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BUILDING. !NSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS Ow-Buildd D€hntioo <br />I hcrcby a.ffirm undcr pculty of pcrjury that I m ampt form thc Coilodor' Lieue [.w for thc followiag rooa (re.7031,5 Buina <br />and Profssion Codc): Any City or Couty which rcquirc a pamh to @atru€l, !hq, improvc, dcmolirh or rcpair uy rtructug prior b fu <br />irsunce, alro rcquira rh€ rpplioil for ruch pqmit to filc r tigncd st tmat tlut hc or rhc ir liercd purult to th€ provirioru of rhp <br />Contractor's Liescd kw (ChEprq 9, ComencinS with Sdion 7000 of Division 3 of thc Buins snd Prof6sioN Codc) or tlrt hc or <br />shc is acmpt tluefiom and thq brsis for the allcged ucmption .Any violation of Setion 7031.5 by ey rpplimt for r pmit rubjcar thc <br />8ppliar !o r civil peuhy of mt mrc thD five huodred doua$ (S500). <br />_I, s omq of the propcrty, or my cmployw wirh wgc u thct $lc ompcutioq will do thc work ud thc $rud.uc ir not intodcd <br />or off{ed for slc ( Sa.7044, Buines and Profcssioro Codc: Thc Contrstur'! Li@Nc law do6 rct lppty to u ow of thc propety <br />who buil& or improva tlruo4 and who doB rwh work hiruclf or lurclf or tkough his or ha om mploye, p.ovidcd dut tuch <br />improvemcnr ee mt intetrdci or offsci for slc lf, howwq, the building or improvemor i! sld wilhin orc yil of ompl.tiot1 the <br />Oms.Builds will havc thc burdcn of proviag thr hc or shc rct build or improvc for thc purpo* of sb). <br />_I, 6 om6 of thc propcrty, am *chsively conraaing with liccrccd @atrrctor to @Etruct thc projq, ( Se. 7044, Bsiacs ed <br />hofcsion Codc: Thc Contnoor's Lieroc hw doa not apply to u oma of propaty who builds or improv6 tlE@o , lsd wfio <br />@ntns for such projs with ! Cotrhdor(s) lic6€d psqnt to thc Coflndor'r Lire llw.). <br />_I m cxcmpt udu Sction & P.C. for this 160[ <br />Datc: Omc <br />WORKERS COMPENSATION DECLARATION <br />I haeby affirm under pcmlty of pajury one of thc folhwing delaruioe: <br />s providcd for by Setion 3700 ofthc <br />hbor Codc, for thc pafotrme of thc <br />&c: <br />Policy a -t- r - os <br />(fhis saion necd not the is for hundrcd orlx) <br />_I c€rtiry tltat in thc pqformne of tbc work for which this pqmit is i$uc( I shall oot dploy uy pdsn itr uy Mq !o E to <br />bccamc subjcc o thc workcn ' ompcution l8B of Crlifornig ud rgr@ t,l!t if I should beomc lubj€t to thc worho' <br />@mp€cltion provisioN of Sdiotr 3700 of thc hbor Codq I shall, fonhwith @mply wirh thosc provisiou.. <br />noto _o..1 "".t <br />WARNING: Frilue to surc work6' @mpcration ovoge is uhwful ud rhall subjct u cmploya to cimiul pcuhic ud civil <br />Iin6 up to onc hgdrcd thound dou$ (S100,000),in rdditioD to thc os of ompcmtion, damrgo c providcd for thc Scrtion 3076 of <br />the bbor Code, intq6t ud anomcy's fc. <br />LICENSED CONTRACTORS DECLARATION <br />I hacly afrrm unda pcBhy of pajury dlt I u tieNcd undq pmvirioo of Cbrpts 9 (omociag with Socriol 7000) of Division 3 of <br />tbc Buirw rtd Profesior Codc, ud my liccre is in full fore rnd cffa <br />L- 3?Liccree l0 <br />Datei Div ( <br />CONSTRUCTION LENDINC AGENCY <br />I hocby rfErm unda p€Blty of pdjury thlt ihse b a comtruction lending rgcncy for thc pcrfomne of the work for which this pcrmh ir <br />issued (Src. 3097, Civ. C.). <br />Lendcr's Name: <br />lrodcr'r Ad&s: <br />APIIJCANT]IIDECIdEAIION <br />Dcmolitioa Pmits-Arb6tos Notifistion Fcdual Rcguhriou (Thlc 40, Part 6) <br />_ Rcquircd Lcna of Notfiqtioo <br />I cstfy th.t thc ftdol rcgulatiou rcguding abGtos rarcBl e mt rpptioblc o |hb pro.ier <br />_ I cdit thrt I hlve rod this appliotion ud statc that thc rbovc ioformtion is with all Chy snd County <br />ed County to 6tcr upon thcordiEncB ud Statc lrw rclating to <br />abovc mentioned <br />Applimt or agot sig. <br />Pqmin€ Eme (print): <br />for <br />hcreby authorizc <br />@rett I <br />1-LL-O <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SI-AB Floor <br />SubfloorA/enulnsul <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/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 Final Report <br />Flood Zone Certif <br />FINAL \ \-an -d?ATttt <br />Gertificate of Occupancy <br />Notes, Remarks, Etc. <br />@mpcNtion insun@, I