Laserfiche WebLink
COMMENTSSITE.WORK DATE ID/SIG <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Jvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />I 6_$-y7,l\l7t)!i ')(FINAL <br />Certificate of Occupancy II <br />Notes, Remarks, Etc. <br />OWNIIR lltllll)llR |)I.),CARA'II()N I <br />I hcrcby afllrnl under penalty of perJury that I anr exempt fronl tlrc Contractos' License Law for the following reason {Sec.70.! <br />Busincss nnd Proltssir)n Codc): Any City or County which rcquircs a lErmit lo conslrucl, allcr, irnprove, demlish or ropan Jstnrcturc.pri(,rrirs issuance.alsorcquirestheapplicantli)rsuchpcmriltorileasigiledslulcmenl lhatlEorshcisliccn*d pur\'7-. <br />lo lhc provisions of lhc Contractor's l.icenscd l-aw (Chaplcr 9. Commcncing wilh Scclion 7(Xn o[ Division 3 ol thc Busincss and <br />ProlessiolsCodc)orthathdorsheisexempttheretiomandtlpbasisti)rtlEallegedercnrflion. AnyviolationofScclionT03l.5byany <br />applicrDl for i pennit subjrcts th. flpplicaDt to a civil pennhy of not ,mre lhrn Ilve hundred dollnrs ($501)). <br />_1. as owncr ol lhc profEf,y, or my e mployccs wth wages as thct $le comncnsation, willdo thc work <br />^nd <br />thc stMtuc is ml <br />iuerxled orofferedforsle(Ss.?04.l.BusincssondProfessionsCode:ThcCoDlracbr'sLicenElnwdocsnolapplyloanowncrof <br />thc prcp€(y who hrilds or improves ther(nl arrd who does such work hinrself or herself or through his or her own employees. <br />proridcdlhAtsuch improvcrrentsmmtintcodcdorollcR-dlorMlc. ll.lnuevcr.lhcbuiklingorimprovcmnti\sldwilhinoncyear <br />of.omphlt r. ttE OwDcr Builler will luvc tlE burden ofprovin8 lhilt he or she tlirl not build or impmve tlrc pmp€Iy for lhe purf)rc of <br />salc). <br />_1, as owncr oflhe properly, dm exclusively contrlcting with licensed conlraclors l() conslrucl lhe project (Sec. 7044. Dusiness <br />and Pft)llssknrCode:ThcContrac(tr's[-icenseLawdoesnotapply!ranownerofpropenywhohuildsorinlprovesthereotr. <br />and who conrraclsforsuchprojcctswithaContracto(s)licensedpursuilllolhcConlraclor'sLiccnsekw). <br />-llnrexemptUnderSection-,B,&P,C.ti'rthisreason. <br />tv()RKERS', ('()t\tPUNSA I I()N <br />DECI,ARATIoN <br />I hcrcby affirm un(lcr l).n.liv of pcriuryonc ()t thc lbllowing declrralxrns: <br />_l have md will nBintain a Ccf,itlcatc of Consent to Self-lnsure for workers' cotrlpensation, as prcvidcd for by Scction 3700 of the <br />l-atpr Code, for thc pcrformrcc of thc work lor which thc pctmil is i-\sued. <br />f haveanrjwillnrrintainworke6'compensationinsulance,as requiredbySection3T0OoftheliborCode,forthcpcrformR.^cof <br />rhc work l'or which thii/frrmit i\ issucd. My wrrktrs'comp<nsation insglancc cmicr frl Flicy oumh!'r ilc: <br />,.^*,,, %.frt. r lyrt) <br />Policy *, n",,/ \6 lx77?1 n*1n",,oltZo <br />_l ccrlity that in thc lrerlirrmucc of Ihe work for which this pcrmil is issucd, I shall not cnrpl()y {ny pcrson in any manner <br />so $tobccotrrcsubjccttothcworkcrs'cornpcnsalionlawsofcnlifornia,andhsrcclhatillshouldbccorrcsubjcctlothc <br />worker!' corrtEn\atioD provisrons of Sectior) 1700of lh. Labor I shrll, fonhwith conrply with rhos provisions. <br />WARNING: Failure to sccurc workcrs'conrFosation covcrdgc is rod shall suhjuct an n) siminal peMlties md <br />civil lincs up to onc hunclrcd thousrtrd dollrrs ($100.(XX)). iD -to lhe cost o[ cotrlp€nsntion.as prrvidcd fttr the <br />Secli()n J076 ofthe tihor C'qle, inlcresl and allomy's fees. <br />3,\\r zoI)ul(; <br />plt&a8axloN <br />I hcrcby allirm under pcnalty of perjury that I 6m licensd uoder provision ol Chapter 9 (cornrrcncing wirh Secrion 7G4O) olDivision 3 <br />of thc Busincss and Prcfcssions Code. afil my liccnse is in full lbrcc aftl cffcd. <br />L Zt-iccnsc C Nurnber:o <br />CONSTR(JCTTON I,I]NDING AGENCY <br />I hereby aUirm under Fnalty of periury thrt thcre is a coDslnrcti(n lerrjiilg rgeDcy fi,r the perf()rmance ofthe work ti)a which this pcm)it is <br />issucd (Scc. .ll)97. Ci!. C.). <br />L!'trdcr'r N.rrc: _ <br />Lemlcr's Addrcss: <br />AP&IST DECIAEAIIAN <br />I h.reby affml undcr pcnalty of perjury onc of lhe following delffalions: <br />Denplition Pcrmits-Asberlos Notifica(ion Fedcral ReSulations (Title.l0, Pan6) <br />_Rcquired t (erof Notifrcation <br />applicable tr) this proiet. <br />is correcl. I with rll Cily and Counly <br />and Couilty b cntcr ufDn tlE <br />I atxrrc m-ntioncd prupcny krr <br />Applic.nt or Agcnt <br />I'r'rtrrit$ nanr( <br />t\\7O <br />BU!LDING. INSPECTOR RECORD <br />Rev. 08-07-201 5 <br />(