101102163 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsulation /.?, Roof Sheathing / Z // '// r I trL./lt /L'L/ Shear Wall , Framing lnsu !ation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Poo! Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif t/FINAL fiLJ(L / z /zo/ ry Certificate of Occupancy Notes, Remarks, Etc. owNER BUTLDER DEI"CARATToN I hqeby aflirm undtr poalty of pâ‚¬rjury that I m cxcmpt from rhe (ri)nrrados' LL'ee tanv for the foll<rwing rcmn (5(.7031.5 Businss md Prof6sion Code): Any City or County rvhich requira a pomit to construct. alts. improvq dcmolish or rfpcir 8f structue. [rior to its isuance. also requirB lhe applicant for such pcnnil to file a signed stetemflt that he or shc is licensed puBuel to the provisiom of the Contraclor's Licensed law (Chapts 9. Comrncncing wilh Strtion 7000 of Division 3 of the Businss ild PrcfsionsCode)orthathcorsheiseremptthqefrommdtheb6sisfortheallegedcrongion. AnyviolationofScctionT03l.5byany applicanl for a pf,nil subjets lhc applicant to a civil penalty ofnot morc lhan fir'e hundred dollus ($500). -1. as o\\'ner of the property. or my ernployecs with u'ages as their sole compensation. u'illdo the u'ork and the structure is not intendrxl or offered for sale (Sec.7044. Business and I'rofessions Code: 'l'he Contractor's License Larv does not apply to an owner of the properly who builds or improves thereon. and rvho does such u,ort hirnself or herself or through his or her orvn ernployees. provided that such improvonents are not intended or offered for sale. lf. horvo,er. the building or improvement is sold rvithin one yeil of cornpletion. the Ou,ner Builder will have the burden of proving tha he or she did not build or imJnove the properly for the purpose of sale). _1. .ts owner of the property. arn exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Btsiness and Ftrrfussion Code: The Contractor's License Larv d<les not apply to an orvner of property rvho builds or irnproves thereon. and who contracts for such projects rvith a Contractor(s) licensed pursuant to the Contractor's License Larv). -lamexemptunderSection-.B.&P.C'forthisreason. I)nte:Owner:_ WORKERS' CONI PT]NSA'IION DECLARATION I hereby affirrn under penalty of perjury one of the [ollowing declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the work for rvhich the permit is issued. _ I have and rvill maintain rvorkers' compensation insurance. as required by Section -1700 of the l-abor Code. for the perfonnance o[ the work ftir rvhich this pennit is issued. My rvorkers' cornpensation insurance carrier and policy number a'e: C"rri.r, I Policy *"^*,_Expires: _l certi} that in the perforrrrance of the rvork for rvhich this permit is issued. I shall not enrploy any person in any manner so as to bc'come subject to the workers' compensation laws of California. and agree that if I should becorne subject to the rvorkers' cornpensation provisions of Section 3700 of the Labor Code. I shall. Ibrthrvith conrply rvith those provisions. WARNIN(l: Failure to secure rvorkers' compensation coverage is unlau'ful. and shall sublect an onplo)'er to crirninal penalties and civil fincs up to one hundred thousand dollars in addition to the cost of comgrcnsation. danages as provided for the Section 3076 of interest and fees. I hereby affirm under penalty of perjury I arn provision of Chapto'9 (cornrnencing u,ith Section 7000) of Division -1 of the Business and Professions Code. and nry license is in full force and effect [.icense Date:-License LC*---2- I hereby aflirm under penalty of perjury issued (Sec. 3097. Civ. C.). Lender's Name: there construction lending agcncy the po'fonnance of the work for rvhich this pcrmit is Lender's Addrcss: APPLICANT DECI,Afu\'tION I herelry afftnn under penalty of perjury one of the follorving declarations: Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Parr6) _Required Letter of Notification _l certify that the federal regulations regarding asbestos removalare not applicable to this project. corify I this application and the above infonnation is correct. I agrec to comply rvith all City and County State and hereby authorize <_ Applicant or l'crnrilcc !rirnrc \- _T*rhE 8g[) - {t z//r'-