Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK rD/stG.COMMENTS OWNER BUILDER DT'LCARATION <br />I h6cby amrm undcr poally of perjury that I m exempt fiom the Conlraclos License Larv for lhc followinS reen (Se.70,3 1.5 <br />[]usincs and l'rofssion Code): Any City or County which requir6 a pqmil to constmcl. aho. improve. dcmolish or rcpair any <br />structu'e. pior to its issuance. also requirG the applicant for such pennil lo file a signed statenol thal he or she is licmsed pureuant <br />lo thc pro\isions ofthe Conlractor's Licensed larv (Chapts 9. Cornrnencing \ith Setion 7000 ofDivision.l ofthe Businss md <br />I'rofcssionsCode)orthatheorsheiseremptthfiefiomandtheb6isfortheallegcdexernplion. AnyviolationofSectionT0,ll.5byany <br />applicanl for a pennit subiects the applicant to a civil penalty o f not nrore than five hundred dollms ( $500 ) <br />[. c orvnv o f the pnrfErty. or my employeG rvith rvags as their sole cornpcnsat ion. $,ill do thc work md lhe strudue is nol <br />intmdc{ orolloedforsle(Se.T044,BusinssandProfssionsCode:'lheContrnckrr'sl-icenscl-arvdo6nolapplyhanownqof <br />lhcpropqty rvhotnildsorirnprovsthson,mdrvhodossuchr\od(hintselIorhcrsclforlhroughhisorheorvncmployees. <br />providedthalsuch imprcvsnenlstrenolintmdedoroffqedforsle. Il.hou'eve.thcbuildirrgoritnprovqncnlissoldvithinoney6 <br />ofconplclion. the Oyner Buildq will have the burdm ofproving that he or she did not build or imprtxe the propGly for the purfise of <br />salc). <br />I.asorvncrofllrepropcrly.anrexclusivelycontacting$ilhliccnsc(lcoDlrilclomlo!onslNctlhcpr()icct(Scc 70.l4.llusincss <br />and l\ulhsior(ixle: lhc(\)ntr0ctor's[-icense[,a\\,docsnolapplytoanoNilcrolp(]pcrlylvhobui[lsorinrprovesthcrcon. <br />a0d rlo conlractsforsuchprcjectsrvilhaConlmcl(il1s)licerse(lpursuatillothc(inilractor'sl.iccnscl.aw). <br />I dn crenlpl under Selion B. & P.C. for lhis renson- <br />Date: owner: <br />WORKERS' ('OI\IPENSAI'ION <br />DECI,ARA'I'ION <br />I hereby affirm undr penalty oflnjury one oflhe follorving dmlarations: <br />IharemduillnraintainaCffificateofconsmltoSelf-lnsureforrvorkus compcnsattm.m prolidedforbySfftion.1700oflhe <br />[rk)r ('odc. for lhe psfomarce of the s'ork for which lhe polnil is i$ued. <br />I have aild Nill rnaiiltain rvorkers cornpensation insurance. m rcquircd by Sectitm 3700 ofthe l.abor (hdc. for the ptrfonnance of <br />thcrrcrkforshichlhispcnnitisissued.Myworkss cornlnrsalioninsrrancccanicranr! Jxrlicy_numbcroc: <br />('an icr: <br />Policy Numtrcr:l:\pilcs. <br />I cciify that in lhe perforrnance oflhe rvork lor rvhich this permit is issued. I shall not enrploy any psson in any mlnner <br />so as to lsonre subj<l to the wofkm' conlptrsation laws of California. and agree that if I should lBome subie-t to thc <br />rvorlus' cornpensation provisions ofSetion 3700 oflhe t,abor Code. I shall. fonhuith comply rvith tho$ provisions. <br />WARNING: faihre to sure rvorkers'compensation coiqage is unla$'ful. and shall subjst .n qnplo)'er lo qiminal Frnaltis and <br />civil llnes up o one hun<Ired thousand dollos 100.000). in addilion b the cost of compens.tion. dalnaSes as pror.ided for the <br />Seclion .1076 ol the Lalr)r (-ode. inlerest les. <br />t)l.t( l,AR.A I toN <br />I hcrcbyaflirrn undcr pnallyoIpcrirry I an licensed undcr provision of( hrptu 1) (cornillencing $ ilh Scction 7000) of I)i!ision -'1 <br />ol lhc llusincss and l\rrfrssions (irdc. trd nry license is in full &rrcc url clfcct <br />l.iecnsc ( lass Liccnsc Nurnbcr: <br />l)xlr 1o (/to U1 <br />I hcrcby allirnr unda ;rnaltyof psjurylhat <br />issucd (Scc. ,10S7. Civ. C.). <br />l-endq's Name: <br />ion lcnding agerrcy lirr thc ptr lirrnrancc ol lhc \1r k for \\ hich lhis per ilril is <br />Lcndcr's Arkltss: <br />APPLICANT DECLARATION <br />I hrttr)'affinn under poalty of prjury one ofthe follos'ing delaations: <br />[)enrrlition Ptrmils-Asbestos Notification Fedqal Regulations (Thle 40. Pan6] <br />Rcquircd Ldtq of Notification <br />Nith all City and Count) <br />and Counly lo flltr upon lhe <br />I corifv tlylhc fcdcral regulations regrding asbestos remoralarc not applicatrlc to lhis projcrr. <br />t .or\tf l"r" ,."d this application md state that the atx)\e inft)nnalion is corccl. I agrcE k) comply <br />rrdinonccs af(,State l-ass rclating to building conslruclion, md hereby authorize reprscnlali\$ oflhis ('it) <br />ah're nrcntFnell frrtrncrty frrr inslmtirrn puryxrsq. <br />nppricanr/orngcnrsrrrr* % l)rre: <br />Pcrtr,ircetr5y'_ frlr*fo &W*l <br />/o/ra1/? <br />Set Backs <br />FormsiSteel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <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 />Engineer Final Report <br />Flood Zone Certif <br />I <br />FINAL 1///z.to -ffi h <br />Certificate of Occupancy '/'U <br />Notes, Remarks, Etc <br />DATE <br />r>*", (o1/o I lQ