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BUI INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf looriVenVl nsu lation I t <br />Roof Sheathinq .{rl tb J-Y"qs <br />Shear Wall I <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 />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL ,Lc 2,^) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />OWNF]R IIUII,DI.]R DIII,CARATloN <br />I hcrchy illlirnl undcr fcilally ol pcrjury lhal I ilnr cxcnifl lionr thc Contrrctors l,iccnsc l-nw for thc lolhwirrg rcason (Scc.70.ll.5 <br />Busincss anrl P()ltssi(ilr Co(lc): Any City rrr Cornly which rcquircs r fcrmil k) construct. alter. irnprovc. dcnr)lish or rclHir any <br />slnrclurc,pri()rk,ils issuancc.dlsorcquireslhcapplicantforsuchFrmillolilcxsigncdslulcnrnl lhalhcorshcisliccnscd pursurnl <br />n) lhc provisions of lhc Coillrilct)r's Liccnscd I;lw (Chnflcr 9. Conurcncing wilh Scclion 7{X)0 ol Division 3 ol-thc Businc\s ilnd <br />Profcssbn\Code)orthalhcorshciscxcnrpllhcrcfr{trnandthchasislbrlhcxllcgcdcxctrrptiul. AnyvioliltionofSectionT0ll.5hyrny <br />alplicnnlli)raFrnlilsuhjcclsthc npplicnntloacivilpenallyofnolmorclhtnfivehundrcddollhrs($5(X)). <br />_1. as owncr o[ I hc pro|tfly. or my cDll)loyccs wil h whgcs n\ lhcir \{) lc coilrlril\nl i()n. s ill do lhc sqk nnd llrc structurc i\ n(il <br />intcndcd orollircdtitrsolc(SN.7(H,l.BnsiDcssand['rolissir:nsCodc:ThcConlractor'sl-iccnscl-dwdocsnotapplytoanowncrof <br />lhcpft)ff,ny whobuikls()rirnprovcslhcruill.dndwh()(locssuchworkhinrscll'orhersclforlhrrrghhis<rrhcrowncrqrkryccs. <br />ol-conrplclioil. lhc Owncr lluil(lcr will havc thc hurtlcn ofproving tlilt hc or \hc (lid Dol buikl or itnprolc lhc pmldy lbr thc purF)sc of <br />sak'). <br />_1. as owncr ol lhc l)rofcf,y. anl cxclusively conlrucling with liccnsc(l c(nilrxclors k) con\trucl thc pfiricct (Scc. 7{}14. Busincss <br />and l}olelssimCodc: IhcConlrilchr'sLiccnscLawdocsnotdpplytonnowncr{)fpropcrtys'hohxildsorimprovcsthcreon. <br />antl ultr) conlracl\ li)r such pr()jccls wilh a Conlrnck)r(s) liccnscd pursuunl lo lhc ('oillraclor's Liccnsc Lxw)- <br />WORKERS' COMPENSATI(IN <br />DECI ARATION <br />I hcrcby allirm undcr pcnahy of pcrjury onc of thc following dcclilrations: <br />-l <br />havc aM w ill rh intain il Ccn illcalc of (itnscnl h Sclf- lnsurc [or workcrs' conrlrcnsrt i(nr. as providcd lirr by Scct irr .17(X) o I thc <br />l,abor Codc. for thc pcrlbrnrancc of lhc work fbt which lhe pcnril is issucd. <br />_l havc and u ill milintain workcrs' <br />lhc $ork lir \htrh Ihiq <br />insuranec. as rcquircd hy Scction J7(X) of thc | -ahor t-odc. li,r thc pcrlin nilncc ()f <br />crnicf Jxrlicy nunrbcr rc: <br />oh <br />b I ires: <br />- Lt-t-hI'olit v <br />-l <br />ccf,ify lhat in lhc pcrfornrance of thc work for which lhis pcrnrit is issucd. I shlll rol cilI)by nny pcrson in aly mrnncr <br />$ as to beconr suhjccl Io lhc workcrs' corrpcnsalion laws o[ Cul ifornir. ilnd agrce thal if I should lxcon]e subjcct k) thc <br />workers'comfcnsulionprovisionsofScctioil3T(DoflhcLrhorCodc.lshrll.lbnhwithcomplywiththo*provisions. <br />WARNIN(i: Failurc k) securc workers comlcnsrlion colcragc is unhwtil. and shall subjcct an cmpklycr to fiminal Frnlltics and <br />civil fincs up tr onc hrndrcd thousanrl dollar\ (Slq),(x,)1. iq cdtlition lo thc cosl oiconrpcnsalion. drrnagcs as providcd for lhc <br />::"r*,ifi T'lE-*"#,:il{g::j.4 . %-s"ffi* u <br />l hcrcby aflirnr undcr pcnalty of pcrjury lhrt l anr liccnscd undcr provisi()n of Chilptcr 9 (conlmcncirg with Sccti()n 7000) ol Divisi(nt .l <br />of lhc Busincss lnd Profcssions Codc. and rny liccnsc is in full frrrcc unrl cllcct.J <br />I-icctr\c <br />Datc: <br />g-1s1171cnthcr::L l9 rB <br />CONSTRI,CTION I,ENDINC AGENCY <br />I hcrchy allirmundcr l*nxllyol pcrjurylhrt lhcrc il aconslruclion lcnding rgcncy lirr lhc fcrlbrmnnce ofthc work for which this pcrrrit is <br />issucd (Scc.3097. Civ. C.). <br />t il@;B <br />IJn(lcr's Nilnrc: <br />L-cndcr's A(ldrcssi <br />APPLICANT DFCI -ARA'TIoN <br />I lrrchy allirm unclcr pcnully of pcrjury onc of lhc lolk)win8 dcclarat ioils: <br />Dcnrolilion Pcrmits-Ashcstos Notilictrtion Fcdcrnl Rcguhtions (l'ille.l0. t'arl6) <br />-Rcquircd <br />Irllcr of Nolilicntion <br />_l cenify that thc fcdcrnl rcguhtions rcgdding ashcsk)s rcrnovol ilrc Dot applicnblc lo this projccl. <br />_l ccnify thnt I havc rca(l lhis applicillion uftl stalc that lhc atx)vc inli)rnrnlioD is corccl. I rgrcc lo conrply wilh all City a <br />rrrdirranccs and Slrtc I-au s rtlating to huilding rcprcscnlalivcs oflhis City an(l Counry to <br />nd (iilnty <br />cnlcr ulx)n tlE <br />ilhovc nlcotx)nc(l pr()t)crly liI <br />Applictrnl or ARenl <br />Itcrnrilrc trilnx.( <br />,,M; <br />l)illc 4*IP <br />I rtrr r\rilrfl un(l.r Scclioil _ _. U. & l'('. lirr thir rcason. <br />I)nlc ()sner: <br />t t