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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS oWNEREUILDERDELCARATION J - <br />I hcrcby all-rm unrtcr lrcnalty of pcrjury that I m cxcmpt lrum thc Contractos' Liccnrc tjw tor thc lolkrwinl rc.srai (Scc.70ll.5 r <br />Busincss arxl Prcfcssion Codc): Atry City or County which rcquircs a lrmil kt conslruct. allcr. impnrvc. dcmolish lrr rcpdr uy .' <br />slructure, prior to its issuancc, also rcquircs thc applicant for such [Ermit kr filc a siSncd statcrcnl that hc or slE i! liccnsd puFuant <br />to thc provisions of the A)nkactor's Lkuse,l tlw (Chaprcr 9, Commcreing wilh Selion 7U)0 of Division .J of thc Business md <br />PrufcssionsCode)orthathcorshciscxcmptthcrctrumandthchasislirrthcallcgcdcxcmption. AnyviolalionofscctbnT03l.5byany <br />apl,licant for a fEmit subjecls lhe applicant k, a civil pcn.lty of not nx)rc than fivc hundrcd doUus ($5U)) <br />_1, 6 owncr of the prolrcrty, or my cmpbyes with wagcs as thcir vrlc comlrcnsation, willdo thc wort and lhc stmlE h not <br />intcfilot oroflbrcd for sle (Se.?(X4, Busincss and Proltssions Gxle: 'fhc Conlrretor's Liccns llw d(Es not aPply lo an owncr of <br />thc poJErty who builds or inprurcs thcmn, dil wk) des such w)rk himsclf or hcr*lf or thruugh his or hcr ovn cmpktyccs, <br />provi.lcd that such imporcmots N mt intcnlcl or ollbBl lbr sab, If, tDwcwi lhc huilling or imlrcwmnt is sokl within orc )td <br />of compbtio[ the Osncr Builter will havc rhc buden of proving that hc or shc rlid m huiLl or ir{x)vc thc pmtEly for thc PUrJns of <br />slc). <br />_1, asowncrof the pmlErty, mcxclusively conlracling with liccn*d cotrlractr6 k) construcl lhc pn)jcct (Se. 7(X4, Busincss <br />arxl l,iufqsbnCodciThcContractor'sLiccnscLawdocsnolapplytoanovncrofpruFrtywhohuildsolimprovcsthcrcon. <br />and who @nlncls lbr such Jmjets wilh a ContBclo(s) liccnscd pursuanl b lhc Conlracbr's l-iccns kw). <br />-l <br />m excmpt undcr Setion-, B. & P.C. lbr this rcason. <br />,,f&, <br />}VORKERS' I:ON I PENSATION <br />I)ECLARATION <br />alfirm undcr pcnalty of pcrjury onc of thc lirlkrwing declarations: <br />_l havc arxt will maintain a Certilicatc of Conscnt to Sclt'-lnsurc ft)r workers' compcnsation. as p()vidcd tirr by Scction -1700 of the <br />I-:bor CcxJc, for the Jrerf<rrmancc of the work litr which the Jrcrmit Ls issucrl. <br />_lhavcanrJwillmaintainworkcrs'compensationinsurancc,as rcquircdbyScctionlT00oflhc[-aborCodc,forthcperftrrmancetlf <br />thc work firr which issucd.workers'insurancc calricr and Jxllicy number arc: <br />) <br />Policy <br />_l ccrtili that in the pcrlbrmance of the work tirr which this Jrcrmit is issucd. I shall not cmpk)y any lrcrson in any maltncr <br />so as to bcconrc subjcct to thc workers'compcnsation laws of Calitirrnia, and agrcc that if I should hccomc suhjcct to thc <br />workers' compcnsation provisions o[ Scction J7fi) of thc Latxrr Crxlc. I shatl, tilrthwirh comply with ltxlsc pntvisirlns. ! <br />WARNING: Failure to rccurc workers' compensation covcragc is unlawful. and shall suhjccl an cmploycr to criminal Jrcnaltics and <br />civil lines up to one hunrlrcd thousand rlollars (Sl00.Um), in adrJition lo thc cosl o[ comJrcnsation, danutgcs as providcd ttlr thc <br />Scction the CtxJc, intercst and altorncy's t'ces. <br />I hcrcby atlrm under pcnalty of prjury that I am liccnscrl undcr pnrvision 9 (commcncing with Scctkrn 7firu) of f)ivision 3 <br />of thc Business and Prot'essions Codc, and nry license is in t'ull lilrce and cttcct. <br />b /rLiccnsc <br />CONSTRUC-TION LENDING AGENCY <br />I herchy affum undcr Fnaltyof Jrcrjury that thrc is a qrnstruction hnditrg {gcncy tbr lhc lfftbrmancc of thc work for which this lrcmit is <br />issucd (Se. 1097, Civ. C.). <br />Lcndcr's Name: <br />[rnder's Addrcss: <br />APPLICANT DECLARATTON <br />I lrcrcby altirm undcr pcnalty of prjury onc tlf thc lblbwing dcclarations: <br />Demolition Pcrmits-Ashcstos Notification Fcdcral Rcgulations (Titlc 40, Parl6) <br />-Rcquircd <br />lrtter of Notilicatitln <br />_l ccAily that the f'edcral rcgulations rcgarding ashcslos rcrnovalare nol applicahlc to this pnljcct. <br />-l <br />ccrtily that I have rcad this application and slate lhal thc ahtvc <br />rlrdfuranccs and Statc Laws relating to building conslntctitltl, <br />ahmvc mentioned propcrty for inspcction purposes. <br />Applicant or Agent <br />Penttitee nante <br />i( <br />inlilnttittiott <br />Set Backs <br />Forms/Steel/Holdowns l(DM'O6L <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenUl n su latio n <br />Roof Sheathinq <br />Shear Wall tl L1 tat >*11{kt,*',ft <br />Framinq t(tt rrn bAA4 n-7 <br />lnsu lation/Energy It rt DAnnr -il.W <br />Drywall- A ,-I A l'i q D*Dnaz etr <br />nt.t2 'l>*mel frffi ttA <br />/t 'tq'i*n <br />[\Iasonrv I f eu2+1rr- - <br />Poo! Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />FINAL Dk+wn 7 <br />Certificate of Occupancy T IT <br />Notes, Bemarks, Etc. <br />lI ovr <br />I lt <br />*ft <br />I <br />//1 <br />I <br />I 4;I lt;l