Laserfiche WebLink
SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf Ioor/Ve nt/! ns u latio n <br />Roof Sheathinq <br />Shear Wall <br />Framinq t'tz-Lt .D;vrP Yr. <br />!nsulation/Enerqy <br />ffintall \' <br />= xt.\iltLitlInt. Lath qr- <br />-u^14 yCoatqluZL <br />lVlasonrv I <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Reoort <br />Flood Zone Certif . <br />(ta,oa 9n*otrr*t{z-Lr Da163 4t <br />F!NAL 0 lr z-t 7 <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />BUILDING- INSPECTOR RECORD <br />olVNI'R I}TIII,I)ER <br />I hcrcby alfirm undcr pcnrlty of JErjury Ihat I am cxcmpl frcm lhc ConlracloN' Liccns lrw for lhc following rcasn (Sc.7031.5 <br />Busrncss ard Profcssion Codc): Any City or County which rcquircs o lEnnil to @nslruct, alts. improvc, dcmlish or rcpair any <br />slruclurc, prior to ils issuancc. also rcquircs thc upplicant lbr such JErmit to lilc a signcd slulcmnt that hc or shc is licenrcd pursu8nt <br />to lhc pruvisions of lhc Contraclor's Liccnscd law (Chaptcr 9. Commcrcing wilh Scction 70OO of Division 3 of thc Busiress and <br />PrcfcssionsCodc)orthathcorshciscxcmptthcrcfromandthcbasisforthcallcgcdcrcmption. AnyvioletionofsationT0-ll.5byotry <br />trpplicunt tbr a pcrmit subjsls lhc spplicunt to o civil pcnalty of nol nmrc than llvc hundrcd dollss ($500). <br />_1. as ()wncr of thc proprly, or my employecs with wagcs as thcir solc comlrcnsalion. willdo thc work and thc structurc ls not <br />intcndcd or offcrcd for salc (Scc'.7044. Busincss and hofcssions Codc: J'hc Contractor's Liccnsc Law docs not apply to an owncr of <br />thc prc1rcrty who builds or irnprovcs thcrqrn. rnd who docs such work hirnsclf or hcrsclf or lhrough his or hcr own cntployccs. <br />providcd that such improvcnrcnts arc not intcndcd or offcrcd for sah. If. howcvcr. thc building or improvcnrcnt is sold within onc ycar <br />of corrplction. the Owncr Buildcr will havc the burdcn of proving that hc or shc did not build or improvc thc propcrty for the purgnsc of <br />salc). <br />_1, as owner of thc property. am exclusively contracting with licenscd contraclors to conslruct thc projcct (Scc. 7W. Busirtcss <br />and Profcsskrn Codc: The Contractor's Liccnsc Law does not apply to an owncr of propcrty who builds or improvcs thcrcon. <br />and who contracts lbr such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc l-aw). <br />_l amcxempt undcr Scction_, B. & P.C. lbrthis rcason. <br />I )atc. ( ) rllre r <br />WORKERS' COM PF'NSATION <br />DECLAR/tTION <br />I hcrcby alTirrn undcr pcnalty of perjury onc of thc following dcclarations: <br />_l havc and will nraintain a Ccrtificalc of Conscnt to Sclf-lnsure for workcrs' compcnsalion. as providcd for by Section 3700 of thc <br />Labor Codc, for thc pcrformancc of the work for which thc pcrmit is issued. <br />_l havc und will rnaintain wurkers' compcnsation insurancc. as rcquired by Scction 3700 of the l,abor Codc, for the pcrformancc of <br />the work for which this pcrrnit is issucd. My workcrs' comlrcnsation insurancc carricr and plicy numbcr are: <br />b a <br />Policy J a 2 z <br />_l ccrtify that in thc pcrfrrrnuncc of thc work for which this prnrit is issued, I shall not cntploy any pcrson in any nunncr <br />so as to bccomc subjcct to thc workcrs' compcnsation laws of California. and agrcc lhat if I should bccome subjcct to ttrc <br />workers' compcnsation provisions of Scction 3700 of thc Lahlr Code. I shall. lbrthwith cornply with thosc provisions. <br />a <br />WARNING: Failurc lo :iccure workcrs' <br />civil fines up to onc hundrcd thousand <br />Scction 3076 of thc Labor Codc. intcrcst <br />Dare: e tnltllat <br />compcnsation coveragc is unlawful. and shall subjcct an <br />dollars (S100.000), in addition to thc cost of compensat <br />cmployer to criminal pcnalties and <br />:ion. danrages as providcd for thc <br />and attorncy's fccs. <br />t)trc't.Atr^'t't()N <br />I hcrcby afl-rm undcr pcnalty of perjury that I am licenscd undcr provision of Chaplcr 9 (contrncncing with Scction 7000) of Division 3 <br />of thc Busincss and hofessions Codc. and my liccnse is in full forcc and effcct. <br />, <br />I <br />)*/0546o1 <br />Licensc Numbcr:ed -1 <br />W <br />I hcrcby amrm undcr Fnalry of pcrjury thal therc is I @nstruction hnding agcncy for lhc lErfonmncc of lhe work for which this Frmit is <br />issucd (S€. 3097. Civ. C.). <br />Lcndcr's Narnc: <br />lrndcr's Addrcss: <br />A PPLICA NT DECLARATI()N <br />I trcrcby alfrnn undcr pcnalty of pcrjury onc of the following dcclarations: <br />Dcmolition Permits-Asbcstos Notification Fcdcral Regulations (Title 40. Part6) <br />-Rcquired <br />l-cttcr of Notification <br />_l ccrtify that the fedcralrcgulations rcgarding asbcstos rcmovalarc not applicablc to this projcct. <br />ccrtify that I havc read this application and stalc that thc atnvc inlbrrnation is corrcct. I agrcrc to cornply with all City and County <br />ordinanccs and Statc ljws rchling to building construction. ard hcrcby authoria rcprcscnlativcs ofthis Cily ed County to cnter qnn thc <br />abovc rncrrtioned propcrty for inspcction <br />Applicant or Agent <br />l)crnritm nnnle <br />rn?rrrG.rtr< (Or nPo r\ tl <br />-f- <br />_Expircs:Q/o <br />qB <br />o,,", r ufllf)t <br />pn*y, D( .S:rr.Gi Gcr tCtCt