Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm undcr Fnrlty of lErjury thlt I am ercmpt frcm lhc CoDlractoB' Liccnsc law for lhe following rcawn (Scc.?031.5 <br />Busincss drxl Profcssion Codc): Any City or County which rcquircs a lrcrmit to conslrucl. allcr. iilrprcvc, dcmlish or rcpir agy <br />slructurc. prior to its issuuncc, rlso rcquircs Ihc applicanl for such lErmit to filc a siSncd stalcrent that hc or shc is liccnrcd pursuant <br />to thc prcvisions of fic Contrrctor's Licenscd law (Chaptcr 9, Commcncing with Setion 7000 of Division 3 of thc Busincss and <br />PrcfcssionsCodc)orthathcorshciscxcmptthcrefronrandlhcbasisforthcallcgcdcxcnption. Anyviolationofsccti,nTO3l.5byany <br />applicant for a pcrmit subjsts thc applicant to a civil penalty of not mrc than fivc hundrcd dolltrs ($500). <br />-1. <br />as owncr of thc prcFrty, or my cmployes wilh wagcs ss thcir mlc compcnulion. willdo thc work ard lhc stnrtrc is ml <br />intcndcd or offcrcd for slc (Sc.7044, Busincss md Profcssions Codc: Thc Conlractor's Liccns ljw dms nol apply to an owncr of <br />lhc pmFrty who builds or in{rmB thcmn, ud who dm such re* himsclf or hcrsclf or threugh his or hcr own cmployccs, <br />providcd thilt such imprcrcrrcnls m not inlcndcd or offcsl for sah. lf. howcrcl thc hoiHing or imprcwmnt is sld wilhin onc )M <br />ofcompbtion. lhc Owncr BuiHcr will havc thc burdcn ofprrving thrt hc or shc dkl nol buih or improvc thc prc1my for thc pur[Ds of <br />$h). <br />_1, as owncr of thc propcrty. am exclusivcly contracting with liccnscd contraclors to construct thc projcct (Scc. 7W. Busincss <br />and Protbssion Codc: The Contractor's License Law does not apply to an owncr of propcrty who builds or improvcs thcrcon, <br />and who contracts for such projects with a Contractor(s) liccnscd pursuant lo thc Contractor's Licensc [aw). <br />-l <br />am cxempt undcr Section-, B. & P.C. for this rcason. <br />Dale: Owner:-,%ilfiftff* <br />{h!p!y aflirm undcr pcnalty of pe{ury orc of lhe following dclatations: <br />Al"r"onawitl mintainaCc(ilEatcofConscnttosclf-lnsurcforworkcrs'compcnstion.$ pmvidcdforbysstion3T0Oofthc <br />tabor Codc, for thc pcrformncc of lhc work for which thc pcmit is issucd. <br />{*lt and will maintain workcrs' compcnsation insurancc. as rcquircd by Scction 3700 of thc labor Codc, for the pcrformancc of <br />for this pcrrnit is My wrlrkcrs''T?r'riTi'lx'*ffi;7 <br />\ roticr Z <br />_l ccrtify that in thc of the work frrr which this pcrrrrit is issucd. I shall not ernploy any pcrson in any rnanncr <br />so as to bcconrc subict to thc workcrs'compcnsation laws of California. and agrcc that if I should bccotne subjcct to thc <br />workcrs' compcnsation provisions of Section 3700 of the Labor Codc. I shall. tbrthwith comply with thosc provisions. <br />WARNING: Failurc to secure workcrs' cornpensation coveragc is unlawl'ul, and shall subjcct an cmploycr to criminal pcnaltics and <br />civil fines up to one hundred thousand dollars ($100.0001, in addition to thc cost of cornpensation. damages as providcd for the <br />Scction 3076 of thc Labor Codc. intcrest L Cunsllrc.i--(lO'tl-T-l <br />LICENSEN CONTRACTOR <br />DECI ^ RATION <br />I hcreby affirm under pcnalty of Srerjury that I am liccnscd undcr provision of Chaptcr 9 (conrnrcncing with Section 7mO) of Division 3 <br />of thc Busincss and Professions Codc, and my liccnsc is in full forcc and cffcct. <br />l3+t (,(, <br />Nunrbcr: <br />1O 'rl-?\rALL L 4 rrol* u .- <br />W <br />I lrcrcby aflirm undcr pcnalty of lrcrjury thtrt thw is a onstructhn lcnding rgcrcy for thc lrcrformrce of lhc uork for which this lmit is <br />issued (Sa. 3097. Civ. C.). <br />lrndcr's Namc: <br />;[rndcr's Address: <br />APPLICANT DECLARATION <br />I hcrcby aftinrr undcr pcnalty of perjury onc o[ thc following dcclarations: <br />Dcrnolition Pcrrnits-Asbcstos Notification Federal Regulations (Title 40, Part6) <br />-Re<luircd <br />lrttcr of Notifrcation <br />_l ccrtily that thc tt'dcralrcgulations rcgauding asbcstos rcnmvalarc nol to this projcct. <br />l;--l ccrtily that I havc rcad this and statc lhat thc corrcct. I agrcc to cornply with all City and County <br />ordinanccs and Statc laws rclating to of this City and County to entcr upon thc <br />abovc nrcntioncd propcrty for <br />I <br />and <br />rfl/Crt <br />I)alt':ig) .ll'/t <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />f,tAffiloor --. I I A <br />Su bf lo orN envl nsu latio n v It ,J l.\DA,rt>1 <br />Hooffheathinq I <br />Shear Wall ,l ^/n_ <br />Framing Dlrtvt I <br />lnsulatio nlEnergy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ltlasonry <br />Pool Fence ( <br />T-Bar <br />Handicap Req.\ <br />Deputv Final Report / <br />Enqineer Final Report <br />Flood Zone Certif. <br />.h l--i \tl q, <br />FINAL u //t)vl.Y 5/ <br />Certificate of Occupancv <br />Notes, Remarks, Etc. <br />/ <br />\ <br />,/ <br />I