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BUI!-DING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG,COMMENTS Owns-Builds Dcclaration <br />I hereby affirm undcr p€mhy of plrjury that I rm exempt form the ContractoB' Liccnsc Law for thc folkrwrng rason (src.?03 I .5 Busintss <br />and ProGssion Codc): Any City or County which rcquira r pcmit to comtrucl. alt6. impreve. dcmolish or rcpair rny structuc. prior,kr its <br />issurncc. also rcquirc thc applicsnt for such pcmit lo filc a signcd stalmnt lhst hc or shc is liccDscd purcuant to thc prcvisiom of thc <br />Cont.actor's Licensed Llw (Chaptq 9, Commcncing with Sction 7flD of Drvision I ofthe Busin63 rnd Prof6sions Codc) or that he or <br />shc is cxcmpt lhefrom and lhc bsb for thc allcgcd cxonption .Any violation ofseclion 70-l 1.5 by any applicant for i ponit subjccts thc <br />rpplicant to a civil pcnalty ofnot morc than tivc hudrcd dollaE ($500). <br />_ l.s owncroflhcpropcrty.ormycmployccswithwag6asthcirsolccompcnsalion,willdolhcwo*endthcstructurcisnotintcndcd <br />or offered for sle ( Se 7044, Busincss and Professions Code: Thc Contraclor's Liccnsc Law do6 ool apply to an owner ofthe prcpcrly <br />who builds o. imprcvG thcron. and who do6 such work himsclfor hc$clfor through his or hcr own cmploys. providcd th.t such <br />improvcments arc not intcndcd or offcrcd for salc. lf. howcvcr. thc building or improvcmcnt is sold within onc ycar ofcomplction. thc <br />Owner-Builder will hsve thc burd.n ofproving that hc or shc not build or improvc for thc purpos. ofsale). <br />_1, as owner of the propefly. arn e.xclusively contracting with licensed conlractors to construct the project ( Sec. 7044. Business and <br />Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon , and who <br />contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License l-aw ) <br />_-l am exempt under Section <br />Date: <br />.8. & P.C. for this reason. <br />_Owncr: <br />WORKERS COMPENSATION DECLARATION <br />I hcrcby affim undcr pcnalty ofpsjury onc ofthc following dslsrations: <br />_l havc ard will maintain a Ccnificrtc ofConscnl to SclfJf,sure for workers' compensrtion, as provided for by Section 3700 ofthe <br />t bor Codc. for thc pcrfomncc of thc work for which thc p€mit is issucd. <br />_l haveandwill nraintainworkers'@mpensationirsurance,as requiredbySectionlT0oofthet,aborCodqfortheperformnccofthc <br />work for which this pernrit is issued. My workcrs' compenstion insurancc canicr and policy numbcr arc: <br />Carrier:_ <br />Policy Number:_ _E.xpires: <br />(This section need not be completed if the permit is for One hundred dollars {$100} or less) <br />#hrffiat in the performance of the work for which this permit is issued. t shall not employ any person in any manner so as to <br />' became subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' <br />compensation provisions of Section .1700 of the Labor Code. I shall. forthwith comply with those provisions.. <br />_Applicant: <br />WARNING: Failure to seure workcrs' compensation coverage is unhwful. snd shrll subjst an employer to siminal pcnaltics ard civil <br />fines up lo onc hundrcd thousand dollaE ($100.000).in addtion to thc cost ofcompcnsation. darnagcs as provided for thc Strtion 1076 of <br />the Labo. Codc, interet and attorney's fc. <br />LICENSED CONTRACTORS DECLARATTON <br />I hcrcby atfim undcr pcnnlty of pcrjury that I am liccnscd undcr prevision ofchrptcr 9 (ommcncing with Scction 7000) of Division 3 of <br />thc Busin6s and Prof6sions Codc. and my liccNc is in full forcc and cffcct. <br />[,icense Class:23263L B,c{.f.*u,no*Y32632 <br />"",,7/// ?_Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I h(cby aflim undcr pcnaly of pcrjury lhat th.rc is a coEtruction lcnding rgcncy for thc pcrfomncc of thc work for which this pcrmit is <br />issucd (Sc. 3097. Civ. C.). <br />Lender's Name: <br />Lender's Address: - <br />Dcmolition Pcmits-Asbestos Notitication Fcd.o, *ffititffiffi <br />_ Rcquircd lrttcr of Notification <br />_l ccnify that thc fcdcralregulstions rcgarding 6b6tos rcmovalarc not npplicablc to this prqiet. <br />,€i;i$,-an", , *vc rcad this application and sratc rhar rhc abovc infomarion is conccl. I rgrcc to comply wirh 8ll City and county <br />ordimncG and Statc kws rclsting to building comtruction. ed hcrcby authoriz rcprBcntrtivB ofthis City and County to otcr upon thc <br />abovc mcntioncd propcny for inspation purposc. <br />Applicant or agenl _Date: <br />Pcrrnittee narrre (print ):-.s--_r,*C <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUInsul <br />Roof Sheathing ^t//ff-T ll-Qc ^l,q KlZt) <br />Shear Wall ( <br />Framing <br />lnsulation/Energy <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 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />Forms\Building-lnspection Record.doc 03.31.06 <br />,!