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!NG.INSPECTOR RECORD <br />Rev.08-07-2015 <br />SITE.WORK DATE ID/S!G.'COMMENTS <br />Set Backs <br />FormsiSteel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulationiEnergy <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 />Enqineer Final Report <br />Flood Zone Certif <br />\'rtr/s.€4, (Z? )F!NAL 6-//-2a lzcl <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />+ <br />oWNItR BT]II,I)l]R I)EI,CARA'TION <br />I hereby affirm under pcnalty of perjury thal I m exenrpl from the Contraclos License l:w for the following rcasn (Sec.70ll.5 <br />llusincss and Prolcssion Codc): Any City or County which rcquires a Jcrmit kr constnrct, altcr, improve, dcmolish or rcpair any <br />slnlctu.e. prior () its issuailce. also requires the applicaot tbr such p€rmit t) filc a signed slalerncnl lhat he or she is licenscd pursuant <br />lo lhc lmvisionr of the Conlraclor's Liccnscd lrw (Chaptcr 9. Comrnencing wilh Scction ?(xxl ol Division 3 ol the Lusincss and <br />ProtessionsCo(lc)orthatfuor\heisexempttherehomandllEbasislbrtlEallegedexemptiq!. AnyviolatiurofSectionT03l.Shyany <br />rpplicrntforapcmritsubjecrslhe dpplicanrtoncivilpelnltyofnormrethullvchundrcddolhrs($5{n). <br />_1, as owncr ol'thc propny. or rny employccs wilh wagcs as thcir solc compcnsation, wil, do thc work md tlE strclurc is nol <br />inerxled orofTcredforule(Se.7Ol.l.BusinessilndPmfessionsCqle:TheContrncbisLiccnscLawdoesnotnpplyloanowncrof <br />rhep&pedy wlx,fuildrorimprowsll)@[axlwlDd(rssuchwrrkhimselforlErsclforthroughhisorherownemployees. <br />providcd thal such improvcrEnts ec mt inlendcd or ollered for sab. Il. howe vci lhc building or ilnprovcmnt is sold within onc )!tr <br />ofconplelknr, (lE Owner Buildor will have thc burden ofprovin8 lhd he or she tlid ntl build or impmve the pmpdy for Ih€ puqis of <br />sule). <br />_1. as owner of the prcpe(y, am exclusivcly conthcting wilh licenpd conlrhck)rs lo conslrucl llE pmjel (Scc. ?(X4, Busincs{ <br />arxl PrrllssinCode:Th€Conlrack)r'sLicenseLawd@snotapplytoanownerofprolE(ywhobuildsorinrproveslhereon. <br />trnd who contrdcls for such projects with a Conlracto(s) liccn$d pu(suMt to lhc Contraclor's Liccnsc Law). <br />_l anr exempt under Section , B. & P.C. lbr this reaq(nr. <br />D.lc:- <br />\voRKl.RS', ( Out'uNs,\'l t( )\ <br />I)U( t.AR,\t t()N <br />I hcrchy allirm undcr pcnahy ol pc'rjury onc oi lhc lirll()wing (lcrlxrrl i()ns: <br />_lhavearxlwillnuintainaCleril'icateofconscnttoSelf:lnsureforworkers'compensalioo,as pruvidedforbyScctionS?00ofthc <br />LatFr Codc, for rhc pcrformrcc oflhe work for which thc pcrmil i\ iisucd. <br />_lhrverndwillnuintxirrworkcrs'compeDsali(xlinsurance,as requiredbySecti(n3700oftheLahorCode,li)rlheperfbrnrance<rf <br />thc w(trk li)r whielr pcrnril issucd.insutanrc crnicr arul;xrlicy nunrbcr uc: <br />/zoaPolicy <br />_l cotili lhrt in thc pertornuncc oftlre work lirr which this lrcrnlil is issucrl, I shall not cnrpkry any pcrson in lny manncr <br />$ as to bccotrE suhjcct to thc workcrs' cofipcnsat ion laws ol Cali lirnlia. and agrcc I hal i t I slnuld bccoE subjccl to I he <br />worker!'conrpnsationprcr'isionsofSectionST00oftheLabor(ixle,Ishall,fonhwithtrcnrplywithrlrcsprovisions. <br />WARNINC: Failurc to wcurc workcrs'conrlrcnsatt)n covcragc is unlawful. and shall suhjccl an cnrployer (r fiminal lrnaltics md <br />civil liDes up to onc huDdrcd thousand dollars ($l00.UX)), in addition to the cost ofconfcnsrlion, dama8cs as provided for thc <br />Srelir)n of Cixlc, iilerest and atbrney's fees. <br />I hcrcby al lirn utrdcr pcnalty ol pcrjury lhal I arn lict'nscd undcr ol Chnptcr 9 (cornmcncinS wilh Scclion 7(Xn) ol Division 3 <br />ol lhc Busincs\ ud Profcsri(,ns Co(lc.:fr| n)y liccn\c is in full Ii)rcc and cf,i'cr. <br />l,iccnsc 60 to <br />( o\s't til'(-tt()N LI.]Nt)t\(;.\(;t,t\( \ <br />I hcreby atlirm uflder lrnaly of pcrjury thal therc is a constructiol leildilg aSency tbr the perfirmnce of the xrrk lbr which this pemir is <br />issucd (Scc. 3097, Civ. C.). <br />[Indcr's Nanrc' <br />It'n(lcr's Ad(lrcs\: <br />APPI,ICAT.IT DECLARATION <br />I hereby uffm undcr pcnalty of perjury one of thc followinB declariilions: <br />DcnDlition Pernlils-Asbcstos Notification Fcdcral Regulations (Tille.l0, Pan6) <br />-Requir.d <br />lrttcr of Nolificalion <br />thut thc federrl rcgulrtions regardi,rg ilrhesk)s renxrval are not applicrble tr this pruiect. <br />_l cenify that I hnve read this afplicalion and stntc lhal thc nbove infomralion is corect. I agree to comply with rll City and County <br />(rdirHnces and State Laws rehtilg k) tililding curstructior, rnd herehy authorizc represeiltatives of this City and Cotrnty to uFnl llE <br />ahovt nrcntirrred lropcfly li,r iflspcclion <br />Appli.{nt or Agcnt <br />Itrrtrritft nilil)r <br />o