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SITE.WORK I hrrchy rllflm nn(lcr pcnnllv ()l ltliury lhil I nnl c\cnrl)l lil)nr lhc (i)nlrtcl(n\ <br />D{tcr-.-- <br />Pohcv Nurrhr'r: <br />-Etfirc*: <br />Lic('nse Chss:-Liccnsc Nunl{tr: <br />i\sucd (Scc. .109?. Civ. ('.). <br />l,cndcr's Namc: <br />I-.rxlcr'\ n(l(l.es\: <br />I-rw li)r thc lirlkrwing rcason (Scc.lo-11.5 <br />Blsincss und Prollssion C(xle): Any Cily or C(Nnly which rcquires a lrrnill l() c1,,r5i,1tcl. rllcr. imPr)vc. dcfr)lish or Npair any <br />t) thc prr)v$t)ns r)l thc (i)nrractlr's Liccnscd l;rw (Chlftcr 9. Commcilcing wilh Sccli()n 7(XX) ol l)ivisi(xr .l of lhc Bu(irrcss dn(l <br />P()ltssions Codc) or that hc or shc is cxcmpt thcrctron xnd thc ha\is tin thc allcgcd cxcnlplion. Any v!)liltion of Section ?0-l l 5 by any <br />appticanlli)rapcriltitsuhjcctsthc xpplicanltorcivilfrcniltvo,Dottrx)rcthaillivchun(lrcrldollrrs(S5(X)). <br />_1. as owrrcr of thc prolrny. or my cnrpl()yccs with wrlcs irs thcir solc cornpcnsation. willdo lhc work afld thc sl@tr|ru is not <br />trilcRlcd orotttrcdli)r$l(.{Scc.7(}44.Busincss3ndProlcssions(irrlc:lhcConlracl()r'sI.iccnqcl-awdoc\notnpplyk,inown.rol <br />thc pnrJrny who huilds or improvcs thcN)n. md who (locs such wor{ hintscll'r)r hcrsclfor lhr)u8h his or hcr own cmployccs, <br />ol con[leti(n. llE Owner Buildcr will hdre thc hurdcn ol pfi)ving llrrt hc or \hc did not hlild or impitvc lhc Pmflny ti)r thc pilrF)s ol <br />srlc ). <br />_1. as owner of the pfi)pcrly. am cxclusivcly c(nilrrcting wilh licdrsed c(n(ractors k) conslruct lhc P(ieel (Scc. 7(X4. Un\trrcss <br />ail Pn)llssiDCodciThcContrnctor'sLiccnscl"awdocsnrilalplyhdnowncr()llroPcrlywhobttildsorimprovcslhcreoD. <br />ind who c()ntn(ls lirr \uch fr()Fcls with a Corilrirck)(s) licctrscd pur\urtrt t) lhc Conlract)r'1 l-iccnsc lrtw). <br />-l <br />anr c\cmp( undcr Scction-, Il. & P.C. li)r lhis rclson. <br />IVORKERS' COI\IPENSAl'ION <br />DECI,ARATION <br />I hlrcby nl l irN un(lcr I^-rxlly ol p!'riury ()nc ol lhc li)lk)wint dcclrrltions: <br />Lahor C(xlc. li)t thc Nrli)rnHncc ol'lhe work ti)r which lh!' PcrDlil is issucd. <br />thc work lr,r which this pcrnlit is i\sucd. My w()rkcrs c(mrJ^-n\ali(nr ir\urancc clnicr nnd F)liey itrlmhcr arc: <br />_l ccniti lhrt in thc [^*rli]rmancc ol thc work li]r which lhis f^.^rmit is irsuctl. I shall n(il cmpl()y lny JErson in any nlxnncr <br />s(r as k) hccomc suhjcct t() lhc workcrs'c()mpcnsalirm laws ofCalili)rni^, irrd agrcc lhat il I shoul(l hecotrlc suhjcct k) thc <br />w6rkcrs'crnnpcn{ationpft)visi(illsoIScction-17(X)ofthcl-ahrr(ixlc.lshall.linlhwilhcr)nrflywilhtlx)sprovisions. <br />IVARNIN(;: Frihxr k) sccurc workcrs eoml&.-nsrlt)n cr)veragc i( unhwlil. an(l shall suhjccl nn cillpl()ycr tr criminill lEnlltics in(l <br />civit liDc\ !p to one hundrcd th(rsand dollrrs (.$l00.lXX)). in ddditir)t k) thc cost ol compcn\ali(n. damlgcs as providcd lin lhc <br />Scctrrn .l{)76 ol thc [f,htr (i)dc. intcrcsl nnd atk)nEy s lccs. <br />l)"t"'- {oolicnnl: <br />LICENSED CONTRACTOR <br />DECLARATION <br />I hcrcby attirn undcr [Entlty ol pc{ury thnt I am liccnetl undcr pn}visin t)l Chrplcr 9 ((omnrcncing with Sccl(rn ?(XX)) ol l)ivision .l <br />ol thc Busincss and Proltssions Codc, uil my liecnsc is in ltll Ii)rce ilrd cUacl. <br />( oNst'RU(TION l,llNI)lN(; ,\(;liN( l <br />APPI,ICANT I)ECI,ARATION <br />I lrNhy allirn undcr penall y ol pc{ury oDc of thc l'r)llowing dcclxral ions: <br />l)cnx,lition ['crnnt\-Astf,'slos Noliliclli(nr Fcdcral Rcguh(ions ('l ille 40 Pxn6) <br />-Rcquircd <br />kltcr ol N(ililicali()n <br />-l <br />ccnily thrl thc ltdcrrlrc8ulations rc8.(ding ashcslos rcnrovaluc nol applicrblc k) lhis ptl)ject. <br />-l <br />ccrlily that I havc rcdd this application and sta(c that lhc ah)vc irlbrmdtion is corccl l agrcc t) cofiply <br />on|nrrrccs and Statc l,rws rclating to huiltlittg xil herrhyxullx)rize r.l)t('scnlxtivc\ ol lhi( ('ily and (i)unly lo cnlcr uF)n tlr!' <br />rtxrvc ntnliinlcd fr(,[x'dy litr insNclxnr <br />Applicaill or Agetrt <br />Itcrtrrilcc n{rtre <br />with rll C(y nnd (irunty <br />ID/SIG.coMMEN;[SDATE <br />u$\- 6#0 gI lltSet Backs <br />UtnlW4,lrtForms/Steel/Holdowns <br />[,,f vErection Pads b -4 t.rUFER Ground <br />SLAB Floor /rl 0v <br />Subf loor/Vent/l nsulation <br />Roof Sheathino <br />tyShear Wall '7 I '&t <br />'-ea- l1 gca)IFraminq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat 'fPu r'v <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />\t <br />v\\4t)>mfi rf -w87FINAL <br />Certificate of Occupancy IT, <br />Notes arks <br />J- <br />BU!LDING- !NSPECTOR RECORD <br />Irele <br />-_ <br />**o/rtf t ? <br />4 <br />n'!ftTnt/ <br />Lq,_2,'tt-l <br />I <br />I <br />''c'/2tr/ r? ak- lb /4 /4t(6 /t, <br />(