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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />Insu lation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />h\ <br />FINAL l0-9-a)h.lt[),fy <br />Certificate of Occu <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCARATION <br />I hcrchy allirm urrdcr Jrcnalty ol pcrjury that I m cxempt Irum thc Contraclos' Liccnsc kw lbr thc lirllowing rcavrn (Scc.70.11.5 <br />Busincss nnd Prolc$skrn Cq.lc): Any City or C(lutrty which rcquircs a lEmit to construct, altcr, impNvc, dem)lish or Elair rdy <br />structurc. pri(rr to its irsuancc, alv) rcquircs thc applicanl li)r such lrrmil lo file a signcd stalcmcnt that hc or shc is liccnscd pursuant <br />b thc prtvisions of lhc G)ntracbr's l.iccnrd [:w (Chaptcr 9, Commcncing wilh Sslt]n 7000 of frivisi(]n J of lhc Busincss md <br />Pr)lcssionsCodc)orth{tlEorshciscxemplthcrctiomandlhcbasislbrthcallegcdcxcmption. AnyviolalionofsetionT0-ll.5hyany <br />applicant lor a Jf,rnit suhjccts thc applicnut to a civil pcnalty of not m)rc the tive hundrcrl dollus (3500). <br />1 <br />1 <br />_1, as ()wncr of the proJrcrty, or my cmpklyees with wages as their solc comlrcnsation, will do tlrc work and thc structurc Ls nrtt <br />intcndcd rlr olll.rcd lirr salc (Scc.7(X4, Busincss and Prol'cssions Crxlc: The Contractor's Licensc [aw docs nol apply to an tlwncr ol' <br />thc pn)pcrty who builds or impnrvcs thcrcon. and who drrcs such work himsclf or hcrsclf or through his rlr hcr own cntpkryccs. <br />prcvidr.d that such inrpnlvcrncnts a.rc nol uttcndcd or ollbrcd frrr salc. If , howcver, thc buikling or intpr<tvcmcnt is stlkl within onc ycar <br />ol'comphtion. tlrc Owncr Buiklcr will havc tlrc burden ol'proving lhat hc or she did not buikl or impruvc the prupcrty fbr thc puryls,c ot' <br />sah). <br />_1, asowncrol'thc pr()pcrty, amcxclusivclycontracting with licenscd contraclorstoconslruct thc pnljcct (Sec. 7M4, Busincss <br />aml Pnrtbssion Cotlc: 'l'hc Contraclor's l-iccnsc Law does not apply to an owner of propcrty who huilds or improves thcrcon, <br />antl who contracts frlr such pnljccts with a pursuant to thc Contractor's Liccnsc Law). <br />_l am lirr this <br />I hcrchy al'l'irnr undcr Jrcnalty ot'Jrcrjury onc of thc tblklwing dcclarations: <br />_l havc and will nraintain a Ccrtilicatc ol'Conscnt to Sell-lnsurc frrr workcrs'comlrcnsation. as pnlvidctl lilr <br />l:txrr Crxlc, lirr thc Jrcrlilrmancc of thc work tirr which the Jrcrmit is issucd. <br />.17fi) ol'thc <br />_l havc and will nraintain workcrs'contJrcnsation insurance, as rcquircd byScction 37fi)of thc LahorCode, lilrthc lrcrlirrntancctll' <br />thc work lirr which this Jrcrmit is issued. My workers' comlrcnsation insurancc carricr anl Jxrlicy numbcr arc: <br />Carrier: <br />Policy Nunrber: Expircs: <br />_l t:crltly tlrat in thc pcrlirrnrancc ol'thc work lilr which this pcrrnit is issucd. I shall not cmploy any pcrson ilt any mannL'r <br />so as to hccomc- suhjcct to thc workcrs' cornpcrrsal ion laws ol'Calilirrrria, and agrce that if I should hccomc subjcct ttl thc <br />wrlrkcrs' conrpcnsalion pnlvisions ol'Scclion l.akrr Codc, I shall, tbrthwith comply with thosc provisions. <br />IVARNIN(i: ljailurc l() sccurc workcrs'is unlawl'ul, and shall subjcct an cntpklycr ttl crintinal J-._ltaltics and <br />civil I'incs up lo onc hurrrlrcd thousand dollars addition to thc cost of damagcs as providcd ftlr thc <br />Scction ol'thc <br />-i <br />and <br />I lrc'rchy al'lirnr undcr Jrcnalty ol'pcrjury tltat I ant licenscd undcr of Chaplcr 9 (commcncing with Scclion .l <br />ol' thc Busincss and Prot'cssions Codc. anrl my liccnsc is in tirll lirrcc and cffbct. <br />Liccnsc Class: Liccnse Numhcr: <br />CONSTRUCTION LENDING AGENCY <br />I hcrchy allirm undcr Fnalty of Frjury that thcrc is a conslructbn hnding agcncy for lhe Jrrfotmrec of lhc work lirr which this JEmil is <br />issucd (Scc. .1097. Civ. C.). <br />lrndcr's Name: <br />[rndcr's Addrcss: <br />APPLTCANT DECLARATTON <br />I lrcrehy atlirm undcr Jrcnalty of pcrjury onc of the lirllowing tlcclarations: <br />Dcmolition Pcrmits-Ashcstos Notificalion Fcdcral Regulations (Title 40, Part6) <br />_Rcqu irctl [rttcr ol' Notilication <br />_l ccrlily that thc l'cdcralrcgulations rcgarding asbcslos rcmoval are not applicablc to this pnljcct. <br />_l ccrtity that I havc rcad this arxJ slate that thc ahlvc inlilrmation is corrcct. I agrcc to with allCity and County <br />rlrdinanccs antl Statc [-aws rclating and County to cnlcr <br />ahrve nrcntioncd prol^-rty lirr <br />Applicnnt or Agent <br />Pentritee nanre <br />constnrction, and hcrcby uprn llrc <br />B.&