Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE rD/srF\COMMENTS OWNl]R DUILDER DEI,('ARAl'loN <br />I hereby a{lirrn undr pmahy ofperiury that I ar erenrpt frorn the Contractrs' l.icose Law for the folhrving reruon (Sa.70.11.5 <br />lJusincss and Prof6sion Code): Any City or County utich requilc a pn:nit to conslnrct. alts. improve. demolish or repair any <br />shrcturc. prior lo its issuaocc. also requirs thc applicanl for such pennit to file a signed slalemtrt that he rrr she is licensed pursuanl <br />to lhc provisions ofthe ('onlrackn's l,icensed l.arv (Chapler 9. Cornmencing Nith Seclion 7000 ofDivist)n 3 ofthe Busincss ancl <br />Prclessions Code) or that he or she is exempt thsefrorn and lhe basis for the allcgc'd eremption. Any violation ofSection 70-1 1.5 by any <br />applicanlforapennilsubjcrlsthe applicanlloacivilpenallyofnotmorelhanfivehundreddollars($500). <br />l. as otr ne of lhe profEfly. or my employ€ wil h \t ag6 6 their sole conrpcnsation. \'ill do the \r,ork and the shtdue is not <br />intoded or offred for sle (S(.7044. Busines md Profssions Code: I he ('ontraclor's l-icmse Itrv do6 not apply to m os ner of <br />lhepft)poly rvhobuildsorimprovsth6an.odslrcdo6suchs'otthirnselforhsselforthroughhisorheotremployca. <br />provicled lhat such impfovsnents de not intmded oroffsel filr sale. ll horvevq. the building or improvonent is sold within one yetr <br />ofcotnploion. the Owner Buildq rvill have the burdfl ofproving tha he or she di<i nol build or improve the prcperty for the prilT[sc of <br />salc). <br />l. m owner ofthe propmy. m erclusivcly conlracling \r'ith licereed conlracloE lo conslrucl the prej(l (Ss. 7044. B6ins <br />md PnrfeionCodc: lheConltaclor'sLicenscLawdosnotapplytoano\r'nflofpropeny$'hobuildsorimpro\,6thfteon. <br />and sho conlmcts for such projats rvith a Conlracto(s) licmsed puBuant to lhe Codractor's Licruc la$ ). <br />I an erempt under S(tion_ _-_ . U. & P.C. for this reson. <br />l)ric:Orviler: <br />\l',OtiKl.trs' ( ot\tPI'NsA'r't()N <br />t)t,t( l,AII|iloN <br />I hcrchr allirnr under pcnaltr ofpcrjurr ore ofthe lrrlkrrvinu clcclarations: <br />lhaveodlvilliltaintaina('ertificateofConsenttoSelf-lnsurefor$'orkm compmvlion.6 providedforbySetion3T00ofthe <br />Latx)r Code. for the pofonnmce of the work for which the pfinit is issued. <br />lhaleandrvillrnaintainworkos'compensationinsurance.as requiredbySectionST00oftheLaborCocle.forthepofonnanceof <br />thc work for *hich this penrrit is issqed. My uorkafunrpmsalion insurance caricr md Folicy nutnher se:l*,*, 17at9lgE LL! / t <br />(ror,.1r.r,u,u*, :grL$7Vo377;67 .*,',*, Yzolc0 <br />I culif) that in Ihe perfornrance ofthe \\'ork for \r'hich this perrnit is issuc(|. I shall ilot enrploy any pcrson in any nlmne' <br />so as lo lEconre suhi{l k) lhc work6s'cornpensalion lalvs ofCalifomia. and a8rcc that ifl should becoille suhjGl to the <br />rvorku's' conrpensation provisions ofSection 1700 oflhe l-abor Code.IirtlrsitI conrplv *'ith llrrsc protisiors. <br />\YARNIN(i: Failure l() sccure \'([kcrs'con)pensalion covcrage is anci shrll suhjcct an enpkrycr to criminal per:allic arrl <br />civil fincs up lo one hundred thousaild dollas ($100.(X)0). in to lhe cosl of compensation. donages 6 providcd ft:: the <br />a:1076 oflhe fbdc. interBl and alk)rncy s f$s <br />to (((q <br />I hcrchv allinu undcr pcnalty o I pd jur] lhal I anr liccnscd undcr ol'( hirlxer()((()rnnrclcirg sith Scctiorr 7000)of I)i\isioil I <br />ol lltc llLrsincss and lloli'ssions (irdc. md mv liccnsc is itr lirll lirrce antl cficet <br />l".n,"cru*, C-L({ <br />\" r i\,.{\rt <br />-- <br />con,.".,* <br />2-7 {rf el-icense Nu <br />CONSTRUCTION LENDINC AGENCI' <br />I hereby affinn undo penalty ofpetjury that thse is a construclion lending agency firr thc pqfonnance ofthc rvork for which this fvmit is <br />issued (S(. -1097. Civ. C.). <br />Lendrr's Narne: _ <br />I-md( s AddrN: <br />APPI,ICAN'T DECLARAl'ION <br />I hcrr$y alfinn under penalty of peljury one oflhe follorving delaralions: <br />l)crnolili()n Permits-Aslxslos Nolification Federal Rcgula(ions ( l ille 40. l'M6) <br />Rc(luiled Letler of Nolifi cfltion <br />I colify that lhe lAltral cbtslos removal are nol applicable lo lhis proj(1. <br />I cfiify lhat I have read this md state that thc atnl'e inlonnation is con L{I. I agrs to conlply wilh all City and Counly <br />ordiilanccs and State l.aws rclaling k)const(rcli)n, eil hereby author izc rcprcscntati\'6 ofthis City and County to cnto' ulrn lhc <br />alxryc Inenli(nred prol)er1y li)r inspccli()n <br />{rplicant or Agclt Signaturc <br />\rnritcc ranrr lprinty:-!Lr\ Cd tAi( <br />D8,e, ,r{t+r, <br />Set Backs I lY. rQ w)/6> <br />Forms/Steel/Holdowns lu-t( t I u-uv <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 />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL lo - z l- (?JalpSrfz @ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />t