Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEL('ARATION <br />! hereby affirnr under penalty oi perjury thal I dn exempt from the Cortrado6' License Law for the following re6on (Sec.703l.5 <br />Busin$s and Profsion Codc): Any Cily or County rvhich requira a pomit to conslruct. alts. improve. donolish or repair m) <br />slnrctrlre, prior to its issuance, also requirG the applicant for such ;rnnh to lile a signed statmrcnt thal he or shc is iicosed pursuanl <br />b rhe provisiom of the Contractor's Licensed Lau (Chaptcr 9. Cornmencing wilh Sstion 7000 of Division 3 of lhc Busine$ ad <br />Profc$ioos Code) or that he or she is cxcmpt thgeliom dd the b6is for the allegcd exemption. Any violalion of S{tion 703 L5 iy ay <br />applicanrforapmnitsubjststhe applicanlloacivilpenaltyofnotmorelhufivehundreddollus($500). <br />l.a orvneroflheproperty.ornrycrnployswithwags6theirslecontpcnsation,willdotheworkedthestruclueisnot <br />intoded or offscd for sle (S€.7044. Busines md hofsions Code: The Cootractor's Licrue law do6 not apply lo d ownq of <br />lhe prepoty u'ho builds or improvc lhq@n. md who do6 such work himself or h6elf or th.ough his or her own cmployec, <br />provided thai such improvmenls ee not inlffded or offqql for sle. lf, horvwa, the building or improvement is $ld within one y@ <br />ofcompletion. the O,*ns Buildq will have the htrd6 ofproving thd he or she did nol build or improve the ympqty for the purpos of <br />ule). <br />_1. s owner of thc property. dn exclusively contracting wrth licensed contractoG to construct the prcjst (Se. 7044, Busins <br />md hufsion Code: 'fhc Conlractor's License Law dos not apply lo e ownq ofpropsty who builds or improvc thaon. <br />and \vho contmcts for such rojats rvith a Contractor(s) licenscd pursuilt to thc Conlraclor's Licme Law). <br />- -l m exempr undq Srtion-. B. & P.C. for this r6on. <br />lVORI(ERS' COMPENSATION <br />DECLARATION <br />I hoeby aflim undr penalty ofpsjury one ofthe followhg deluatioro: <br />_l havc md will mainlain a Ccrtificale of Consol lo Self-lnsure for workos' compwtion, c provided for by Sction 3700 of the <br />kbor Code. for the pafommce of the work for which the psmit is issued. <br />Valt havc and will mainlain workcB comp€mation iNurance. 6 required by S<tion 3700 of lhe tabor Code, for the psfomilce of <br />the work for rvhich this pemil is issued. My workm compflsation ins[ilce cmier ad policy numbe ae: <br />c*io, 4 hc r ica rt L1 <br />Policy Numt'er:Erpircs: <br />_l certify that in the peformance of the work for which this ponrit is issucd, I shall nol crnploy any pcrson in any nmffi <br />m rotok<omcsubjecltothework6'composationlarvsofCalifomia.mdagrethatiflshouldbecomesubjcltothe <br />workss' compmsation provisiom ofS{tion 1700 ofthc Latnr Code. I shall, forthwith cornply with those provisions. <br />WARNING: Failure to wuc workers'compeNation coverage is unlawful. dd shall subject m mployo to airninal perultis od <br />civil fines up to one hundred thousand dollm ($100.000). in addition to the cost of compensation, dmagcs s provided for the <br />Scction 3076 ofthc tibor Code. interst ild attomey's fe6. <br />urr",t?-f-['?cr?o <br />I hcreby affinD under pmalty ofpcrjury thal I an licenscd 9 (connncnring $ith Seclirn 7000) ofDivisrrn -1 <br />of the Busins md Professions (-'odc. ild my licsse is in full forcc md effet. <br />License LC)N urntrr: <br />c, <br />CONSTRUCTTON LENDINC ACENCY <br />I hoeby affim unrlo panalty of ptrjury that thq€ is a construction lending agency for the pefomance ofthe work for which this pfinit is <br />issued (Se. 3097. Civ. C.). <br />Lcndq s Namc <br />[-endq s Addrss: <br />APPLICAN T DECLARATION <br />I hqelry amm under penalty of po.;ury one ofthe following dcclaations: <br />Demolition Pfrmits-Asbcstos Notification Fedqal Rcgulations (Tillc 40. Pa16) <br />Rcquired l-clter of Notifi cation <br />-l <br />cffify that rhe fc'dcral rcSulations relitrding aslrestos rcmoval arc nol applicable to this projecl. <br />is conet. I agrc to comply with all City and County <br />I reprGentativ6 ofthis City ild County lo cnt6 uF)n thc <br />akve mmtioncd propmy for iropcstion <br />Apolicant or Agent <br />Prrnitte nanrc <br />\. <br />inl_onnation <br />o*"[]-lQ4e? o <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drwvall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonrv <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I -t , <br />FINAL zlzqw DIY{Y)f?:w x-/ <br />Certificate of Occupancy ,Ir <br />Notes, Remarks, Etc. <br />Own{rl <br />cr-t 9) l( n