Laserfiche WebLink
BU!LDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS Owner-Buildcr Declaration a <br />I hcrcby rfrirm uDdcr pculty of pejury thrt t m qcmpt form thc CotrEsctorr' Lieroc [rw for thc following ranon (roc.7031.5 Buincl <br />Erd Prof63ion Codc): Any Ciry or County which rcquirc r pcrmit to outruct rltq, improvg dcmolbh or rcPoL my ttructuq ptior lo iE <br />issune, rlso rcquira thcrppliont for ruch p6mit !o filc r tignod sutcmcnt d[t hc or the ir lierucd punmt o thc prcvirior of tltc <br />Conr6clor't Licmcd lrw (Chlpts 9, Commcrcing with S*tion ?OOO of DivLion 3 of thc Buinar rnd Proforior Codc) or tht hc or <br />shc is ucmpt thcrcfiom rnd thc h!i! for thc allcgcd qcmption .Any viohtion of Scction 7031.5 by rny rPPliont for r pmit tubjo{tt thc <br />.ppliant !o r civil pcmhy ofnot morc lhrn frvc hundrcd dollrm ($500). <br />_I, u omcr of the propsty, or my cmploye with mgo u thcir $lc ompcMtior\ will do tho work rnd thc ltrudur it mt itrtadcd <br />;-ffqcd for slc ( Se.Zitll, Bwinar rnd Profcsrioro Codc; Thc Contrrctor'r Lieruc Lrw doq not spply to u ow of thc prcpcty <br />who buildr or improva thoroq rnd who dos rwh work himrclf or horclf or through hir or ha om cmploya, Providcd thlt tuch <br />improvcmcnB ari not iatcndcd or offgcd for ulc. tf, horcu, ths building or improvcmcnt ir rold within orc yc of omplctiot\ $c <br />Omcr-Builds will hrvc thc burdcn of proving thrt hc or thc not build or improw for thc putPorc ofslc). <br />_1, rs omcr of thc propaty, am aclurivcly onraaing witlr liccGcd ontrrctors to oiltruct thc projct ( S€. 7044, Bwinst 8nd <br />Prcfcsiion Codc: Thc CoilEc'tor's Lienrc lrw do6 not rpply to u owr of propaty who buil& or imptovq th6sn , rnd who <br />@ntrrcts for such projcr6 eith . Conrrcior(r) licmcd pu[unt to thc Contnclor's Lienlc [:w.), <br />_I am cxempt under Scction & P.C. for this <br />Date:2- <br />I hereby affrrm undcr perulty of perjury one <br />_t havc and will mrirbh r Catifietr of Coucnt to ScU.IBurc for wrk6' @mpwtior\ u Providod fo! by S*-tion 3700 of tho <br />Lrbor Codo, for thc pcrfomne of thc mrt for which thc ponit ir isucd. <br />_I hevc ud will mintril workm' ompeution iuwcq u rcquircd by Scstion 3700 of thc ltbot Cods, fot thc Pdomncc of th. <br />rcrk for which thir pcrmit it ir.ucd. My mrko' ompcution iulme mie urd policy nmba uc: <br />Policy Numbcr: ExPires: <br />(This scaion n. or lcst) <br />_I certify that in the performance of the work for which this permit is icsuod, I shall not employ any parson in any mtnner so as to <br />became subjcct to the workcrc ' compcnsation hws of Crlifornia, and Egroc thst if I should become rubjoct to the workcrt' <br />compcmation provisiom of Soction 3700 of the Labor CodC I ltnll, <br />Date: <br />WARNING: Frilure to s@ure workers' compeluEtion <br />fines up to one hundred thousend dollarc ($100,000),in <br />the [abor Codc, interest rnd tnorncy's fecs. <br />covcragc is and shsll subject ur employcr to criminal pcnalties and civil <br />rddition to thc cost of compcruttion, damrgcs ar providad for tho Soction 3076 of <br />@ <br />I hqcby affirm undg pcnhy of psjury thrt I mlieuod undc pmvirion of Chrptct 9 (@mmoncing whh S€tion 7000) of Division 3 of <br />thc Businccs rnd Profs3io[ Codc, md my liccs. it in full fore rnd efrcct <br />Drte: ftntrsctor: <br />W <br />I hcrcby rfrirm unda pc[lty of psjury thrt th6c it r coutruclion lcnding rgency for thc pctfomtre of thc work for wtich thir pGrmh i! <br />Civ. C.). <br />Lctrda'3 Addrs: <br />ATEI.ICANIILDECIdBAIJAN <br />Dcmolition P6mit!-A!bctt$ Notiliodoo Podanl Rcgulrtiou (Tillc a0, Prrt 6) <br />_ Rcquircd L€ts ofNotifiotiot <br />I 6tiry tht ihc ftdf,l rcguhtionr rcgrdhg ubstor rmul uc not rpDliflblc to thit prcioct" <br />_ I ertify thrt I hrvc rad thir rypliatbn rnd ttrto thrt th3 rbow informtion ir @rod I rgrco to 6mply with dl City end Coumy <br />ordinances and Stste [.aws relrting to building corutruaioq utd of thic City end County to entcr upon the <br />abovc mcntioncd property for inspection purPoscs. <br />Applicant or sgcnt <br />Permittec neme (print): <br />oo <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorNenulnsul <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall A <br />G$,nnt(LaW L( rt (rn ltur< <br />Brown Coat Z..--' /6o7 .dfun <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br /> ,/n <br />FINAL I j.7$u[rl,)A) <br />Certificate of <br />Notes, Remarks, Etc. <br />Forms 03.31.06