Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hereby affrrm under poxlty of ptrJury that I m crempt from lhe Contracto6' LiceEe law for thc following remn (Ss.70.11,5 <br />Busines dd Profession Code): Any City or County which rcquirc a lmit to construct, alro, improvq dsnolish or repair mf <br />structuc. prior to its issumce. also rrluire lhc applicet for such pemit to file a signed slatonmt that hc or she is licdsed pmumt <br />to lhe provisioB of the Contactor's Licensed Law (Chapts 9, Conrmencing *ith Setion 7000 of Division 3 of the Business md <br />PmfessionsCode)orthatheorsheisexemptthgcfromildlheb6isfortheallegedexernption. Anyviolationofs(lion70ll.5byany <br />applicantforapsmitsubjectsthe applicanttoacivilpenaltyofnotmorethmfivehundreddolles($500). <br />_ I. as orvno ofthc prop€ny. or tny employs with wags 6 thci[ $le coilrpensatien. will do thc work ud thc struclw is n([ <br />inloded or offercd for sle (Se.7044, Businas md kofssiom Code: Thc Conlractor's Licme law do6 not apply to m own6 of <br />thcprcFny whobuildsorirnprovethq@n.mdwhodo6suchworihimsclforhosclforlhroughhisorhoorvnernployee. <br />provided that such improvments de not intmdcd oroflqed for ele. lf, howflr, the building or improronent is sld within one )@ <br />ofcornpldion. the Ownq Buildq will have the budq ofFroving that he or she did not build or inrprove the prcpay for the pur;oe of <br />sale). <br />_1. re orvner of the property. mr exclusively conlracting wilh licffed conlraclo6 lo conslruct the prdect (Ss. ?M4. Bsine$ <br />md PrcfesionCodc:'fheConlraclor'sl-iccnsel,awdo6notapplytoanownqofpropqtyrvhobuildsorimprovesthqeon. <br />and who contracls for such prcjcts with a Conlractor(s) liccnsed pursuanl to the Contractor's License [aw) <br />I m exernpt under S(tion-. u. & P.C. for this recon. <br />()$ ncr: <br />\i'dr{KiiRs' ( orr r'INs,\'r'loN <br />plr( 1,,\lr^ lloN <br />ol thc !rtllorvinu dcclarrtions:I heeby allirm unde peflahy ofpqjury onc <br />I have md r,rill maintain a Certificate ofCoBent to Self-lnsure for u'orkm'cornpensation, o provided for by Setion 3700 ofthe <br />Labor Code, for the pefonnmce of lhe trork for rvhich thc pmit is issued. <br />ffilgc and rvill nraintain worktrs' compensation insurance. 6 required by Sation 3700 of the tnbot Code. for the pofommce of <br />lhe $ork for uhich this pmnit is issucd. My worktrs' cornpensalion rnslrancc caris md policy numba ue: <br />cil,*:i-cq{c]:. , ?1ee{hl -Co <br />l" I I \ <br />ror,c1 .r,,nrxi ll ou <br />-16 <br />\ S"G a o2o2-Lk--)*0n". - tJ-t IZ t <br />_l cenily thar in the psfonnancc of the work for which this pornit is issued, I shall nu anploy any person in any hamq' <br />so a to becorre subjal to lhc works' compmsation laws of Califomia. ild agree thal if I should bccome subjel lo the <br />workss' compcnsltion provisions ofSetion -1700 oflhe tabor Codc. I slmll. forthwith colnply with lhos provisions. <br />WARNING: F'ailure to sue workers'conpensation covsage is unlarvful. and shall subjet m onployo to oiminal poaltia md <br />civil fines up lo one hundred thousmd dollas ($100.000). in lo lhc aosl ol'ion.o provided for the <br />Section 1076 of intcrGt and altomey's <br />Zo <br />t)t.-( t.,\R.\ I Io\ <br />I haeby al1irm undo penahy ofpc{ury that I an licm*d under provision ofChapto 9 (cornmocing with Selion 7000) ofDivision 3 <br />of the Busins md Profasions Codc. ad rny licme is in full forcc ad effcct <br />) <br />L?),c{t c C)Z 1 6 ooctYcLicc[se <br />( ONS'l RL'(-tlON t.lrNt)lN(; A(;EN( \ <br />I hmby affrm unde pmahy of psjury that thqe is a construclion lmding agmcy for the gnfonnmce of thc work for uhich this pmit is <br />issued (S(. 3097. Civ. C.). <br />l-mder's Addr6s: <br />- <br />APPLICANT DECLARATION <br />I h:tby allinn under penalty of poiury onc ofthe following drcloations: <br />Demolition Pqmits-Asbestos Notification fedqal Rcgulations (Title 40. Paa6) <br />- <br />Rcquircd l-elts ofNotificalion <br />_ I colify that lhe fedoal regulations regrding astHk)s removal trc nol applicable to this projccl <br />V*ify rnnl have read lhis application md slale that the atnve infonnation I a8re k) conrpl) <br />fthis ( itv <br />rvith all City and County <br />ald County to cn'fr ulren the <br />z-/ i />o <br />odinancs ild Slate Laus relating to <br />I above mmtioncd propeny for <br />Applicntrl or Agcnt <br />Pcrmilce nailrc <br />ud <br />'..5\ <br />Date: <br />Set Backs <br />Forms/Steel/Holdowns ?n >/ttr)67rY/ <br />Erection Pads I <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <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 />Engineer Final Report <br />Flood Zone Certif <br />I <br />FINAL talla 'lp Dfrnnu -+81 <br />Gertificate of Occupancy lt <br />Notes, Remarks, Etc <br />Dsle: <br />Lender's Namc: