Laserfiche WebLink
BUILDING. !NSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET,CARATTON <br />I hqchy affm undo pcnalty of pcrjury thar t m cxmpt fiom thc Contrsctotr' Lire hw for thc following @n (Se.7031.5 <br />Buins ard Prcfsion Codc): Any City or Coutrty which rcquirc a pcrnit to snstruct, altq, imprcvq danolish or rcpair uy <br />sructuc' prior to its issmcc, also requirs thc applicmt for such pamit to filc a signcd statmmt that hc or slrc b licos€d pGuet <br />to thc provisioB of tlE Contractor's Licmscd hw (Chapt6 9. Comcncing with S*tiotr ?000 of Division 3 of thc BBitrs sd <br />Prcfsios Cod€) or thst hc or shc is qop rhqcfrom ud thc basis for thc allcgcd cxmption. Any violation of Sctbn 7031.5 by uy <br />applicut for a pomh subjets thc applimt to 8 civil pcmlty of not mrc th& fivc hundrcd dollm ($500). <br />-1, <br />u omq of the propcrty, or my mplo)6 with w8g6 I thcir sle smpcGatioo. will do thc wort atd thc {rulw is rct <br />intadod or ollcrcd for slc (Se.7044, Buine ud Profeioro Codc: Thc Contractor's Lic6c kw do6 not apply to e omo of <br />thc propqry who builds or imprcs thoor1 sd who dc such w* hiruclf or hmelf or thrcugh his or ho om cmploycc, <br />providcd that such imFovqmts e rct htodod or offotd for slc. If, hoM, thc huildiru or impromt is sH wilhin one )@ <br />of@rpldioa thc Ovtr6 BuiH6 wil h.E thc hrda ofproving thd hc or shc di, mt buiH or improrc lhc propqty for thc prpos of <br />ele). <br />-1, <br />r omq of thc Fopaty, m cxcluivcly contrscring with lics€d contrscloE to coEtruct thc Fojci (Se. 7044. BEir6 <br />and Proftssbn Codc: Thc Contrutor's Licosc Law doe not apply to u owno of propaty who builds or imprcve ths@q <br />ud who contracts for such projcts with a Contncto(s) licos€d puBunt to thc contrac{or's Lic@c llw). <br />-l <br />am exempt under B. & P.C. for this reason. <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby affrm under penalty of perjury one of the following declarations: <br />-l <br />havc and will maintain a Ccrtificate of Consent to Self-lrsure for workers' compensation. as provided for by Scction 3700 of the <br />I-abor Codc, for the performance of the work for which thc permit is issued. <br />-l <br />have and will maintain workefti' compensation insurance, as requircd by Scction 3700 of the l-abor Code, for the pcrformance of <br />the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: <br />Policy Number: Expires: <br />-l <br />certify that in the performance of the work for which this permit is issued, I shall not anploy any person in any manner <br />so :rs to becorne subject to the workers'compensation laws of California. and agrce that if I should bccome subject to the <br />workers' compensation provisions of Seclion 3700 of the t-abor Code, I shall. fonhwith comply with those provisions. <br />WARNING: Failure to sccure workers' compensation coverage is unlawful. and shall subject an onployer to criminal perTalties and <br />civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compcnsation. damages as provided for the <br />Section 3076 of the tabor Codc, interest and attorney's fees. <br />I hereby affrrm under penalty of perjury 3 <br />of thc Busincss and hofcssions Code, and my licerue is in full forcc and effect. <br />License Class: Liccnse Numbcr: <br />I)q i o' <br />W <br />I h@by 8ffm mdcr Falty of Frjury thrt tbsc b i @ndrudbn hndiry rg@y for thc pqforec of thc mrt 6r which thb pqmit i! <br />issucd (Se. 3097, CiY. C.). <br />knd6's Nmc: <br />Lender's Ad&ess: <br />APPLICANT DECLA]TATION <br />I hercby aflirm und€r penalty of pcrjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Fedcral Regulations (Title 40, Pafl6) <br />_Required Letter of Notification <br />-l <br />cqtiry thal thc fiical rcgulatioro rcgrding rbctos movd re not spplicablc to this prcjet. <br />-l <br />cstiry thal I havc md this application and stalc thal the abovc infomstion is cor61. I rgr to @mply with all City ed Couty <br />ordimcB od Statc l:m relalLu to buildirg coNtruction, od h6cby ruthori4 rcTrMtaliv6 of thb City ud Couty to mt6 upon thc <br />above m@tioncd prcpqty for iroperion purpos. <br />Applicent or Agent Signeture: I)ete:_ <br />P.mile umc (prlrt): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bfloor/Ve nul nsu latio n <br />Roof Sheathinq 7-u-zo ffitu <br />Shear Wall <br />Framing <br />lnsulation/Enerqy <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 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />a,