Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby aflirm undcr Jrcnalty of fErjury that I dn cxcmpt fmm thc Conlr&to6' Liccns tjw for thc folloving rcasn (Ss.7031.5 <br />Busincss ard Profcssion Codc): Any City or County which rcquircs a Jsmit lo conslrucl, alter, improvc, dcrclish or repair cny <br />$truclurc, prior to ils issusncc, als rcquircs thc applicmt for such lErmil Io lile a signcd strtcrcnl that he or shc is licenscd pursuanl <br />lo lhc provisions of lhc Cotrlractor's Licenrcd law (Chaptcr 9, Commcncing with Scction 7000 of Division 3 of the Busircss od <br />Prrfcssions Codc) or that hc or shc is cxcmpt Ihcrcfrom ud thc bdsis for the allcgcd cxcmption. Any violation of Sction 703 1.5 by any <br />applicant for a pemit subjsts the applicunt to a civil pcmlty of not rmrc than fivc hundrcd dollus (5500). <br />-1. <br />as owncr of thc propcrty. or my cnrployccs with wagcs as thcir solc cotnFrcnsation, will do thc work and thc stnrcturc is not <br />intcndcd or offered tbr salc (Scc.7044. Busincss and Profcssions Codc: The Contractor's Liccnsc Law does not apply to an owncr of <br />thc proJrcrty who builds or improves thcrcon. and who docs such wrlrk himsclf or hcrsclf or through his or hcr own cnrployccs. <br />providcd that such irnprovcnrcnts arc not inlcndcd or of}'crcd for salc. lf. howcvcr, the building or irnprovcrncnt is sold within onc ycar <br />of conrplction. thc Owncr lluilder will havc thc burdcn of proving that hc or she did not build or inprovc the propcrty for thc pur;nsc of <br />salc). <br />-1. <br />as owncr <lf thc proprty. amcxclusivcly contracting with liccnscd contraclors to construct thc project (Sec. 7(}1'4, Busincss <br />and Profbssion Codc: Thc Contractor's Liccnsc Law docs not apply lo an owner of propcrty who builds or improves thereon. <br />and who contracts lbr such projccts with a Contractor(s) liccnscd pursuant to the Contraclor's Liccnsc Law). <br />-lantcxemptundcrScction-.B.&P'C.lilrthisreason. <br />I)itle :Owner:_ <br />]TOEtrEBLCOMPIN$AIION <br />DECI.ASAIION <br />I hcrcby afnrmundcr pcmltyof perjuryonc of thc following deluations: <br />-l <br />havc autd will nuintoin I Ccrtifrcate of Con$cnt to Sclf-lnsurc for workc$' compcnslion, as prcvidcd for by Scction 3700 of thc <br />I:hor Culc. for thc pcrfornuncc of $e work for which thc permit is issucd. <br />2l havc and will mainlain workcre' compcnsation insurarcc. as rcquircd by SEtion 3?U) of thc tibor Codc. for thc lErfotmrcc of <br />Ihc work for which lhls pcrmit is issued. My workcrs' @mJEnsation insurancc cmicr and grlicy number uc: <br />All.'.*,f lallrr^.l.c $1eoiu1- fr.Carricr: <br />Poricy *r,rro"r. caoootlo?t^o I Expircs:lO. o) - ?otl <br />-l <br />ccrlify thal i[ lhc lrcrlirrDurcc of thc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any mnncr <br />s us to bccom subFcl to lhc workds' con{rcnsation laws of Califomia. and agN lhal if I shouH becom subjet to the <br />workcs'compcnutkrnpmvisionsofSetion3T0OofthctiborCodc. Ishall.fonhwithcomplysiththosprcvisions. <br />WARNING: Failurc to scurc workc6'compcnsotion covcmgc is unlawful, and shall subjcct an cmplolcr to qiminal Fmltics and <br />civil lincs up to otrc hundrcd thousand dollus ($100,000), in addilion lo thc cost of conrpcnsation, darogcs us providcd for thc d <br />Scction 3076 of lhc tntnr Codc. intercst and attorrcy's fes. <br />-\ , <br />Date. b-?.t-to, I noorr-^, fu lVrfr '7"*u Vl.l,^,r' <br />LICENSED CONTRACToR <br />DECIAMIION t <br />I hcrcby aflirm undcr penalty of Frjury that I am liccnrcd undcr prcvision ofChapts 9 (commncing with Scclion 7000) of Division 3 <br />o[ thc Busincss and Prcfcssions Codc. and my liccnrc is in full f<)re Md cffcct. <br />License Cla"*' Ei Liccnsc Nunrbcr:73 tt <br />'O-zrl - ?o? t conrracro r, Ta^4: ?r4cko- u . kPRl Co^tl. <br />W <br />I hcrcby affirm undcr trcn{lty ofperjury that thcrc is s construclion lcnding agcncy for thc pcrforruncc oflhe work for which lhis lf,rmil is <br />issucd (Se. 3097, Civ. C.). <br />Lrndcr's Addrcss: <br />I <br />APPLICANT DI.-CI .TRATION <br />I hcrcby aflirm undcr pcnalty of pcrjury onc of thc following declarat ions: <br />Dcnrolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Parr6) <br />-Rcquired <br />lrttcr of Notification <br />-l <br />ccrtify that thc l'cderalregulations rcgarding asbcstos rcmrvalarc not applicablc to this projcct. <br />q[rccrtify that I havc rcad this application and statc that thc atnvc inf<rrmalion is corrcct. I agrec to comply with all City ancl Counry <br />ordinanccs and Stalc [:ws rclaling to building construction. and hcrcby rcprcscnlativcs of this City and County to cnlcr uJxrn thc <br />alxrvc rrrcntioned propcrly for inspcction <br />Applicant or Agenl <br />pernritee n,.me (print):- fugp:- --2, lrb:rl- <br />- <br />orr", C'?4 '?O? I <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf Ioor/VenVl nsu Iation <br />Roof Sheathinq <br />Shear Wall <br />Framinq ol bfr.*?7 <br />Insulatio nlEnerqy <br />Drywall ,t l( ol ,-7r\bt&7 .7 <br />Ext./lnt. Lath I J <br />Brown Coat <br />[Masonry <br />Pool Fence I <br />T-Bar c -7i <br />Handicap Req.,v'r <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />I I tl t-, <br />FINAL I E 'l/l hkYt ;-/ <br />Certificate of Occupancy v <br />Notes,lRemarks, Etc. <br />Id1 - <br />-7 J-I -.1 I <br />2 <br />1 - <br />-lrl -l-.-&H '>14 <br />a <br />tt <br />l)atc: <br />l,ender's Name: <br />a