Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrchy atlirm undcr Fnally of pcrjury that I m cxcmpl lrom thc G)ntractoN' Liccnsc [aw for thc tblloeing rcaon (Se.7)] 1.5 <br />Business anrl Profcssion Cqlc): Any City or County uhich rcquircs a pmit lo conslrucl, altcr. improvc. demlish or rcpair any <br />structurc, prk)r to its issuancc, .lso rcquircs thc a{rplicmt for such lrrmit lo l'rlc a siSncd slalcmnl lhal lE or shc is lien$d Pmuanl <br />to the la)visions of thc Contractor's Liccnscd [:w (Chaptcr 9, CommcncinS wilh Sstion 7000 of Division 3 of the Busincss and <br />PrufessionsCqlc)orthathcotshciscxcmptth€rcfromandthcb.sisforthcallcgcdcxcmption. AnyviolationofsetitnT0ll.5byany <br />applicanl tbr a pcmil subjets thc applicant to a civil penally of nol morc than livc hundrcd dollars ($500). <br />_1, as owrcr olthc pNFrty, ot my cmpkryes with wages &s thcir solc comlrcnsati(rn, will do ttE wqk afil lhc strulrc is noI <br />intcDlql or ollbrcd f(rr slc (Se.?044, Busincss md Profcssions Colc: Thc Glntrackrr's Licus llw d(Es not apply to m oercr of <br />thcpn)Frty wlx)huilds()rimpmrcslhcBln.arlwhod@ssrehu)rkhimscllorhcrclforthn)ughhisorhcromcmployccs, <br />provided that such impR)vcmnts N not inlerxldl orofibrcal for sb. Il; tx)wcwf, thc huildin8 (tr imFowmnt is rcll wilhm orc )a[ <br />of complcti)n, thc Owncr BuiLlcr will haw the burdcn of provin8 that hc or shc did mt builJ or impmrc thc pm[Hty for thc purFrc of <br />eb). <br />_1, al owncr()l thc lm)lrcny, am cxclusivcly contracting with liccnsd cohlrackrs lo construct thc In jccl (Sec. 7(X4, Businc*s <br />anrl PnrtbssirnCorlc:'fhcG)ntracbr'sLiccnscLawd@snolapllytoanowncrofp()lrcnywhohuildsorimpnvesthercon, <br />and who qlnlracts lor such prujsts with a ContEcto(s) li@nsed pursuanl k, lhc C(rilrucklr's l.iccnsc Law). <br />I am cxcmDt unrlcr Selion-, B, & P.C. Ibr this rcason. <br />IVORKERS' CONTPENSATION <br />DECLARATION <br />I hcrcby all'irm undcr Frcnalty of pcrjury onc o[ thc lbllowing dcclarations: <br />_l havc arxJ will maintain a Ccrtilicatc of Conscnt to Self-lnsure tbr workcrs' compcnsation. as provided tbr by Section 17ffi of the <br />Labor Crxle, tor thc Jrcrlbrmancc of the work tbr which the grcrmit ls issucrJ. <br />_l havc and will maintain workcrs' compcnsation insurance, as rcquircd by Scct ion -17fi) of lhc [:bor Ctldc, for the Jrcrftlrmancc tlf <br />the work tbr which this prmit is issued. My workcrs' compcnsation insurancc carricr arxl pllicy numbcr are: <br />c t7 -a /(- a: l- Acc <br />lhat in thc pcrlirrnrancc ol'thc work trlr which this pcrmit is issucd, I shall not c:nploy any pcrson in any manncr <br />subjcct to thc workcrs'comlrcnsation laws of Calilirrnia, and agrcc lhat if I shttuld hccttme subject to thcsoas <br />wrlrkers' contpcnsation provisions of Section J7fi) of the Lahrr Codc, I shall, lirrthwilh contply with thtlsc provisions. . <br />WARNING: Failurc to sccurc workcrs' conrpcnsation coveragc is unlawtirl, and shall suhjcct an cmpkrycr to criminal pcnalties alld <br />civil lincs up lo onc hundrcd thousand dollars ($100,Uru), in adtlition trl thc cttsl of damagcs as providcd for thc <br />Scction ,]076 of lhc Latxlr Crxlc, intcrcst and atlorney's <br />u (./r'(. <br />a <br />(comnrcncing with Section 7000) of Division JI hcrchy al'lirnt undcr Jrcnalty ol'Jrcrjury thal I am liccnsed undcr pnlvisitln ol' <br />ol' thc Business and Pnrtbssions Corlc. and my licensc is fur t'ull litrcc and cfl'cct. <br />Liccnsc c- 38 <br />7-d,11 <br />I hcrchy all'irnr undcr pclralty ol'pcrjury that thcrc is a <br />issued (Scc. l0t)7, Civ. C.). <br />lcntling aPcncy of thc work firr which this pcrrnit is <br />[rndcr's Nanrc: <br />APPLICANT DECLARATION <br />I trcrcby allirm undcr pcnalty ol'Jrcrjury onc of the lbllowing rlcclarations: <br />Dcmolition Permits-Asbcstos Notificalion Fedcral Regulations (f itle 40. Part6) <br />_Requ ircd [-ct tcr ot' Notilication <br />-I <br />thc l'cdcralregulati<lns rcgan-ling asbestos removal euc nol applicahlc ttl lhis pnrjcct. <br />ccrtily that I havc rcarl this application and state that thc atxlvc intirrntalion is correcl. I agrcc to comply with all City and Ctlunty <br />rcprcscntativcs of this City and County to entcr uJxrn thcorrlinances and Statc Laws rclaling to <br />atxlvc nrcntioncd pnrJrcrty lbr <br />Applicant or Agent <br />Penrritee n&une <br />construction, arxJ hereby authoriz"e <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor ildno ?--*st ^oly' <br />"2i <br />) <br />S u bf loor/VenVl nsu Iation I u r\J"t- <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsu lation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[Vasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />/t .F <br />FINAL 6ltblzo TI)(n @,I <br />TCertificate of Occupancy <br />Notes, Remarks, Etc. <br />,rr" <br />*,,: /'f - Aa