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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 />Su bf loor/VenVl ns u lation <br />Roof Sheathinq <br />Shear Wall I <br />Framinq a bfnrto L#>y <br />lnsulation/Energy I I <br />Drywall 7-0 bft-rma L*>a <br />Ext./lnt. Lath ,J <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 />I ^A <br />FINAL <\a \z^:)M\,ffiT <br />Certificate of Occupancy t <br />Notes, Remarks, Etc <br />,,*,,",*1"-[?l'il",1"["'3kLll$t1Xn," r"*',r rhc rorowins o"."M, <br />Busincss anl Prulbsstrn G)dc): Any Cily or County which rcquircs a JEmit lo conslruct, allcr, improve, y'cmrlish or rcpiiant <br />structurc, Fior k) its issumcc. also rcquircs thc applicanl ti)r such [rcmit to lih a signcd slalcrenl lhal hc or shc is liccnscd pu.rumt <br />b thc Imlvistnrs ol tlrc Contmck)r's Liccnscd Law (Chaptcr 9. Commeming wilh Scction 7000 of Division J of lhc Bulincss and <br />Pnrfessi(rns Codc) or thnt hc or shc is excmpt thqclion and thc hnsis lirr thc allcScd cxcml,lion. Any vt ati(rn of Setkrn 70J L5 hy any <br />rpplicanlforapcrnritsuhjNtsthc applicantbacivilpcnlllyofnolm)rclhantivchundrcddollars($5fi)). <br />_1, as owncr of thc prrFny. or my cmpk)yccs with wagcs as lhcir $lc cumfrcnsilion, will do tlrc work aftl tlE strutm is nol <br />interklcd orotlircdlirrsalc(Sc.T044.BusircssandPnllcssionsGilc:ThcConlrack)r'$LicenscLawd(Esnotnpplyhanowncrof <br />thc pNlrcny wh) huilds or iilJrn)vcs thcB)n. uxl wtk) d(rcs such qrrk himsell or hcEclf ()r thnnrSh his or hcr own cmployccs. <br />pr)vided that such impovcmnts rc fr)t intcillcd or ollercrl li)r salc. ll. lx)wcrci thc huilling or imJm)rcmnt is srld within onc }aU <br />ofcomphtion, thc Owner Buillcr will havc the hunlcn of proving that he or she did nol buill or imJnrvc thc pruprty for thc purpc$ of <br />slc). <br />_1,:rsowncrol'the pnrJrcrly. amcxclusivclyconlrat:ting with liccnscdcontraclorsloconstntct thc pnrjcct (Scc.7044, Busirtcss <br />and Profbssion Code: '['hc Contractor's Liccnsc Law does not apply lo an owncr ol'proJrcrty who huilds or imprtlvcs lhcreon, <br />and who contracts krr such projccls with a Conlractor{s) liccnsed pursuanl to thc Contractor's [-iccnsc Law). <br />-IamexcmptundcrScclitln-'B.&P.C.lilrthisrcasrln. <br />I t..,,, . <br />TVORKERS' COTVI PENSATION <br />DECLARATION <br />I hcrcby alTirrn undcr pcnalty of perjury onc ol'thc lirlkrwing dcclarations: <br />_ttravcandwill maintahaCertilicatcofConsenttoSclt-lnsurelilrworkcrs'comJrcnsation,as providcdtirrbyScction.)700ofthc <br />Labrlr Ctxlc, lbr lhc Jrcrfrlrmancc of the work lbr which thc pcrmit ls issuc'd. <br />_l have and will nraintain workers' comJ^*nsation insurance. as rcquircd hy Section 17fi) of thc l-abrlr Codc, for thc Jrcrlitrmance of <br />thc work lilr which this permit is issucd. My workcrs' compcnsation insurancc carricr arxl Jxrlicy numbcr arc: <br />r\c itsgB--r-r AAI;T tz O t- F, (L€L)(_ LC <br />l'olicy c-L \\ ut,G o\'\o I lor l'zo'Lo <br />_l ccrlilythat in thc pcrlirrmancc of thc work lilr which this pcrmit is issucd, I shall nol cntpkry any lrcrson in any manncr <br />so as to bccomc subject to thc workcrs' comlrcnsation laws ot'Calililrnia. anrl agrcc that if I should r^.bcomc subjcct lo lhe <br />workcrs' contpcnsation provisions of Scction -17(X) of thc l-ahrr CrxJc, I shall, tirrthwith comply with thosc prtlvisittns. <br />WARNING: Failurc to sccurc workcrs'suhjcct an cmpkrycr lo crintinal Jrcnaltics and <br />civil tirrcs up lo onc hundrcd thousand conrpcnsation, damagcs as pnrvided lilr thc <br />Scction 1076 of thc Latxrr CrxJc. intcrcst <br />q rjlt 1. <br />LICENSED CONTITACTOR <br />DECLARATION <br />I hcrcby allirnr undcr pcnalty ol'perjury thal I am licenscd undcr pnrvision ol'Chaptcr 9 lcommcncing with Section 7firu) rlf Division J <br />ot' thc Busfurcss anrffrut'essions Codc. and my ticense is in f'ull lbrcc anrJ ct'l'ect. <br />comlrcnsalion coyfagc is unlawtill, and shall <br />dollars{$l00Jm), in arldition to lhc cost o[ <br />an,l at.lrrDf,rcs.^^#,,& <br />Number:'3?L-\tnl.iccnsc <br />t< <br />CONSTRUCTION LENDING AGENCY <br />t hcrcby all-lrm uilcr JEnaltyof pc(jury thilt thcrc is a conslruclion bnding agcncy lbr thc pcrli)rmncc o[the work ti)r which lhis Jrcmil is <br />issucd (Scc. l(n7, Civ. C.). <br />lrnder's Namc: <br />l-cndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcrchy atlirm undcr lru.*nalty of pcrjury onc ol'thc lirlkrwing dcclarations: <br />Dcmolition Permits-Ashcstos Notification Fcdcral Rcgulations (f itlc 40, Part6) <br />-Rcquircd <br />lrtter of Notitication <br />_l ccrtily that the l'ctlcralrcgulations rcgarding ashcstos rcntoval are nol applicablc lo this pnrjcct. <br />_l ccrtity that I havc rcad this application :urd statc lhat the ntxrvc intirrnration <br />rlrtlinanccs antl Statc Laws rclating lo c<lnstnrcl ion. and hcrc-hy aul horizc- <br />atxlvc' mcnlioncd proJrcrty lbr <br />Applicant or Agent <br />Pofiuo}, <br />is corrcct. I agrce to comply <br />' rcprcscntativcs of this City <br />with all City and County <br />and County to entcr uptn thc <br />IDermilee nAnre (nrint): <br />I ):r ln. <br />*,". 'l ls/r1