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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 nsu lation <br />Roof Sheathing <br />Shear Wal! <br />Framing <br />lnsu lation/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 Fina! Report <br />flood Zpne Certif .-\W,LN"luoff Jat4)L -77-?A <br />>( <br />FINAL "LV-71 *'x,fi0) <br />Certificate of Occupancy vv- <br />Notes Remarks , Etc. <br />lttr I l.l)1..R I)E1.cA RA'l't( )N <br />I hcrchy rllirm under pcnalty of pcrjury that I am cxcmpt frcm lhc G,nlractos' l-iccnsc Lrw li)r lhc following rcawn (Sec.70ll"5 . <br />Busilcss ad Pmlcssion Gxlc): Any Cily or Coutrly which rcquircs a Jrcrmil k) construct. altcr. improvc. dcmolish or rcpaf any <br />slructrrc. prklr b its rssuancc. also rcquircs thc applicant fbr such lrcrnril k) tilc a silucd stalcmnt thal hc or shc is liccnrcd pursuant . <br />k) lhc pn)vist)ns of lhc Conlracbr's l-icenscd [:w (Chaplcr 9. Conrmcncin8r wilh Sslion 700O of Division .1 of thc BusirEss lnd <br />Prtlbssiurs Codc) or thal hc or she is cxcmpt thselftlm and thc hasis ltrr thc allcgcd crcmption. Any vtrlattln of Scction 703 1.5 hy any r <br />applicail tor a pcrmit suhjets lhc applicatrt to a civil pcnalty of not morc than livc hundrcd dollars ($5(l()). <br />-1. <br />as owncrof lhc pn)pcrty. orrnycntpklyccs with wagcs as thcir solc comJrcnsalirur. willdo thcworkaftt the structure Ls nol <br />intentlcd rlr oll'ercd lor salc (Sc.c.7M4. Busincss and Pnrl'cssitlns Crxlc: '['hc Contractor's Liccnsc Law docs not apply lo an owncr rlf <br />thc pnrprly whrt buikJs rtr impnrvcs thcrcon. and wlrrl r-krcs such wrlrk hirnsclf rlr hcrscll'rlr thnrugh his rlr hcr own cmployecs, <br />providcd tltat such intprrvcn*-nts iue txrt furtcndcd or ollbrcd lirr salc. If, howcvcr, thc huilding or inrprovcrncnt is sold within onc yciu <br />ttf cttmpletion. thc Owncr Builder will havc thc burtlen of proving that hc or she did mlt truikl or improvc thc pnlpcrty lirr thc purprsc of <br />salc). <br />i <br />-1. <br />as owncr of thc pft)pcrty. am cxclusivcly conlracting with liccnscd contractrlrs lo construct thc pnrjcct (Scc. 7(X4, Business <br />and Pnllbssion Codc: "l'ltc Contractor's Liccnsc Law docs not apply lo an owner of propcrty who builds ur inrprlvcs thercon, <br />and who conlracls litr such prujccts with a Contraclor(s) liccnscd pursuant to thc Contractor's Liccnsc Law). <br />_l arn ('xcnlpt un([-r B. & P.C. lirr this reason. <br />WORKERS' CONI PENSATION <br />Ihercbyat.l.irmunderpcnaltyofJrcrjurytlnctr[thctillklwin*ffi <br />-lhavcandwill <br />mainlainaCertiticatco[ConsenttoScll-lnsurctirrworkcrs'conrpcnsation,as provitlcdtbrbyScctiorr.]7fi)ofthe <br />Lahrr Codc, Ior the pcrlilrmrnce of thc wrlrk lbr which thc pcrmit is issucd. <br />--fl^u"and will mainlain workcrs'contpensation insurancc. as rcquirerl by Scction .1700 of tlre l-abor Cotlc, tirr thc Jrcrfirrmancc of' <br />the work lirr which this Jrcrmit is issucd. My workcrs' comlrcnsation insurancc carricr urd prlicy numbcr are: <br />carricr: (ta.. \ e-F. -n d <br />PolicyNun,t"r' 46JOSlll9 t..xpires:(+ / t lzot.( <br />-l <br />ccrtity that in thc Jrcrlirrmance ol'thc work tirr which this Jrcrmit is issucd, I shall n()t empk)y any lrcrson in any ]nanncr <br />so as to hecomc suhjcct lo thc workcrs' compensation laws of Calitilrnia, antl a-urcc lhat if I should bccomc subjcct to thc <br />workcrs' comlrcnsation pnlvisions of Scction -1700 ol'thc Labor Ctxlc. I shall. tbrthwith comply with tlxlsc pnrvisions. <br />WARNIN(i: Failure lo sc'curc workcrs' conrpensation covcragc is unlawful. and shall suhjcct an cmployer to criminal Jrcnaltics antl <br />civil tincs up to onc hundrcd thousand dollars in addition to lhe cosl of compcnsalion.as pnrvided lirr lhc <br />Section .1076 of thc l.ahrr Crxlc, intcrcst and <br />1 <br />I hcrc'hy at'lirrn undcr pcnalty of prjury lhat I anr 9 (commcncing with Scction 7firu) of Division .l <br />ol' thc Busincss atrd Pnll'cssions Cotlc, and my liccnsc is irr hrll lilrcc aril cll'ect. <br />I..icc-lrsc'L-10 Nrrnrrrcr: <br />q12oq8 <br />I hcrcby allirnr undcr pcnalty ot'pcrjury that <br />issuc'd (.Scc. .1097, Civ. C.). <br />is a conslruction lcnding agcncy lirr thc Jrcrtilrmancc of thc work tilr which thi.s pcrmit is <br />Lendcr's Namc: <br />lrndcr's Atldrcss: <br />APPLICANT DT]CLARATION <br />I lrcrchy allinn undcr pcnalty ol'perjury onc ol'thc lillhrwing dcclarations: <br />Dcmolition Pcrmits-Ashcslos Notificalion Fedcral Rcgulalions lTitlc 40. Part6) <br />_Rcqu irctl [rttcr ol' Not ilication <br />-l <br />ccrlily that thc l'cdcralrcgulations rcgarrling ashcslos rcmovalurc not applicable to this projccl. <br />6"n,t:v lrat rc'ad this applical ion :uxl statc tlut thc atxlvc inlilrnration is corrccl. I agrc.c lo comply with all City and County <br />arrd Laws reprcsentativcs of this City and County to enter ugnn lhc <br />abovc propcrty <br />Aplllic:url Agent <br />Pcnrritee nanre <br />relating t<t huilding conslruclion,and hcrchy <br />o*r, lrt "'18 , L1