Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor I <br />S u bf loor/Ve nUl ns u Iation a l7 u SA-'t+{/ <br />Roof Sheathinq I <br />Shear Wall <br />Framinq <br />Insulation lEnergy -,, <br />Drywall Dkryk 7 <br />btffi*4,Ext/I tb a L <br />Bro\nfCoat / <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 tf)-5-Ll l--f 1- <br />Certificate of Occupancy <br />Nofes, flemarks, Etc.,.71 ^ll ,1 tJ\- <br />ht 1 'l/_..-- t)lQ( a-)/ DlW6"/\\\l' I <br />OWNER BUILDER DELCARATION <br />I hcrchy lllirm undcr Jrcnally of lErjury lhal I am cxcmpt liom lhc Conlraclors' Lbcnsc law lirr thc lirlhwinS rca$n iscc.pll.5 <br />Ilusmcss ad Prolbssion Gxlc): Any City or County which rcquircs a lrrmit t(, construcl. allcr. improve, &molish or rc;uL any <br />slructurc, ltri(rr b ils issuancc, also rcquircs thc applicant lbr such [Ermit kr lilc a signcd statcmnt that hc or shc is liccnsd pursuant <br />to thc p()visions of thc Conlracbr's Liccnsd Law (Chaptcr 9, Comrcncing wilh SNtion ?000 of Division .l of thc Busircss and <br />Prufcss(fis Codc) or thal hc (r shc is cxcnrpt thcrcln)m and thc basis li)r thc allcgcd crcmplion. Any violati(]n of SR-tion 703 1.5 hy any <br />applicanl ti)r a JErmit subjccts thc applicant to a civil pcnalty of not morc thm fivc hundrcd dollars (5500). <br />_1, as owncr of'lhc propcrty, or my cmployees with wagcs as thcir solc compcnsation, will do thc work arxJ thc struc'turc is not <br />rntcm.lcd rlrotl'crcd lirr sale (Scc.7044, Business and Profcssions Cqle: Thc Contraclor's Licensc L:rwdocs not applyto anowncrof <br />the pnlprty who builds or inrpnrvcs thcrcon, and who docs such work himsclf or hcrsclf or thnrugh his or hcr own cmpkryccs, <br />provitlcd that such improvcrncnts arc mrt intcndcd or ol'tcrcd lirr sale. It. howcvcr, thc building or improvcrncnt is sokl within onc ycar <br />of conrplction. thc Owner Buillcr will havc thc burtlcn <ll'proving that hc rlr shc did rrrt huihl or improvc thc propcrty lbr thc purJxrscol' <br />salc). <br />_1, as owncr ot'thc propcrty. am exclusivcly contracting with liccnsed contractoni lo construct thc projcct (Scc. 7W, Business <br />arxl Pnrtbsskrn Codc: Thc Contractor's Liccnse Law docs not apply to an owner of propcrty who builds or improves thercon, <br />and who contracts tor such pr<rjccts with a Glntractor(s) liccnscd pursuant to thc Contractor's Liccnsc Law). <br />_l am cxcmpt undcr Section_, B. & P.C. for this rcason. <br />f l.-. ^. <br />WORKERS' CONI PENSATION <br />DECLARATION <br />I hcrcby affirm untlcr Jrcnalty of pcrjury onc of thc tirllowing dcclarations: <br />_l havc and will maintain a Ccrtilicate ol'Conscnt to Scll'-lnsurc filr workcrs' comJrcnsatiotl, as pr<lvidcd tirr by Scction .1700 of the <br />l.atxlr CrxJc, for lhc Jrcrlormancc of thc wrlrk firr which thc Jrcrmit is issucd. <br />_l havc and will maintain workers' cumpcnsation insurancc, as rcquircd hy Sectiorr .1700 of thc Labor Code, tbr the pcrtrlrmancc of <br />thc wrlrk liu'which this permit is issued. My workers' compensation insurancc carricr and plicy numbcr arc:- <br />Poticy b t) <br />_l ccrtily that irr thc Jrcrtirrmancc of thc wrlrk lirr which this issucd, I shall not cnrpkry any lrcrson in any <br />so as to bcconrc sulr.icct to thc- workcrs'conrpcnsation laws and agrcc that if I should hccomc subjcct to tlrc <br />workcrs' conrJrcnsation pnrvisions of Scction 3700 ol'thc Lahlr I shall. tirrthwith comply with thosc provisions. <br />WARNING: Failurc to s:ecure workcrs' comJrcnsati()n coveragc shall subjcct an empkrycr to criminal and <br />irt c()sl compcnsation, damagcs as firr thc <br />I hcr,-by allirm undcr Jrcnalty ol'Jrcrjury that I am liccrrrctl undcr pnlvision of Chaplcr 9 (comnrcncing with Scction 7UX)3 <br />ol' thc IJusincss and Codc, and my liccnsc is in lirll lirrcc anrl cll'cct. <br />I-iccnsc a <br />D x <br />CONSTRUCTION LENDING AGENCY <br />I herchy allirm undcr pcnalty ol'pe{ury that there is a construction lcnding agcncy tirr thc pcrftrrnrance of thc <br />issucd (Scc. 3097, Civ. C.). <br />lrndcr's Namc: <br />which this pcrnrit is <br />[-cndcr's Atldrcss: <br />APPLICANT DECLARATION <br />I lrcrchy allrrn undcr pcnalty ol';rcrjury orrc of the lirlklwing dcclaratiorrs: <br />Dcmolrtkrrr Permits-Asbestos Notil'ication Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notilication <br />L*:T,::l'cdcral rcgulations asbcslos rcmoval arc nol applicablc to this pr<ljcct. <br />rcad this iurd statc tlrat lhc ahrvc inlirrntation is con'ccl. I kl comply <br />his City <br />with all City and County <br />rlrdinanccs and Statc [-aws relating to County to cnter uJxrn thc <br />atxrvc mcntioncd pnrJrcrty lilr <br />Applicant or Agcnt <br />Penrrilee nanre <br />and autlxrrizc ol'I <br />, <br />Elarr n9--n7 -2n I q <br />a <br />a <br />Ibt <br />\ <br />civil lincs up to ()nc <br />Scction 1076 <br />rD <br />I