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BUILDING. INSPECTOR RECORD SITE-WORK V -DATE ID/SIG.COMMENTS Set Backs I Forms/Steel/Holdowns 7fi, lzt ,lx#2" Erection Pads | -(lu UFER Ground SLAB Floor Su bf loo r lV enll I ns u I atio n /'at Roof Sheathins 'rvl)t-A\JBF_ pEJ* * .I/0 C*+_ Shear Wall 1-An"A VlLfrq Framinq v lnsulation/Energy ?,-l?-tt llrr 71 Drywall 7--z(-zl E/J 3q Ext./lnt. Lath 'J 'ZC'Ll ptJrl Brown Coat tttasonry S L(KLll cl>fi 1/rl lu Lw 37 Pool Fence f T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL D -I T.LI tD rSct Certificate of Occupancy Notes,, Remarks, Etc 11 tl 0,z/nh (k I\)t / \-/ t, ! I hcrcby aftrrm undcr pcnalty of Frlury that I am cxcmpt from thc Contrac{ors' Liccnsc [.aw for thc following reason (Scc.7031.5 Bu.sincss and Profcssion Code): Any City or County which rcquircs a pcrmit lo construct, alter, improvc. &molish or rcpair any structurc. prrlr to its issuance, also rcquires thc applicant for such pcrmit to frle a signcd statenrent that lre or she is liccnsed pursuant to thc ;novisions of the Contractor's Liccnsed t-aw (Chaptcr 9. Commencing with Scrction 7000 of Division 3 of the Business and Profcssions Code) or that he or she is cxcmpt thcrcfrom and thc basis for thc allcged excmption. Any violation of Scction 703I.5 by any applicant lbr a pcrmit subjccts thc applicant to a civil penalty of not morc than fivc hundred dollars (S500). __1, as owncr of thc propcrty. or my cmployecs with wages as thcir solc compensation. willdo thc work and lhc stnrcturc ls rrrt irrtcnded or oil'cred lbr sale (Scc.7M4. Busincss and Profcssions Codc: I'he Contractor's License l-aw does nol apply to an owncr of thc property who builcls or irnproves thcreon and who docs such work hirnself or herself or through his or her own cmployees. providcd that such inrprovenrcnts arc not intendcd oroffcred for sale. lf. howcrrcr. thc buikling or inprovenrnt is sold within one ycar of comphtinn. thc Owncr Buildcr will have thc burdcn of proving thtt trc or she did not buikl or improvc thc propcrty for thc purynscof salc). _1. as owncr of thc profrcrty. am exclusivcly contracting with liccnsed contractors to construct the projcct (Scc. 7044. Busincss end Prolirsskln Codc: Thc Contractor's Liccnsc Law docs not apply to an owncr of proJrcrty who builds or inrprovcs thercon. and who contracts for such Jnojccts with a Grntracto(s) liccnsed pursuanl to thc Contraclor's Liccnsc kw). _l am cxcmpt undcr Scrtion_. B. & P.C. for this reason. Date:_0wner:_ WORKERS' COMPENSATION DECLARATION I hcrcby allirnr undcr pcnalty of prjury onc of thc following declarations: _-l havc nnd will nraintain a Ccrtificatc of Conscnt to Sclf-lrrsurc for workcrs'conrpcnsation. as providcd for bySection 37ff) of thc [-abor Gxlc.lirr thc pcrfornuncc of thc work for which the Jrcrrnit issucd. altd will nraintairr workcrs'cornpcnsalion insurarrcc.:LS rcquircd by Section 3700 ol'the [:bor Codc.tbr thc 1^-rfonrmrrcc of l'or ylt'pcrrnit is ,r-rry)conrpcnsation insurancc carrtcr aml ;xrlicy l'tuntbcr arc: )-( Policy 6 Lr LL __l ccrtily that in thc pcrformancc of thc work for which this pcrmit is issucd. I shall not employ any pcrson in any nunner so as to bccomc subjcct to thc workers'conqrensation laws of California, and agrec that if I should bccont subict to the workcrs' comlrcnsation provision-s of Section 3700 of thc [:bor Code. I shall, forthwith conrply with thosc provisions. WARNING: Failurc to liccurc workcrs' conrpensation covcrage is unlawful. and shall subjcct an cmploycr to criminal pcnaltics and civil fincs up lo onc hundrcd thousand dollars ($100.000). in addition to thc cost of compcnsation. damagcs as providcd for thc Scction 3076 of thc Latxlr Codc. intcrest and atlorncy's fces. ?-t I Applicant: LICENSED CON'I'RAC'TOR I)I'CLARA'I]ON I hcrcby afl-rrnr undcr pcnalty of perjury that I arn liccnscd undcr provision of Chaptcr 9 (comnrncing with Scrction 7ftn) of Division 3 of thc Busincss and hofcssiorrs C<lde. and rny liccnsc is in full forcc and cffc.ct. b? 4 t)- Dale:_ W I hcrcby amm undcr Fnalty of Frjury thal IhcE is a constructk n lending agcrcy for thc tErforlllmc of thc work for s,hich this tEmit ir issucd (Scc.3097, Civ. C.). bndcr's N.m: lrnder's Addrcss: APPLIC.TNT DECLARATION I ncrcty allinn undcr pnulty of prjury onc of thc following dcclarations: Dcnmlition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Trtlc 40. Part6) -Requircd Lcttcr of Notification _l ccrtity that thc fedcral rcgulatiorts rcgarding asbcstos rcnxrvalarc nol applicablc lo this projc.ct. ccrtify that I have read this application and statc that thc atnvc inforrnatitxr is corrcct. I agrce to comply with all City and County and Statc laws rclating to construction and hcreby nuthorizc rcprcscntativcs of this City and County to entcr upon the abovc nrcntioncd property tbr ?-l '-Z I or Agenl Ilennilee namc Rev. 0B-07-201 5 I l/.