Laserfiche WebLink
BU!LDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER I}UILDER DEL('ARATION <br />I hreby affirm undo penalty of perjilry that I m exernpt fiom the Conlraclore' License Law for the follow'ing remn (Se.7031-5 <br />Businss and Profssion Code): Any City or ('ounty lvhich requirG a pennit to construct. allq. improve. dmolish or rqrair any <br />structure. p.ior to its issumce. also requirB the applicant fur such ;rcmit to frle a signed statanml lhal he or she is licmsed pursumt <br />lo thc provisions ofthe Contractor's Licensed [,a$'(Chapt6 9. Commencing Nith Scction 7000 ofDivision 3 ofthe Busin*s and <br />ProfessionsCode)orlhathcorsheisexemptthqefromandlhebasisfortheallegedexemplion. AnyviolationofSectionT0-ll.5byany <br />applicanl for a pennit subjccts the appl icant to a civi I penalty of not more than fi\'e hundred dollars ($500 ). <br />I. as owner o f the prcfffy. or nry etnployeG $ ith rvage m their sole cornpensat ion. rvill do the \vork md lhc struduc is not <br />intordcd oroffqedforsle(Sa.7(X4.BusinssandProfesioNCodc:'lheContractor'sl-icenseLawdo$nolapplytoano$f,erof <br />lhepmftry uhobuildsorimprovslhq@n.mdr\hodossuchuorkhimselforhcrselforthroughhisorhoosnemploles. <br />pro\idedthatstrch improvonotsilenolintodedoroffscdforsle. lf,horvo'a.lhetilildingorirnprovqntrtis$ldwilhrnonelar <br />ofcornpletion. lhe Ourer tluildq will have the burclm ofproving that hc or shc did not build or improve the property for the prrpo* of <br />sle). <br />_ l. as orvner oflhe properly. iln erclusively contracling with licenscd contracl06 to construcl the project (Ss. 7044. Business <br />md l'rolBsionCode:'[he(bntraclor'sl-icensel-awdosnolapplyloanolvnerofpropenywhobuildsorirnprovesIhoeon. <br />and $ho contracls for such prejsls \\'ilh a (-onlracto(s) licensed pursuant to lhe Conlractor's Liccnse la* ). <br />-l <br />m exempt under Sslion-. B. & P.C. for this re6on. <br />Drte: 0nner: <br />wotrKl.rra'( oNrPt'tNs,r r r(ii\ <br />t)lt('l,',\trA iloN <br />ol thc Ii)ll(l\\ iilg (lcchr nl i(,nsI hereby aflirm unde poalty ofpoiury one <br />I have ild will mainlain a Cflificate ofConsent to Self-lnsure for workqs comptrsation. d frovided for by Scction 3700 ofthe <br />Labor Code, for lhe pcfonnuce of the work for rvhich the pmtit is issued. <br />[./_l have and rvill mainlain works' compensation insurance. 6 reqtrired by S(tion -]700 of the l-abor Code. for the pafomance of <br />the work for which this pernit is isued. My worktrs compssation imurmce canio md policy numbo ae: <br />,*,* h { ,1.4o *r S, 6tl * i'v G <br />Pori.yN,.bo, l, "rc oo8<3ooz ? E,pi,",,t1tl <br />_l ccrlify that in lhe psformance of lhe work for which this pomil is issued. I shall not snploy any poson in any rnanno <br />so m to become subjet to the workq's' compensation laws o I Californin. md agrft lhal i f I should bccome subject to lhe <br />\vorkm' compenstion provisions ofSetion 1700 oflhe t.abor Codc. I shall. fonhNilh comply sith thos provisions- <br />WARNINC: l-ailure to sure workss' compensalion is and shall subjct an mployr poaltiur and <br />civil fines up lo one hundred thousand dollils ($lO0.il00). <br />Selion .1076 of thc tnh)r (bde. trtsGl md attomey s fc6. <br />lo lhc cosl ol provided for the <br />o^r",5,i7'11 <br />DECI,iRATION <br />I hreby affinn under poalty of perjury that I m licmsed undo pro! ision ofr (cornmflcing \r'ith Setion 7000) of Di!ision l <br />of the Ilusiness and Profcssioro Code. md my licose is in full forcc md effecl. <br />Licensc Class: <br />Drte:S <br />CONSTRUCTION LFNDING AGENCY <br />I hffiby amm undq p€nahy of perjury that th6e is a conslruclion loding agmcy for thc gnfomsce of thc lvork for N'hich lhis FEmit b <br />issued (Se. 3097, Civ. C.). <br />[f,nder's Nme: <br />Lfids's Addr6s: <br />APPLICANT DECLARAI'ION <br />I hodry atfm under poalty of perjury one ofthe follot'ing dclarations: <br />Demolition Pennits-Asbestos Nolification Fed{al ReEulatfuns ('l illc 40. Part6} <br />Required t-ellq oI Notificalion <br />I ccrtif,v lhat lhe ledcral regulatioils asbeslos removal are nd applicable lo this prejccl <br />I cdify thd I have read Ihis ()n lhal rhc I aSre to comply wilh all City and ('ounty <br />ordinanccs and Slate l,aws rcl0ling lo oflhis Cily and ('ounly to enls'ufx)n lhe <br />above nlenlioned property for <br />Applicrill or Agcnt Signattrre: <br />Pemite name (print): <br />and <br />in[onnalion <br />_*,., {. /8. I 7 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/VenUl nsu lation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL 1 -L- t7 J /c5-*w) <br />Certificate of Occupancy <br />Notes, Remarks, Etc.