Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />Rev. 08-07-201 5 <br />SITE.WORK DATE ID/SIG.COMMENTS owNER IltilI,])t]R I)t),cARA't't()N <br />I hereby affirnr under penally of pcrJury thal I am exeDpi fmm thc Contractos' License l:w for thc following rca$n (Ss,703lf <br />[lusincss and Proltssion Code): Any City or County which requircs a [Ennit lo construcl, altcr, irnprove. dcrmlish or rcpair any <br />struclure. prior m its issuance. also requires the applicanl li)r such pernit to filc a si8ned slaleren( that he or sha i$ Iicenscd pursuaril <br />to th.' pmvisions of lhc Conlractor's l,icenscd law (Chaptcr 9. Comrncncing wilh Scction 7ffn oI l)ivision 3 of the Busincss ard <br />Pro[cs\i([sCodc)orthathcorqhcisexemptthcretiomandthcbasisti)rlheallegedexenrptiul. AnyviolatiotofSectionT03l.5byrny <br />applicrnt for r pcnnir subjccts the applicatrt lo tr civil penahy of not more thnn fivc hundrcd dollars ($5(X)). <br />_1. as owncr ol'lhc profEny. or my cmployecs with waScs as lhcir slc compcnsation, will do lhc work ard thc stmue is mt <br />inlerilal or offered for ulc (Se.7(X.1, Business and Prcfessions Codei The Conlrrctor's Liccnsc Llw does nol apply lo an owncr of <br />the propef,y who builds or inqrrows lheron. md who does silch work hinrself or herself or through his or her own employecs. <br />providr'd lhat slch improvcrrcnls e mt inte trded or olfcrcd lhr slc. ll, howcvei thc txrilding or irnprovemnt is sold within onc }l{ <br />ofconphrbn, th. Owrer Buillcr will havc the burden ofpmvinS that he or shc did frn build or irnpmv. fic pmpe(y for dE purlrs of <br />salc). <br />_1. ils owncr ofthe propcny, anr exclusively contrnctinS wilh licensd con(rack)N () conslruct llE pmjcct (Sec. ?(N4, Busincs\ <br />aill PmtlssionCode:TheCi)ntrack)r'sLicenseLawdoesnotapplyt(,anownerofprope(ywhobuildsorimproveslhereon. <br />and who conlracts for such preiccts with a Coflractor(s) liccnscd pur\uml to lhc (:onlrrctor's Licensc Law). <br />-IinleIem|lunderSecti<rn-,B,&P,c,li,rthi$reasotr, <br />WORKI.:R5' COlll PIINSA'l'I( )N <br />DECLARATIoN <br />I hcrcby rtlirm undcr pcnrhy of pcrjury onc of thc lirllowing dcclnrati()ns: <br />_l hrve afil will nBinlain a Ce(iticate of CoNe nt to Selr:lnsurc for workers' conlpensation, as pmvitled for by Section 3700 of the <br />Luhtr Codf. <br />,K"*u <br />for lhc pcrformmc of the work for which lhc permit is i\sucd. <br />will maintaiD workers'compensstfun insurance, as rcquircd by Section 3700 of lhe bbor Code, for the p€rfomrcc of <br />which thls lrcrnrit is issucd. My workss' rcmlrcNalion iNurance ceicr afll lElicy numhcr ue:thc |4< <br />2(Policy \t-l- <br />_l ccnity lhat in the pcrli)rnlancc of the work for which this pcrmil is issucd. I shall not cn[loy any pcrson in any nunncr <br />s as lo bccorrc suhjccl lo thc workers'compensatioD laws ofcalifonria. and aSrce lhat ifl should bccorrc subject lo lhc <br />workers conrJlnlation provisions of Section 3700 of the Llbor Code, I shall. fo(hwith conrply with tlrc* provisions. <br />WARNINGI l:ailurc to sccurc workcrs'compcnsilion covcrrrgc is unlawful, and shrll subjcct e cnuk,yer to fiiminal pcnalties and <br />civil lines up lo one hundred thousand dollars ($lm.(Xl)). in addition lo thc cosl ofcornpensalion. daroges as providcd for lhc <br />Section J076 ofrhe labor C(xle. intcrest and atlomy s fees. <br />UEENSEEgNIWIgE <br />DI:CLARATION <br />I hcrcby allirm undcr penahy of perjury that I am liccnsed undcr provision ofChaptcr 9 (cornmcncing with Seclion 7000) ol Division 3 <br />of thc Busincss and Profcssions Codc. and nly liccnse is in full fbrcc and clfect. <br />Liccns!'B-e to Nilrnl{r: <br />(3z q(( <br />(J <br />W <br />I hercby alfrm undcr [Emhy of perjury that lhere is a @nslnrct ion hndllg agefty li)r the perfomree of thc work for which this pmit is <br />issucd (Scc. 1097, Civ. C.). <br />Lendcr's Nailrc: _ <br />[rndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hercby atrm !nder pcnalty of perjury onc of the following dcluations: <br />DenDlition Permils-Asbcstos Notification Federal ReSulations (Title 40, Parl6) <br />_R4uired trttcr of No(ificalion <br />_l certify lhrt lhe federnl regulali(r)s regarding ilshesk)s rcnx)villarc [[ applicahle to this p()iect. <br />_l cenify that I luvc rend this application and starc lhat Ihe ibove infornmlion is corecl. I il8rcc lo Llmply with nll Cily and County <br />onlinances and State llws relatiilg to coD\rnlctiol aild hereby ofthis City and Counry io enrer utx)n the <br />xtDve nr(nli()n(l ffi)l--(y i)r <br />Applicsnt or Agcnt <br />l'eilrilcr nanrt <br />PUrJx)scs. <br />CJ <br />z /-za <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ltrlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />,--t q- <br />FINAL lDy+J-iA L/'/€tvZ'rtY> Z / <br />Certificate of Occupancy <br />Notes, Remarks, Etc.