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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loor/Ve nt/l nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framinq I I q <br />I ?/0 DftTfl <br />lnsu lation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[\Iasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />I ,l <br />FINAL (0l (/Dftqq <br />Certificate of Occupancv tt <br />Notes, Remarks, Etc. <br />TION <br />I hcrcby atfirm undcr Fnalty ot Frjury that I am cxcmpt from lhc Conlrack)s' Liccns Law lirr thc following rcavlr (Scc.70.ll.5 <br />EusiDcss arxl Protbssi()n Culc): Any City or County which rcquics a trmit to conslruct. altcr. improve. dclq lish or n1Q any <br />structurc, prior k) its issu{ncc, also rcquircs thc applicanl lirr $uch Frmit lo lilc a signed slatemnt that hc or shc is licenrcd pursuatrt <br />k) thc pruvisions of lhc Cotrtraclor's Liccnscd llw (Chaplcr 9, Commncing wilh SNlion 7fi)0 of Division .l of thc Busircss and <br />Prutbssions Codc) or that hc or shc is cxempt thcrcltom and lhc hrsls lirr the alleged ercmfli(rn. Any violation of Sectitm 70-l 1.5 hy any <br />applicant l()r a lrcmit subjccts thc applicanl kr a civil pcnally of not m)rc thar five hundrcd dollars ($500). <br />_1. as owner of thc propcrty, or my cmployccs with wagcs as thcir sole compensation, will do thc work and thc slructurc is ltttt <br />intcnlcd or oU'ercd ftlr salc (Sec.7(X4, Busincss and Pnrfbssions Culc: Thc Contractor's Licensc Law dtrcs not apply to an owner of <br />the pnrpcrty who huilds or inrprovcs thcreolr, antl wlxr drrcs such work hinrsclf or hcrscll'or thrrugh his or hcr owlt cmployccs. <br />provirlcrl that such improvcrncnls arc mrt intcrulcrl or ollbrctl lilr sah. Il, howcvcr, thc buiLling or improvcrncnt is sokl withrn onc ycar <br />ol'complction, tlrc Owncr Buildcr will havc thc burdcn o[ proving that hc rlr shc did rxrt build or impnrve thc pnrperry lbr thc purprsc ol' <br />salc). <br />_1. as owncr ol'thc pnrpcrty, am cxclusivcly corrtracting with liccnscd contractors lo conslruct thc prcjcct (Scc. 1OM, Busincss <br />and Pnrtbssiln Codc: Thc Contractor's Liccnse Law docs not apply lo an owncr of pro;rcrty who builds or improvcs thcreon, <br />und wlxl contracts lbr such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnse Law). <br />-IamcxcmptundcrSectiolt-,B.&P.C.forthisreastrn. <br />lV( )RKT:RS' COI\ I PENSATION <br />I)ECI,ARATION <br />I hcrchy al'l'irm urtrlcr Jrcnalty ol'Jrcrjury onc of thc tirlkrwing declarations: <br />_l havc and will maintain a Ccrtilicatc ol'Conscnt to Scll'-lnsurc tor workcrs' comJrcnsation, as pnlvidcd titr by Scction .37fi) of thc <br />Latxlr Culc. tirr thc pcrlirrmancc of thc wrlrk for which thc pcrmit ls issucd. <br />_l have antl will maintain workcrs'comJrcnsation insurancc, as retluirctl hyScrtion 3700of thc LaborCodc, lilrthc Jrcrlirrmanccof <br />thc wrlrk is compcnsation irrsurattcc carricr and Jxrlicy nunrhcr arc:this pcrmit <br />IV e c <br />I'olicy <br />{ ccrtity that in thc Jrcrlilrmance ol'thc wrlrk tirr which this Jrcrmit is issucd, I shall mlt cmpkry any lrcrson in any manncr <br />s6 iNto bccomc sub.jcct to lhe wrlrkcrs' cornJrcnsation laws of Calitilrnia, and agrcc that if I shoultl becomc sub.icct ttl thc <br />workcrs' comJrcnsation pnlvisions of Scction 3700 of thc Lrtxlr Crxle. I shall. lorthwith comply with thosc provisions. <br />WARNIN(i: I:ailurc li) sccurc wrlrkcrs' <br />civil lincs up to onc huntlrcd tltousanrl <br />is unlawlirl, and shall suhjcct an cmploycr to crimittal Jrcnaltics and <br />damagcs as providcd for thctrt thc cost (rf <br />Scction 3076 C<xlc, intcrcst and <br />I hcrcby al'lirm undcr pcnalty of ;rcrjury that I anr undcr provision ol'Chaptcr 9 (comnrcncing with Scction 7firu) ol'Division .l <br />of thc tsusincss and Prol'cssions Codc, arxl my liccnsc is in full tilrcc arxl cthct. <br />1 <br />[-iccnsc Z <br />I hercby allirm undcr Jrcnalty of prjury that thcrc <br />issucd (Scc. 3097, Civ. C.). <br />lrndcr's Namc: <br />agcncy firr thc Jrcrlbrnrancc of thc work tbr which this Jrcrmit is <br />lrnrler's Address: <br />APPLICANT DECLARATION <br />I hcrcby allinn under 1**nalty of Jrcrjury onc of thc ltrllowing declarations: <br />Demolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations ('l'itlc 40, Part6) <br />-Rcquircd <br />l,cttcr of Notilication <br />_l ccrtily that the' lbdcralrcgulatiuns rcgiuding ashcstos rcnxrvalarc not applicablc lo this projcct. <br />-l <br />ccrtfrhat I havc rcad this application arxl statc that thc ahrvc intirrmation <br />rlrdinanccs and Statc Laws rclating to arkl <br />atxrvc mcntioncd pnrpcrty tirr <br />Applicant or Agcnt <br />Pcrnritce nanre <br />with all City and County <br />altd to cnlcr ugln lhc <br />Parr nP.-n7-2n1q