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SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs \\ <br />Forms/Steel/Holdowns <br />Erection Pads lu_,\ <br />UFER Ground /:\\ /n ',/il/ <br />SLAB Floor {\\ ,\,- <br />S u bf loor/Vent/l n s u I ati o n <br />Roof Sheathinq \l , <br />nShear Wall \.'''l l-ol ziL <br />Framinq ,/\l- t ' t \t <br />-\Insulation/Energy I ./ <br />Drywall {*p,i <br />Ext./lnt. Lath I <br />Brown Coat <br />Jt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL zt trtD A7 <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />I CN Utt <br />I u Ilv <br />OWNIIR BUILDER DEI,CARATION <br />I hercby atljrnr undcr pcnalty of perjury that I atn cxctnpt from lhe Conlraclors' Licensc [-aw for the following I ..s <br />Busincss snd Profcssion Codc): Any Cily or County which rcquircs a Jrrmit lo conslrucl. allcr, impmvc. dcmlish or rcpair any <br />structurc. prior to its issuancc. als requires thc applicdnt for such Jrcrmit to l'ilc a signcd slstcmnt thal hc or shc is liccnscd putsuant <br />to lhe pmvisioos of thc Contructor's Liccnscd [aw (Chaptcr 9. Commncing wilh Scclt)n ?fiD of Division 3 of lhc Busincss and <br />Prcfcssions Codc) or that he or shc is excmpt thcrcfrom end thc basis for thc ollcScd cxcmption. Any viohtion of Setbn 701 I .5 by any <br />applicant lbr a lcrmil subjccts lhe applicont to a civil pcnolty of not morc thrn fivc hundrcd dollars (5500). <br />-l.as <br />owncrol'thcpro;rcrty.ormyenrployecswithwagcsaslhcirsolcconrpcnsalion.willdothcworkandthcstructutcistxll <br />intcndcd or oll'crcd ftrr salc (Scc.7044. Busincss and Prot'cssions Ctilc: Thc Contraclor's l-iccnsc l-aw does not apply lo itlt owttcr ol' <br />thc proprty who huilds or improvcs tlrcrcxrn. and who docs such work himsclf or hcrsclf or lhrough ltis or hcr own clnployccs. <br />providcd thal such itnprovctrrcnts are not intcndcd or ollbred lirr sale. lf. howcvcr. thc huikling or irnprovcment is sokl within otlc yc:tr <br />of conplction.llrc Owncr Buildcr will have thc burdcn of proving that trc or shc did rxrt builcl or inrprove the propcrty for lhc purprscof <br />sah). <br />-1. <br />asowncrof thc profrcrty. amexclusivclycontracting u'ith liccnscd contractorslo c()nslruct thc projcct (Scc.7014.llusittess <br />and ProfcsskrnCodc: 'IhcContractor'sLiccnscLawdocsnotapplyloanowncrofpropcrlywhobuiltlsorintprttvcsthcrcott. <br />and who contracls ltrr such projccts with a Conlructor(s) liccnscd pursuant to lhc Contractor's Liccnse Law). <br />-lulncxclrtplundcrSectiott-.B.&P.C.forthisrcastln'Dale: Owner:_ <br />WORKFRS' CONIPENSATION <br />NECLARATTON <br />I herchy affirrn undcr pcnalty of prjury onc of thc following declarations: <br />_l havc arxt will nuintain a Certif-rcate o[Conscnt to.Sclf-lnsure for workcrs'comlrcnsalion. as providcd for byScclion.]7fi) of thc <br />Labor Codc. for thc Jrcrformancc of thc work for which thc ;rcrnrit is issucd. <br />_l havc and will ntaintain workers'compensalion insurarrcc. its requircd by.Scction 37(X) of thc Labor Code. f<rr thc pcrlirrnuncc o[ <br />thc work frrr which this pcrmit is issucd. My workcrs' cornpensation insurancc carricr antl Jxrlicy numbcr are: <br />Policy Numbcr: Expircs: <br />_l ccrtily that in thc pcrforrnance of thc work lirr which this pcrnrit is issucd. I shall nol crnploy any person in any tniltlncr <br />so aslohccorncsuhjccttothcworkers'conrpcnsationlawsofCalilbrnia.andagrecthatif lshouldbcconrcsubjccttothc <br />workers' conrpcnsalion provisions oI Scction 37fi) of thc Latxrr Codc. I shall. forthwith contJrly with thosc provisions. <br />IVARNING: Failurc lo sccure workers'unlarvf'ul.shall suhi'ct an cntploycr to critniltal pcnaltics antl <br />civil fincs up lo onc hundred thousand dollars ($irr cosl o[ cornJrcrtsaliott. danuges as provitlc-tl lor lhc <br />Scction 1076 of thc Lrtnr Code. inlerest <br />ox", 67 - 3 l- zo IB <br />I al'lrrln thal I arrr <br />rurtrl lir ll <br />Zol <br />I hcrchy affirnt undcr lrcnalty of perjury <br />issued (Scc. 3097. Civ. C.). <br />Lcnder's Narnc: <br />thcrc il agency tirr lhc pcrlorrnattcc of thc work lbr which this prnrit is <br />Lendcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcreby allinrr under pcnalty of perjury onc of thc following dc.clarations: <br />Dcmolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) <br />-Rc<luircd <br />l-ctter of Notificalion <br />_l ccrtily that thc l'cclcralregulations rcgartlirrg asbcslos rcrnovalarc rtol a;rylicablc to this projcct. <br />_l cerlily rcad with all City antl County <br />ordinanccs and County Itl cnlcr ul)ort thc <br />abovc <br />Applicant or <br />Pernritee nanre <br />for <br />t hat <br />- o,n, o7'3 i'ZO I b <br />BUILDING. INSPECTOR RECORD <br />)/r <br />!;\ <br />\ <br />/ r:,tl, fl <br />t/ol lr,t.t <br />JI