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BUILDING- INSPECTOR RECORD <br />SITE-WORK tD/stG.'COMMENTS OWNER BUILDER DDI,CARATION <br />I hcr.by ammr undd p.n.lty ol pojurl rhal I m c!€nDr Eon rh€ contacrom Liccnse LaN lor thc follosin8 r.en (s( 70l l 5 <br />Busin6s md Proasion Cod.): Any cn, or county Nhicn requtB . psnil lo co6ttu.t, .1i6. nnprcve dflolsh or rc1dn dy <br />struc1ua. pnor ro irs Budcq also reqtrt6lhc applicanl for such pmil rr' nl. a si8n.n natemd tha n€ or sic is lics.d pu$el <br />ro lhe prorisions ofrhe Contacro.s Lic.n*d bw (chaprcr g. Comnrencing wilh Ssri.n 7000 ot oivision I ofrh. B sincs md <br />Prcf*ions Code) or rhar hcorsh. iscx.mpt ihd.trom d rh. b6is lor theall.s.d.r.mpion Anyviolalionofselion?0ll5byanv <br />apDlicant for a p6nir lubt<lsihc npplic.nt to.cnilpeaaltyolnol oorerhe filehondreddolleslSS00) <br />I. 6 ovns of thc prcpsly, or iy mploy6 Nnh NasB s thcir sol€ collFtrerio.. {ill do th. {o ( {'d thc srucru. is nor <br />iordded or oard.d ror el. (s{.7044. Ausin6s and I'roaeiore Cod. l h. Conrraclois l-icqse lntr .loe nor tpPlv b a" oMd .l <br />rh. !6Fny lvho boilds or imlrov6 lh@n, ed who dos such rvo't hims€lfor hdlaor rluo!8i his or h€r own.mplor.6. <br />prcvided lhzr such inprovffirs m mr inhi.d or or.r.d fo, ek lf. howd6, $. btildi.S o, nry.o\ .1Mt is $ld wnhh ooe yw <br />oi comrErior thc OUM Buildd wiu hilc th. hrdd orrroribE rhd hc or she Jid ml boiu or nnFro\t rhc piopdly lor lh. pu,IF& of <br />-l.6om6oarhe <br />protdr. ncxcnNivcly cotuaclirr rvilh licNd contaclo6lo conslrucl rhe pmrd (Se.7044, BBin6 <br />ed Erfesion Codcr 'l h. Conracrdas l-ic.6. L,re do6 not amlt ro afl oNn€r o f r/openy *ho buildi or improvcs lhdcon. <br />!.d who conk ds for such l,oj.ds wnh a Cor racio(s) lico*d pr@.r r. rhe(onlraclri ljcose l-as) <br />I m.r.md und6 S(lion .B &PC forrharcen <br />Drte: Orre: <br />llaBtrlBfl(9-UtgdlAfror <br />DECLARA'UON <br />I hscby amn uhds p6ahl olpiur) oic ollh.lollorvins ddlfati.nsl <br />I have ud s i ll mai.rain a cdilicarc of Congt lo S€lf- lsur€ for sork€n conrpensarion, s Fovid.rl ior by S.ci ion I700 o f lhc <br />Labor Cod€, lor rhc psfomMc. olrh. $o.t for shich lhe pdnit G isued <br />-l <br />ha{ ed Nill Mantrain wolteB comp€Nalioo iarulane- as reiluir.d by Sdion ll?00 ol rh. ljhor Code. lor lhc psromdce of <br />lh. sorl lor *hi.h rhis Fmil is isuqi. My workes' .o'np.6ation imu!.ncc caris od plicy numbr dclMt Etul <br />^"',,.., <br />qlll 3 5 x <br />l0 I ccni! rhal in rhc ndfomanc. oathc Nort for which Ihis psn is issded. I shall nol mplq any r.6on in onv ronq <br />so s to h..oftc $bj(r b th€ wo*qs conpensrion taws .fc.lifomia. nnd asr rhal il I shduld b.tomc subjecl lo lhe <br />lvorkm.oflp.nsarionprovisiosorsc.lionlT00olrhcl?ll.r(bdc.rsh.ll-aonhwnhcomplywirhrh.sprolisn,ns <br />WAR-NINC Piilut ro surc sorkql composarion .ovrasc is unltelul. ud shau subjd r dplo$r lo simiml FrlriB &d <br />ciril li.es up lo onc hundrcd lhousdd dollds ($100.{xr0). ih 0ddlioo ro rh.ion. danascs d providcd for ihc <br />s6r ion 1076 o t lh. libor Cod., inrad ed aiomey <br />Da,c I hl ('J <br />^,,,.",,r Drr( r.\R.\ll(rN <br />I hqeby aiin. undr loalry of ldjury rlDl I m licasd und6 lro\ ision olChapld 9 (commocins $ilh sdrion 7000) ofDivisio.l <br />ol lhc Busin6s .nd Pol6$oc Code. 4d my licme is itr tull torce od efi(l <br />b <br />k("C <br />0 1q3U, <br />it <br />ArflrcaNfD[ci.aSallaa <br />I hd, atrnn uid6 Fnalty of Fjury onc oarhc aollo$in8 deldal ions <br />Deoolnion Pcnnir.-Asb6ros Nolificarion Fcdsal Resulariols (Tirl. 40, lb16) <br />-Roiun€d <br />lit6oaNorifi calion <br />-l <br />cenirylhal lhe tcdsal t sultrios ESddins 6bc(os renovald. n.ramli.sblc lo rhis proiccl <br />yt ccr'rrrhd I lwe , e.d rhis .pplicar'on <br />oidi.ancB ed srrlc ljws Elatios ro buildi <br />and srarc rhd rht d&'rc nrfo nalion iscodEr I alle to conrtly rirh rll( iry dld (-ou.ly <br />ir6 olrhis cny and Counry ro ord trpon fi. <br />abovc,n€nlion.n prep.ny lu <br />\L ^- ult+ltt <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />FINAL Itlzq lt,, I t. 0"/t.-tr /4,1/t+/-i) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />DATE <br />Flood Zone Certif. <br />t <br />IAX$IBUCIIOII,EUUNC-8GENII <br />I hdcby .llm und6 Fnahy of lqjury lhal lh6. E a ooBltuction ldldirs asd.y for lhc pofommc. oflh€ wo* lor Nti.h lbis p6,nil is <br />issued (sft.3097. civ. c.) <br />Len.lH , \5me <br />- <br />H- <br />--------T------