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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS ()WNER ITUILDT]R DELCARATION <br />I hcrchy allirtr undcr pcilrlly of pcriury lhat I iln cxetrrpt from lhc Contracbm' L-iccnsc Law lirr thc folhrwing reflson (Scc.7o]l.5 <br />Busincss and l,rolcssion Codc): Any City or County which rcquircs a lEnnil lo con\truct. allcr. improvc. dcnnlish or rcpair any <br />structurc. prior k) its issurncc. also rcquircs lhc spplicatrl for such 1--rrnil lo lilc a signcd slfllciltnl lhal tE or shc is liccn{d pursuant <br />to thc provishns of thc Cootracbr's Liccnscd Liw (Chaplcr 9, Conrmcncing with Scclion 7UD of Division -l of thc Busincss and <br />Profcssir)nsCodc)orlhsth(orshciscxcnrpllhcrclromnndlhchasislorlhcullcgcdcxemplion. AnyviolationofSeclion?03l.5byany <br />applicrnrlorapcnnitsubjcclslhc applicanlloilcivilfcnilll)'oflolnrorcthanllvehundrcddollars(S5Ul). <br />_1, xs owncr ol'thc pro|rny. or nry cillployccs with wugcs rs thcir solc cornpcnsati()n. willdo lhc work nnd lhc slruclurc is not <br />iilcndcd orollcrcd for salc (Sa.7(X,{. Busiilcss and Prolc\si(rns C()dc:'l-hc Conlrnclor's l-iccnsc lnw docs not apply k) an owncr oI <br />thcp()frfly whohuildsoriilrprowstlrmn.{idwhod(rc\suchsorkhiillsclforhcrsclforthroughhisorhcrowncnrpk)yccs. <br />provi(lc(lthatsuch itnptl)vctrrcntsarcnotintendc(loroltcrcdli)rsrlc.llhowcvcr.tlrcbuiltli[gorirrprolcnrcnlissoldwilhinr'rcycar <br />ofconllcti(rl. lhc Owncr Iluildcr will havc thc burdcn ol provirrg thul hc or she (li(l not huikl or inrprovc lhc pmJ)(fy tbr lhc purfmsc of <br />sh) <br />_1. ar owncr of thc prolcrly. am cxclusivcly conlractinS wilh liccnscd conlrxck)rs k) conslruct thc projccl (Sec. 7044. Busincss <br />and lhrtcssilrCodc:'l'hcConlraclor'sLiccnsc[-awdocsnolapplyloilnowncrofproprrlywhohuildsorimprovcslhcrcon. <br />and who conlracls lor such projccts wilh r Conlrnck)r(s) liccnscd pursuanl lo lhc Conlractor's Liccnse [-aw). <br />I rnr cxcrntn urdcr Sc.li()il-. I| & P.('. lbr lhis rcrsoil. <br />Date: <br />- <br />ownerr <br />-WORKERS' COMPENSATION <br />DECLARATION <br />I hcrchy alllrm uDdcr pcnalty of pcrjury onc of lhc li)llowing dccluralion\: <br />_l hnvc and will nuintilin a Ccrlillcatc of Conscnl lo Scll:lnsurc lirr workcts corttpcosolion. rs prcvidcd tor by Sccti(m :l7U) ol lhc <br />titx)r (:odc. li)r lhc pcrfornuncc of lhc work lor which lhc pcrmil is issucd. <br />_lhilvcandwilltnainlaiiworkcrs'conrpcnsalioninsurricc.as rcquirdbyScction.jT(X)ofthct,nbor(i)dc,lbrthcpcrlirnnanccof <br />thc work for which lhis pcrnlit is i\sued. My workcrs' conrl)cnsali()n insurancc canier r[d lx)licy DUorhcr arc: <br />Carricr: <br />Policv Numbcr: <br />-Expircs: <br />D <br />_l ccrlily rhtl in lhc fcrli)rilrilnce oflhc work li)r which lhis perilril is issucd. I shall nol cnrl)k)y any pcrson in any ilrrnncl <br />s rs () h(conE subiecl lo lhc workcr\' compcn\illiotr laws ol Cflliforniil. and ilBrcc lhrl il I shoukl ttcolnc subjccl to lhc <br />workcr\'conrpcn\flti(DDrovision\ol-Sccti(il-17(X)ofthcl,ilh)rCotlc.lshall.li)rlhwilhcoilrplywilhlhoscp()vi\ions. <br />WARNINO: [;aihrrc lo sccurc workcrs'conrfcnsxtion covcrrSc is uildwtul. lld shtll \ubjccl an cnrphycr lo crinlirril ncnallics afd <br />civil lincs up lo one hundrcd thousand dollars ($100.(xx)). iil a(klilion lo lhc cosl of compensrlion. darugcsu*as providcd lirr lhc <br />Sccti()n albrrcy's fccs. <br />Dillci <br />I hcrcby altlrm undcr pcilalty of pcriury that I am liccnscd undcr pr)vision o[ Chaptcr 9 (commencirt8 with Scction 70U)) ot Divisk)tr 3 <br />of lhc llusiDcss nnd Prolcssions Codc. Md nly licensc is itt full tbrcc and clllcl. <br />Liccnsc <br />Date:L ? cont ^"tor, <br />CONSTRUCTION LFNDING AGENCY <br />I hcrcby affirrr undcr pcntlly ofpcrjury that lhcrc is a conslruction lcnding agcncy for thc pcrformancc ofthc work for which this frrmil is <br />issucd (Scc. 1097. Civ. C.). <br />Lcnrlcr's Nanrc: <br />Lcndcr's Addrcss: <br />APILII;ANLIIECI.AMIIQN <br />I hcrcby aflinn undcr penalty of pcrjury one of lhc following declarations: <br />Demolilion Pcrmils-Asbcslos Notilication Fcderal Regulations (Tillc 40. Pan6) <br />-Requircd <br />lfltcr of Notillcatk n <br />-l <br />certify lhal lhc fcdcralregulations rcgrding asbeslos rcmovalarc not uPPlicablc lo lhis Projcct. <br />_l cedify that I have read this applicrtion and slute that thc above information is corect. I agre lo comply wilh ull City and County <br />ordinances and Statc Laws rclaling to building conyruction. uM hcrchy {ulhorizc rcprcscnlutivcs of this City and County to cntct upon lhc <br />abovc rmntioncd propcdy l'or ins\K rrurrylia ,/./ / <br />AppncanrorAgenrsronru"", .l y'Vd/ U* ,rr", )// S- - <br />Pemiremme(prrn,r. L*r-4 Lr *A-u <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Vent/l nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Eneroy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Cefiif <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />It