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BUILDING. INSPECTOR RECORD <br />ID/SIG COMMENTSDATESITE.WORK <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathinq <br />,AShear Wall vdlu\Framinq i-tz-V <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 />7o <br />Rema Etc. <br />FINAL <br />Certificate of Occu <br />I colify thal in the perfonrance ofthe Nork for Nhich <br />w as tr beconre subjal to the workes'compenstion larvs <br />fo lkrwing (Sec.70.1 ,5 <br />this pemit is issued. I shall not mploy my pe6on in any milnq <br />ofCalifomia. and agrc lhat ifl should b€come subj(t to the <br />()\\ N I t()N <br />lhalrrjury e\cnlPl frorn lhe ConlracloB'-tcense Ias for lhehsebyalTirrnunderpenahy <br />Businss md Profsion Code): Any ('ity or Couily shich requirG a p€nnil to conslrucl. altd. improve. donolish or repoir any <br />struoure. prior ro its isumce. also rcquire the applicant for such pennit to filc a signed slarmmt thal hc or she is licf,sed pmu'int <br />to the provisioro of the Contractor's Licensed Law (Chaplq 9. Commencing N ilh S(lion 7000 of Division J of the Busines and <br />profcssionsCode)orthatheorsheiseremptthBefiomandlhebsisfortheallegedcxmption. AnyviolaltrnofSationT03l.5byany <br />applicantforapmitsubjststhe applicanttoacivilpenaltyofnotmorethanfivehundrcddollds($500) <br />_1. o owns of the pnopeny, or my employec wilh wag6 6 their mle cornposalion. sill do the work dd the slruclue is not <br />intodsl or offqed for sle (56.7M4. Busins ild Prof6siom Code: The Contraclor's Licmse Law doe not apply to d out6 of <br />the pmtEly rvho buil& or improvs lhqon. od rvho doe srch $ort himself or h6elf or thrcugh his or ho orvn employec. <br />provided lhat such imptrovflols ilc nol intoded oroffaed for sle. lf. horvo'o, the building or improvmol is oH rvilhin one )q <br />ofcomplaion. the O*oq Builclq *,ill have the htrdo ofproving thd he or she did not build or improve the gopqly for the purpos of <br />sle). <br />l. m owner oIlhe propoty. an exclusivcly contracting wilh licensed contractoB to construcl the preject (Str. 7044. B6ins <br />and PmfesionCode: TheContractor'sLiccnseLawdoesnotapplylomownaofpropenyN'hobuildsorilnprovesthqq)n. <br />and who conlmcls lor such Fojects with a Contmcto(s) Iicmsed pumudl to lhe Conlractor's Licmsc Lau'). <br />I dn exempl unds Setion --. B. & P.C. for this reoon. <br />of <br />Loder's Addrsr <br />Owner:l)rlel <br />WORKERS' COMPENSA'IION <br />DDCLARATION <br />I hereby affirm undq poalty ofpojury one ofthe following declarations: <br />_l havc od will maintain a Cc(ificate of Const to Self-lnsure for rvorkm' contpcnsstion. 6 provided for by Sstion 3700 of thc <br />Iabor Code. for thc psfonnmce o f the u'otk for lvhich the pqmh is i$ued. <br />I have and will maintain rvorkos' compemation insurancc. 6 required by Setion -1700 of th€ tabor Code. for the [sfommce of <br />the work for which this pmil is isued. My workas' compesation insuroce cmia ed policy numbq se: <br />BArzf +,rrqrz,< <br />Policy <br />--Expn""' <br />/'/- 2o2 o <br />workss' cornpenelion provisiof,s ofsection 1700 ofthe t-atnr (bde. I shall. fodh$'ilh comply with those provisions. <br />WARNIN(i: Irailure lo sdure works's'compffiation coverage is unlarvful. and shall subject an onployer to oiminal pmaltiB and <br />civil finesuptoonehundredthousanddollas($100.000),inadditiontolhecoslofconlpensation.donagesoprovidedforthe <br />Section 1076 ofthe Labor ('ode. inlerGt and atlomey s fccs. <br />l,t( ENSED ( ON] R"\( 1()R <br />t)t:( t,ARAl loN <br />I hoeby affirrn undo poalty of p€rjury lhat I m licmsed undr provision ofChapts 9 (commocing rvith Scclion 7000) of Division 3 <br />of the []usinas and Profssions Code. od my license is in full force md effct. <br />ct*'B 'l-iccnsc Nunlber:/ts / ?7 <br />'O -3o1?conrracror: C D T <br />CONSl RU('1 ION LENDING ACEN('Y <br />I hereby aflirrn undo penally ofperiury th.t llrse is a conslnrction lcnding agency f()r lhe pofonnmce oflhe rvork for which lhis ftrnil is <br />issued (scc. 3097. Civ. C.). <br />Lendcr's Name: <br />APPI,I(]AN'T DECLARATION <br />I tertry allim under poralty of pcrjury one ofthe following dcclilalions: <br />Dmlolition Pqmits-Asbdtos Notification Fedoal Regulations (Title 40, Part6) <br />-Required <br />Ldltr of Notificalion <br />-l <br />cgliry lhd the fedsal regulatiom rcgading Gb6tos ranoval tre not spplicable to this prcjct. <br />I cfitify lhal I have read this application ild state lhat the ahrve inftrnnation is const. I agrc to cotnply lvith all Cily and County <br />ordinancG and Srate Laws relating to building conslruction. md hocby authorDe rcpr6mtaliv6 ofthis Cily and County to mld upon the <br />above iltenlioncd prope(y for inspection <br />or,\grtrl on",/a - 3o '/ 7 <br />,,^"ron u, % 4lUArz€4S€^/ <br />DPff'('IUI )vf5"\' <br />I