Laserfiche WebLink
-{BU!LDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrchy allirm under Fnalty of Frjury lhal I am crcnrpl ltrm lhc Grnlrackrtr' Liccnsc Law tirr lhc tirll(rwing rcav,n (Scc.7o-l 1.5 r <br />Busrrcss anl Protcssion Cole): Any City or County which rcquircs a Jrrmit k) construct. allcr. imp()vc. dcmolish or rcpair any <br />slruclurc, prirr tr its issuancc, also rcquircs lhc applicanl for such Frmit to filc a signcd stalcretrt lhat hc or drc is licenrd pursuant <br />to thc [mvisions of tlrc Contrack)r's Liccnscrl hw (Chaplcr 9. Commncing with Sslion 7000 of frivisi(]n .l of thc Busincss and <br />Prcfcs$ions Codc) (rr thnt hc or shc is cxcmpt thqetiom and thc basis for thc allcgcd crcmption. Atry vi(rlation of Setbn 703 1.5 by any <br />applicatrtforrpcrmitsuhjcctsthc apnlicanlloacivilpcnaltyofnotB)rcthanlivchundrcddolhs($5m), <br />_1. as owncr trl'thc propcrty, or my cmployces wilh wagcs as thcir solc compcnsation. will do thc work arill thc slructurc is not <br />irrtcndctl oroll'crcdlilrsalc(Scc.T044,BusincssandProt'cssionsCtxlc:'l'hcContraclor'sl-iccnscLawdrrcsnotapplyloanowncrof <br />thc propcrly wlx: huilds ()r impr)vcs thcrcon, and wlx) d<rcs such work himsclf or hcrsclf or thr)ugh his or hcr own cmployccs, <br />providcd lhat such intpnlvcmcnts arc not intcndcd orollbrcd filr sah. It, hlwcver. thc buikling or improvcnrcnt is sokl within otrc ycar <br />ol'contpletion, the Owncr Builtlcr will have thc hurdcn ol'pnrving that hc or shc did not buikl or improvc thc propcrty lbr thc purJxrsc ol' <br />salc). <br />_1, as owncr of the pn)pcrty, am exclusively contracting with licensed contractors to construct lhc projcct (Scc. 104/', Busincss <br />and Ftotbssion Code: The Contractor's License Law docs not apply to an owner of pnlpcrty who builds or improvcs thcreon, <br />and who contracls lirr such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc taw). <br />-IamcxcmptundcrScction-,B'&P.C.lbrthisrcasrtn. <br />Date: <br />WORKERS' COIT I PENSATION <br />DECLARATION <br />I hcrcby atTirm undcr Jrcnalty of Jrcr.jury one of thc lblkrwing dcclarations: <br />-l <br />havc arrd will maintain a Ccrtilicatc of Conscnt to Scll'-lnsurc tirr workers' conrpcnsation, as providcd for by Scction 3700 of thc <br />Latxlr CrxJc. lirr thc Jrcrftrrmancc of thc wrlrk tirr which thc pcrmit is issuctl. <br />!&,0u" and will maintain workers' comJrcnsation insurance, as rcquiretl by Scction .17(X) of thc Labor Codc, lirr rhe Jrcrlbrmancc of <br />thc work lilr which this pcrmit is issucrl. My workcrs' compcnsation insurancc carricr and Jxllicy number arc: <br />Policy c /o <br />X I ccrtify thar in thc Jrcrlirrmancc of thc work lirr which this Jrcrrnit is issuctl, I shall not cmpkry any pcrs()n in any manncr <br />so)st,l bcconrc subjcct to thc workcrs' c<lmpcnsation laws of Califilrnia, and agrcc that if I should bccomc suhjcct to thc <br />wrlrkcrs' compcnsalion provisions of Scction 37ffi of thc Lahlr Crxlc, I shall. firrthwith eomply with those provisions. <br />WARNING: Failure to sccure wurkcrs' compcnsation coveragc <br />civil lincs up to onc hundrcd thousand dollars ($100,0ffi), in <br />is unlawlul.an cntployer to crinrinal pcnaltics and <br />ol'tlamagcs as providcd tirr tl[ <br />Scction J076 Crxlc, intcrcst anrl attorncy's l'ccs. <br />DECLARATION <br />I hcrchy allrm undcr pcnalty of pcrjury that I am liccnscrl undcr pnrvision of Chaptcr 9 (conrmcncing with Scction 7U)()) of Division J <br />ot' thc Busincss and Prot'cssions Code, arxl my liccnsc is in lull tirrcc uxl cttcct. <br />e ?-Liccnsc Nunrbcr: <br />W <br />I hcrcby afi1rm under IEMlty of Frjury that thcrc is d constructk n bnding agcncy for Ihc pttbmncc of thc mrk litr which this fsmit is <br />issucd (Scc. 3097, Civ. C.). <br />lrrxlcr's Narc: <br />knder's Addrcss: <br />APPLICANT DECLARATION <br />I hcrcby allrm undcr pnalty of pcrjury onc ol'the lirlkrwing dcclarations: <br />Dcmolition Permits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rct;uircd [-ctter of Notification <br />_l ccrtrly thal thc l'cdcral rcgulations rcgarding asbcslos rcnroval arc nol applicablc to this projccl. <br />_l ccrtily that I havc rcad this application and inlbrmation is corrcct. I agrcc to comply with all City and County <br />ordinanccs arrd .Statc [-aws rclating to buikling <br />atxrvc mcntioncd pnlpcrty lilr <br />Applicant or Agent <br />Pernriter. nanlc <br />hcrcby autlxrrizc rcprescntativcs of <br />:,',","'^:;"'7"* <br />Set Backs <br />Forms/@F{oldowns fll 5 -/?-L1 tuc g 7r/ <br />Erection Pads , <br />UFER Ground <br />SLAB Floor F/dc,'ei4 7CB*U Zo-zt I <br />S u bf loor/VenVl ns u latio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsu lation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lVlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />^tr^.h t'tfihz 6- lz,zl kc%-t ) <br />7 r <br />FINAL lo-5< t AY4 {r- <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />NR )fi1 <br />/^/- s,a^e fi<Vao <br />/-7t-Zz