Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION <br />I hceby atfim unda pcnalty of perjury that I m cxcmpt from thc Coriltaclom' Licmc Law for thc following rcon (54.7031.5 <br />Busines md Profsion Codc): Any City or County which requirc a pemit to coGtruct. 8ltq. imprcvc, dernolish or repair my <br />struclue. prior to its isumce. also rcquire thc applicut for such pcmit to file a signed statmf,t that he or shc is liceNcd pffiuflt <br />to the provisions of th€ ContEctor's Liccnrcd Law (Chapts 9, Commencing with Setion 7000 of Division 3 of the Busins ud <br />Prefe$ions Code) or that hc or shc is exmpt thocfrom ild thc basis for the allcged exmpion. Any violation of Sction 7031.5 by 8ny <br />applicantforapmitsubjctsthc applicanttoacivilpcnaltyofnotmorcthefivchundreddollus($500). <br />-1. <br />6 oqq ofthc propory. or my mploye with wag6 6 thcir mle mmpemtion. rvill do thc wort md the stnrtm b mt t <br />into,aoa o. ofisea foi sb (4c.7044, Bsins ild ProfsioN Codq Thc Conlractor's Licffi Law do6 not apply to an 0$!6 of <br />the propcfly who builds or improc thon. ard who doe such rcr* himself or hmelf or thrcugh his or ha om cmploye. <br />providc<l that such irnprovmot3 e not intoded or ofldcd for gle. tf. howd6. the hrilding or imprcvqtrot is $ld within one )qr <br />ofcomplaion. the Owre Buikk will have rhe hrdo ofproving thar he or she did not build or imprevc lhe plopsly for thc putrt$ of <br />mlc). <br />_ l.sownqofthcprop6l).mcrclusivelycontractingrvithlicsdcontractoEtoconslruclthcproj*t(SE.7044.BGinN <br />and PFf6sionCodc:;lheContractor'sLiccnscLarvdosnotapplytoflown6ofpropqlywhobuildsorimprovBth6@n. <br />and who contmcts for such projeds with a Contracto(s) licqE€d purs@t to the Contractor's Liccc t w). <br />- <br />I arrt cxentpl under Section B. & P.C. for this reason. <br />l):t I c.On'ner: <br />\\'o RK Iti{S; ('tri\ t Pl,N sl'l'10 N <br />I)t(LAlt,\IlON <br />I hseby aflim undq paaltyof po'juryonc ofthc follorving dclaatioro: <br />_l have md will maintain I Ccrtificatc of CoBdt to Sclf-lNure for rrcrkm' comptuation, I trovidcd for by Sction 3700 of the <br />Labor Codc. for the psfomuce of the wrt for which the pmh is isued. <br />t'?avc and witt maintain workm' compcmation ircurancq s requfed by setion 37OO of thc labor Code. for thc pofommcc of <br />' thc u'ork for which this pclmir is isucd. My work6' composalion insurucc cuia ud policy numbd rc: <br />('an'icr:st f lvrSut-KanC*P Cs <br />/' /.lsPolicy,r,uo, B [\ Lt IYK <br />-Expires: <br />+ <br />_l cerrify that in the perforrnance of the work for which this perrnit is issued. I shall not etnploy any person in any manner . <br />so as to become subject to the workers' compensation tau's of California. and agree that if I should become subject to the <br />\.r,orkers' compensation provisions of Section 3700 of the t,abor Code. I shall. forths'ith comply with lhose provisions. <br />WARNING: Failure to s€cure \\,orkers' compensation covef,age is unlaw'ful. and shall subject an onployer to criminal penalties and <br />civil fines up to one hundred rhousand dollars ($100.000), in addition to the cost of cotnpensation. damages as provided for the <br />attorney's fees. <br />I hereby affrrnr under penalty of perjury that I arn licensed provision of ('hapter 9 (comtncncing s'ith Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and efFect. <br />License ctass' C- <br />,rr.' 1/3, <br />1])_License <br />a.-o-E+ <br />a. I <br />CONS'IRUCTION LENDING AGENCY <br />I hereby amrm undq penalty ofpojury that thoe is a construction lmding agocy for the perfonnance ofthe work for rvhich this permil is <br />issued (Sec. 3097, Civ. C.). <br />Lendcr's Narne: <br />Lender's Address: <br />APPLICANT DECLARA'I'ION <br />I hereby aflinn under penalty of perjury one of the follorving declarations: <br />Dernotition Perrnits-Asbestos Notification Federal Regulations (Title 40. Pan6) <br />--Required Letter of Notification <br />I certify that the lderalregulations regarding asbestos removalare nol applicable to this project. <br />-l <br />ccrrify thar I have read this application and state that the above infltrnnation is correct. I agrer to cornply rvith all City and County <br />thcordinanccs and State l.arvs relaling to building and representatives of this City and County to entcr upon <br />above rnentioned propetly for <br />Applica:tt or Agent <br />Permitee name (print): ---- -BL g- Hrrt t".'-l - <br />r,",",--l t(slo+" <br />Set Backs <br />-A- <br />- <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor I <br />S u bfloor/Ve nUl ns u latio n l^.A Lt ^/ <br />Roof Sheathing I -t wru wtqfiy }A <br />Shear Wall I <br />Framing <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[\4asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif. ,fD / 1,,, ^ffif-o-l - l-/-21-ZO 2c 2rl <br />FINAL Z-f -zo?-a /Lct?,Je @> RD <br />Certificate of Occu pancy <br />Notes, Remarks. Etc <br />a