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BUILDING. INSPECTOR RECORD <br />S!TE.WORK DATE ID/SIG.COMMENTS OWNTJR BUII,DER DEL(.ARATION <br />I heretry affrm unde poalty of perjury that I an erempt from lhe Conlraclos Licnsc Law for the follorving reurn (Se.70i 1.5 <br />Businss and Profasion Code): Any Ciry or Counly rvhich requira a;nrnit to conslruct. alt6. improve. dmolish or rcpair any <br />I <br />slructure. Frior lo ils isudce. also requirB lhe applicanl f<rr such pennit lo file a signed statement lhat he or she is licosed luGuant I <br />to lhe provisions of the ('onlraclor's Licensed Law (Chapt6 9. Commencing with Section 7000 of Division 3 of the Brrsincss and .- <br />| <br />Profesions Code) or that he or she is exempl lhtrefiom and the b6is for the alleged eronption. Any violation ofSaion 703 I 5 hy an1 <br />| <br />applicantforapennitsubjslsthe applicaf,lloacivilpcnallyofnotmorethanfivehundrcddollars($500). I <br />I. as orvncr oflhe Jroperty, or my employG rvith wags o their ole compomtion. u.ill do the work md the structltrc is not <br />intoded or offqcd for sle (Se.7044. Busins and hofessions Code: 'fhe Contractor's Licflse Law docs nol apply to an o\!ner of <br />theproperly rvhotuildsorimprovoth6@n.mdwhodo6suchrvorkhimselforhoselforthroughhisorhaownemployec. <br />providcd lhat such improvqnmts tre not intmded orolTsel for ele. l( howsq. the boilding or impormot is mld s'ilhin onc yw <br />ofcomplaion. the Ou,ns Buildq will have the burdo ofproving thd he or she did nol build or improle the prcp€ty for the purlFse of <br />ule). <br />I. as ower ofthe properly. an erclusively contracting rvith licmsed contractore lo construcl the projd (S(. 7O14. Bwins <br />and Prcfasion Code: l-he Contractor's l"iccnse Law do6 not apply to il o\\'ns ofpropcny who builds or irnproves lhoeon. <br />and Nho conlracls for such proiets u'ith licensed lo the Cont'.ck)r's l-icmse Lalv). <br />I an exempt undtr Setion . l].P,C <br />r)r,e. lt-L-t| <br />I hcreby affirrn under penalty ofpojury one oflhe follorving <br />I have ild will nrainlain a Cfiificale ofconsol to Sclf-lnsure for workes cornpeisalion, o provided for by Section 1700 ofthe <br />kbor Code. for lhe psfomancc of lhe rvork for which the pmnit is issued. <br />- I have and rvill maintain workm' compeNalion insurance. as required by Sslion 3700 oflhe Labor Code. for the psfonnance of <br />the work for which this pmnit is issued. My rvorkos' comgrnsation insurdce cffiier md policy numbo ue: <br />Policy Numba:Expires: <br />_l cenily that in lhe pofirnrance ofthe rvork for which this permit is issued. I shall not onploy any pemon in any nranner <br />sr aslobcornesubjectlotheworkqs'compensationlawsofcalifomia.andagrcthatiflshouldbccornesubjcttothe <br />rvorkos'cornpensationprovisiomofSelionlT00oftheLaborCode.lshall.fonhrvithcomply*'ithlhosprovisions. <br />WARNING: Failurc lo sure s'orkfis'composalion is unlal'lirl. and shall subjcct an onpkrvcr lo oilnirral poallis and <br />civil fines up to one hun&ed lhousnd dollars ir d(ldil lhe comPensation.as provided for the <br />Section 1076 ofthe l-abor Code. inttrst dd allomey <br />I hereby a{Iifln undo pmahy of pojury that I am licosed undr <br />of the Busines and Profesions Codc. ad my licmse is in full <br />Sation 7000) of Dit.ision l <br />Liceroe Class:-[,icense Number: <br />I)itlc:Contrac(or:_ <br />CONS'TRUCTION LENDINC AGENCY <br />I hoeby affitm under penalty ofperjury that th6e is a construclion lending agmcy for the psfonnance ofthc work for rvhich this permit is <br />issued (S(. 3097. Civ. C.). <br />Lendo's Name: <br />-- <br />- <br />t,ods s Addr6s: <br />APPLICANT DECLARATION <br />I hqd:) aflim unds poalty ofprjury one ofthe following declarationsl <br />Demolition Psmits-Asbestos Nolification Federal Regulations (Title 40. Par16) <br />Required t-etl6 of Notificalion <br />_ I cfiify thal lhe ,aleral regulatiore regading mhstos rmoval ue nol applicable to this preject. <br />I cdii, lhal I have read this applicalion ed statc that the atp|e infonnation is corecl. I agre to comply <br />: reprMtaliv6 of this Cily\_ <br />lvith all City and Counly <br />md Counly lo enle upon Iheordinancs and Stalc Laws <br />above mmtioned propeny for <br />Aplrlicailt or Agenl )I'ernrite neme (prin(): <br />lo and horize <br />D^1" l12-/7 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenVl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Energy <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 ?-tB-re JJ.Jo*rTr\ <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />('an'icr: <br />,,r", L.LII--