Laserfiche WebLink
BUILDING. INSPECTOR RECORD t -.SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,I)ER T'ELCARATI('N <br />I hcrcby allirm undcr Jrcnalty of pcrjury that I am cxcnfl lhnn thc Clnltrack)s l.iccnrc Law ti)r thc foll(lwil8 rc$on (Scc.70JL5 <br />Busincss and Profbssi(rn Colc): Any City or Grutrty which rcquircs r lEr[lit kr conslruct. dlcr. improvc, dcmolish or rcnnir dily <br />struchrrc, prior k) its issuonce, also rcquircs thc dpplicaut tor skh lrcmit to filc a signcd slalcrcnt lhit hc (rt shc is liccnsd pursuillrt <br />to thc provisions ()f lhc O)nlractor's l-iccnsed lfiw (Chaptcr 9, Commcncing wilh Scction 7ilD o[ l)ivisirrr -l of thc ]lusincss ilc' <br />Prulcssi(lnsCode)orthatlEorshciscrcmplthcrcliomandthchdsisli)rthcallctlcdcxcmpti(trt. Artyvi(rhttrnofScctionT0-ll.Sbyany <br />applicaltli)ralrcnnilstrhjcctsthc applicanttoacivilpcMltyoftrotmorcthdnlivchundrcddollnrs($5U]). r <br />_l.as ownerofthcpn)perly,ormycrnpk)yccswithwagcsaslhcirsolcconrpcnsalion.willdolheworkandthcstruclureisnol <br />intendcd orollbrcd lilr salc (Scc.7&4, Business and Prol'cssions Ctxlc: "l'hc Contraclor's l.icensc [-aw dtrcs not apply ltt :tn owncr ttf <br />thc pnrpcrty who huilds or impnlvcs thcrcrrn. antl wlxl tkrcs suclr worft hinrsclt'rlr hcrscll'or tltnrttgh his or hcr own cntployccs. <br />providcd thal such imprrlvcrncnts arc not intcrxlcd rlrollbrcd lilr salc. lt, howcvcr. thc huikling or intprrlvemcnt is sold within onc yciu <br />of crlrnpletion. thc Owncr Buildcr will havc tlrc burrJcn of pnlving lhal hc or shc tlitl mrt huild or inrprovc lhc propcrly titr lhc puqxrsc ol' <br />salc). <br />_1, asowncrof thc propcrly. amcxclusivclyconlraclirrg with liccnscd contraclorsloconslruct thc prrjcct (Scc. 7(X4, Busittcss <br />and Prulbsskln Codc: 'I'hc Contractor's Liccnsc Law tltrs nol apply lo an owner ol'pro1rcrly who builds rtr imprrtves lhercon. <br />and who contracts tirr such pnrjccts with a Conlrilct()r1s) liccnscd pursuunt to lhc Chrnlraclor's l-iccnsc l-aw). <br />-IamexemptunderScctkln-.B.&P.C.litrthisreastln. <br />IVORKERS' CONI PENSATION <br />DECLARATION <br />I hcrchy alTirrn undcr Jrcnalty ol'Jrcrjury rxrc ot'thc lirlkrwing dcclarations: <br />_IhavcarxtwillmaintainaCcrtificatcofConscnttoSclt-lnsurclirrworkers'conrJrcnsati()n.as pruvidcdlilrbyScctionlT()0ot'thc <br />[atxrr Ctxle. for the Jrerfrlrmancc of thc work lirr wlrich lhc Jrrmit is issuctl. <br />_lhavcandwill maintainworkers'compcnsationinsurancc.as rcquirctlhyScctionST(X)of'lhel-ahorCrilc. lirrlhcpcrlirrnrancco[ <br />thc work which this Jrcrmit is issuctl. My workcrs' c()rnf^-nsation irrsuriln(:c ciuricr antl prlicy nunthcr iuc: <br />h I Zu{ tC <br />Policy Zo <br />_l cc-rtity that in thc p-rlirrmancc ol'tlrc wrlrk krr which tlris prmit is issucd. I shall nol cnrpkry irny lrcrson in any manncr <br />so astobccolnesuhjccllotheworkcrs'cornpensalionlawsol'Calililrrria.antlagrccthaliflshouldbc'cttnrcsuhjccltothc <br />workers' comlrcnsation provisions of Scctkllr J700 of thc Lahrr Crxlc. I slrall. lirrthwilh contply with thosc provisiolts. <br />lVARNING: Failurc to sccurc workcrs'comJrcnsali()n c()vcragc is unlawlirl. arrrl shall suhjcct an cmpkrycr lo criminal Jrcnaltics arrrl <br />civil lincs to onc hundrcd lhousand dollars (.Sl(X).(XX)). in additiotr lo lhe cosl ol conrlrcnsaliott. tlant:tgcs as prrvided lirr the <br />Scction and all()nrcy's l'ccs. <br />DECLARATION <br />I hereby allirm untlcr pcnaltyol'perjury that I arn liccnscd urrrlcr provisiorr of Chaptcr 9 (crtmrncttcing with Scction 7fim) ol'Division J <br />ol' thc Business and Prol'essions CrxJc. and my liccnse is in lirll lirrcc and cl'f'ccl. <br />[,iccnsc Nunrhcr:nl\f)C^o <br />CONSTRUCTION LENDING AGENCY <br />I herchy allirnr undcr Jrcnaltyof perjury lhat thqc is a conslruction lcndilg agcncy for thc pc]lirrmancc of lhc Mrrk for which this lErnlit is <br />issued (Scc. 3097, Civ. C.). <br />Lcnrlc-r's Natrtc: <br />I-cntlcr's Addrcss: <br />APPLICANT DECLARATION <br />I h:rrtry allirm undcr pcnalty ol'pc'rjury onc of thc lilllowing tlct:laraliorrs: <br />Donolition Pcrrnits-Asbcstos Nolil'icatirxr l;crlcral Rcgulatiolrs ('l'itlc 40. l)art(r) <br />_Rcquircd Lcttcr of Notilicalion <br />_l certity that thc l'cdcral rcgulations rcgarding asbcslos rertxrvalarc not applicahlc lo lhis projcct. <br />0 ! tccflif y that I have rcatl this application anrl statc that thc ahrvc inlirrmltiorr is corrccl. I agrcc to contply with all City and Counry <br />ordirranccs antl Slate Laws rclatins to huildins conslnrction. and to cnter uSxrn thc' <br />Perrrrilee nanle t( <br />hcrchv aulhlrize <br />/9 <br />rcprcsenlativcs of this Cily rnrl <br />Z <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loor/VenVl ns u lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation lEnerqv <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif l/ <br />t rytflra:4 a <br />FINAL v <br />Certificate of Occupancv <br />Etc.