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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/S!G.COMMENTS OWNER BUII,DER DEL('AR 'I'ION <br />IherebyaflinnunderpenaltyofperiurythalIanerenrplliomlheContractors LicenseLa\r'forthefollosirrgreason(f9c.7031i <br />Businas and Profesion Code)r Any Cily or Counly *hich rcquila a lnrnit lo conslnrct. aho. iruprofi. deinolish ry repair my <br />sluclure. prior lo its issumce. also requirs the applicant for such lEmrit to file a signed slalement lhal he or shc is licensed pursumt <br />to the provisions ofthe Conlraclor's Licensed Larv (Chapter 9. Cornrnencing rvith Section 7000 of Division I ofthc Uusines and <br />ProfessionsCode)orlhalheorshcisercntptlhcrcfiolnandthebiuisfortheallegcdexernplion. AilyviolalionofSecti(rn70-1l.5byany <br />applicantforapennilsubjelslhe applicanttoacivilpenaltyofnotnmrethanfi\ehundreddollars($500). <br />l. ts oN no of the properly. or nly ernployees \vilh wags as their $le compensat ion. s'ill do the Nork md the slructue is nol <br />intmded oroffqedforsle(Sq.T044.BusincsandPtofessions('ode: TheContractor'sLicose[,awdoesnolapplytoanorrnrof <br />lhepmpcny uhobuiklsorimprovalh6@n.frd$hodo6suchrvorkhirnselforherselforlhroughhisorherorvncnrpkryes. <br />provided that such improvfilents tre not intodql oroflo'ed for sle- If, ho$eva. the buikling or inrporernent is sold rvithin one )q' <br />ofconrplelion. the ()wner Buildfi will havc the burclot ofpror ing lha he or she did not trril<l or irnprovc the prolEly for llre pull$s of <br />sle). <br />-1, <br />m o\ na of lhe propmy. an erclusi!ely conlracting silh licensed conlr.clore to construct lhe proi(t (S(. 70{4. I}usin6s <br />and I'roffssirn Code: The Contractor's License Law docs nol apply lo an orvner ofprope(y \\'ho builds or inproves thcrcon, <br />and rvho contracts for such projets s ith a Contraclo(s) licensed pulsuanl to the Contraclor's License l-a$ ). <br />I dn exernDl mder llection <br />o^""J//21_L <br />lhis <br />I hereby affirm undr penalty ofpojury one declarations: <br />-l <br />have md rvill maintain a Cenificale oIConsenl to Self-lnsure for *'orkos compmsalion, as provided for by Sstion 3700 of the <br />trtnr Codc. for the pq'foinancc oflhc work for rvhich the pmnit is issued. <br />IhaveandN'illrnaintainsorkss'conrpensalioninsurance.a requiredbyScctionlT00oIlhetnbor(bde.forthepufonnanceof <br />the sork for u'hich this pmnit is isued. My workas coilrpensalion insurance canier and policy nuntber a'e: <br />Carier: <br />Policy Nurnbo:_11rpircs: <br />I cqlili lhat in lhe perfornnnce ofthe sork for shich this pornit is issued. I shall not ernploy any person in aily illanne <br />$ as to berotne subiet lo the wori(qs' cornpensalion la$ s of Califor:ria. and agree thal i f I should beconre subject h the <br />workos'cornposalionprovisionsofSationST00ofthet.atnrCode. lshall.fulh$ithcomply$iththospto\isioDs. <br />WARNINCT Failure lo secure rvorkes'cotnpensation co\era8e is unlarvful. and shall subiecl an enpk))cr lo oirninal lEulti6 and <br />civil fines up lo one hundEd thousand dollars (in acldittrn to the cost of conlp€nsali()n. tlarnages as pror ided for lhe <br />Sation,1076 of the inleresl and <br />I <br />I heretry aflirm under penalty of periuy that I undo pror ision ofChapl6 9 (commencing \rith Sedion 7000) oI I)i!ision 3 <br />of thc Ilusinss and Profssions Code. and mv license is in full force and effect. <br />Liccroc Clu:-Liccme Numbcr: <br />l)rle:( otrtrack)r: , <br />CONS RUC'I'ION LENDINC ACENCY <br />I hmby affirm under penalty of perjury that thtre is a conslnrction lending agency for the pefonnance oflhe Nork for shich rhis pqmh b <br />issucd (Se. 3097. Civ. C.). <br />Lends's Nme: <br />I-ender's Ad&as: <br />APPLICANI' DECLARA'TION <br />I hoetry aflinn unda penalty of perjury one of t he follorving dec laral ions: <br />Demolition Pcilnits-Asb6tos Notification Fcdcral Regulations (Tille 40. Par16) <br />--Requircd <br />Letter of Notification <br />_l coliry lhat lhe federat regulations reguding nsbolos rcrnoval are uot applicable tr this projcct. <br />- -l cmify that I have read this applicalion ard slale that lhe ahrr e infornralion is correct. I agre k) c(rrnply rvith all ('itr and County <br />ordinancG and Statc l,a$s relating to building conslnrction. and heretry aulhorize repreentalives of this ('ity and Counly to enlfr upon lhe <br />atrcve nlentiona{ propcny for <br />Applicrnt or Agctrl <br />Pcrnritee <br />l""tlzlt< <br />Set Backs <br />Forms/Steel/Holdowns ()7r t1 <br />Erection Pads I l l'l (i4 <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enUl nsu lation <br />Roof Sheathing I D rtl ) <br />Shear Wall t,t fr <br />Framing I 1l L'7 1.{u.+, -.'/4rn <br />lnsulation/Energy 7 //<44 <br />Drywall 7 -1 q(1O <br />GxD/lnt. Lath 6 '+t,,1 7 4y'4 Vl ) <br />B-rown Coat t )l-7 O!- +fl Vto*^ L €.,<\ <br />Nqa€effy 9..-la<l<-{t'7 /U4fi9 )/ <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />l <br />FINAL l)k t ',&0 <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />I olL <br />v <br />tlllq <br />tl7 <br />t/' <br />tl <br />*{4q rE <br />,,rl/