thc Contractor's Liccnsc Law does not apply to an owncr ol'proJrcrty who builds or improvcs thcrcon, <br />and who contracts lilr such projccts with a Contractrlr(s) liccnscd pursuant to thc Contractor's Liccnsc Law). <br />-IamcxcmptundcrScctitln-'B.&P'C.filrthisrcasrln.f t.,r^. <br />IIABTEBSSAIIPINS]SIAN <br />DECLARATION <br />I hcrcby atl-trm undcr Jrcnalty of Jrcrjury onc of thc lirbwing delaralirns: <br />_l havc atf,l sill rointah a Ccnificatc of CoNcnt to Sclf-lnsurc lbr workcrs' r$mlEn$ation. .s Fovidcd for hy Selion .1700 of lhc <br />l2lxrr Code, for thc Jrcrlbrmree of thc work tbr which thc psmit is issucd. <br />@havc anr! will msintsin workcrs' comlrcnsation insurancc, as rcquired by Scction .!?U) of thc khor Codc, lbr thc perlilrmncc of <br />thc sork for which this Jrmit is issuq.l. My workqs' smJrnsation insurancc cmicr arxl F)licy numbcr ec: <br />Policy <br />ffi.",1i1'uF-that in lhc pcrlirrrnancc of thc work tirr which this Jrcrrnit is issucd, I shall not cmploy any lrcrson in any manncr r <br />so as to bcconrc suh.icct to thc workcrs' compensat ion laws of California, and agrec that if I strtuld bccomc subjcct to thc <br />workcrs' coml^-nsation pnlvisions of Scction 37(X) of thc Lahrr Crdc, I shall. trlrthwith comply with thosc provisions. <br />WARNING: Failurc to liccurc workcrs' comJrcnsation covcragc is unlawlirl, and shall subjcct an cmpkrycr to criminal Jrcnaltics and <br />civil l-urcs up to onc hundrcd thousand dollars (SlU),UX)),to thc damagcs as providcd for thc <br />JScction 3076 of thc l:txrr CrxJc, inlcrest and attorrrcy's t'ccs. <br />Date: <br />I hcreby atlirm undcr penalty of pcr.iury that I am liccnscd undcr provision ot'Chaptcr 9 (commcncing with Scction 7m0) ol'Division .l <br />ol' thc Busincss antl Prcl'cssions Codc, and my liccnsc is in lull lirrcc aml cl'l'cct. <br />Liccnsc <br />W <br />I hcrcby afnrm undcr lEnalty of Frjury that thsc is r crnstructi)n lending agcrcy lirr thc Isli[mncc of lhc work for which lhis lrcmit is <br />issucd (Se. .lG)7. Civ. C.). <br />kndcr's Namc: <br />kndcr's Addrcss: <br />APPLICANT DECLARATION <br />I lrcrcby atlinn undcr pcnalty ol'pcrjury onc of thc folkrwing dcclarations: <br />Dcnrolition Pcrmits-Asbcstos Notificalion Fedcral Rcgulations (Title 40, Part6) <br />lXG"euit"d lrrtcr of Notification <br />,Lll ccrtify that thc fcdcral rcgulations rcgarding asbcstos rcmoval are not applicable to this proicct. <br />with all City and County <br />and Courrty lo entcr uJxrn tlrc <br />atxlvc nrcntioncd proprty li)r <br />Applicant or Agcnt <br />Penrritee nanle <br />and statc lhat <br />*", 12[6D <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf lo orlY enulnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <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 s^ <br />FINAL n l,?-l lrll)Dfiqd7 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />Porr nQ-n7-2n16 <br />xYn-l V'r