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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steeli Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />D rywall <br />Ext./lnt. Lath <br />Brown Coat <br />N4asonry <br />Pool Fence <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />s\5-Z^h'k{2)./ <br />Certificate of Occupancy <br />No.tes, Remarks, Etc <br />OWNER BUILDER I'EI-CARATION <br />I hs€by amrm rndo p<nahy ofpcrjury that I an cx.npl Foh lhe ConImclom Liccnsc LaN for lhc lolloNiog r€@n (S€c 7011.5 <br />Busin6s and P,of6ion Codc): ny Cit, or cou , Nhi.h rqut6 r pdnil lo co6rrucl. alr6. ihprov., d@.lish or repan my <br />sttudu.. prior ro its i.sumcq also rqun6lhc Aplicanl lor such poni to 61. a sirn.d sr"rdnd rhat h€ or $c is lic€nsen puIJUml <br />ro lh. FovisioB of$€ Co,tracto.s l-io..s.d b* (cnrpis 9. Comm.ncins with Sslion 7000 of Division I ofth€ Dusin€s ed <br />Pmf6sions Cod€) or rhar lE or sh. t.x.,npl lh6.fro md thc bsis tor lh€ all.rcd d@ption. Any liolalion olsdion 70.r I 5 by any <br />appli.d foi a pmri subjea th. applica.tloacililp€.alirolnotnor€lhanfivrhundreddoll&s($500) <br />-1, <br />s o* nd ot rh. l'oFny. o ny .nlPlo!6 $nh saE6 6 rh.t $1. comF6ation. will do rhc No* dd t $MG is tur <br />intsd.d or o lla.d lor elc (56.7044. Buin6 and PrcfsioB Codc ft€ cont dor s Licd. t-aw do6 nor appl, lo a own6 ol <br />rhr porrly who builds or inptuv6 thd@n, ed wh6 dd6 su.h wJrk hlBelaor hd€l t or rhruush his or ho own chtloys. <br />proride{l rhal sucfi i'.t.ov@rs e 'or intaddl 6r ofio.d fo' sh Il howd6, rhc hrildin3 or imprcrarcd G $ld vilhin o.. ,sr <br />ofclmplclio!. lhc O* os Builjr $ill h.( lh. hndd otFovins lha h. or 3h. did mr tnild or improve fic preDqly rot rh. purts$ oa <br />l.6 own{oflhe Fopcny. dexclusiv.lyconrh.rios \ith licoscd conhadouro coar ct lh. lroject (S(.7044, B6'n* <br />.nd Pslsiod codc: Th. Conrraclois Liccnse l,aw do6 not apply lo eowns o lDorrry sh{, buildr or imptov.s lhdsn, <br />,nd *ho co.ta.k for such prcjdts wilh a (bnrmdo(s) lics.d puEuot <br />I on.x.mpl undr S( <br />I hdcby .finn' ud&r p.tah! ol pajtr <br />I havr dd eill ,n.intoin a Ccniarcarc ol Consflt ro Sclf-lnsur c for wrkdi' cdnrpeftd r, a1 trovid.d lor bySdion l?00 ofthc <br />rib.r coda for rhe p6aollMc. oalh. md for $hicn the pqnil is isued. <br />-l <br />have and sill mainlain workers Nnpc6.l n insranc., * r<lutcd btsdtion l7O0 oarfi. Labor Cod€. for lh. pdLnnec.of <br />the sork lo' which Ihis pdnir is Gsued My wor lcru' co6p.@rbn iNuecc c.tri6 dd polic, nunrbq dc, <br />Policy Nombd:-Exp;s: <br />I ccnify thar in lnc Ffomancc olrhc \rcrl ror shich rhis ponir ir i3strcd. l shall rot anploy anr, p6on in any nr&nd <br />s aq ro b.cone subjd $ rn worl6' conpcns,rion ln$ s ol C alilbmia. ed .s@ lhal if I should b€(oo. 3ubje! <br />'o <br />lh€ <br />*0*6' conrDctudion arovisioB of sdrion 1700 of rh. Ijh.i ('odq I slEU. tonhwithcomplyw h lhoe porsons <br />NING Irailoie ro wr. Norkol compasalion covemgc is unla{ful, a d sharr qrblor m dplo).r ro <br />fincs up ro onc hrtrdrcd thousand doll s <br />n 1016.1'rlr lri-' {'.d. inrdsr and <br />a <br />I lErctry imnn uods rEtr.llyoiperjrr ll'al I a'n I <br />of rh.ausins d I'rofsionsCode. dd my liccBc is in lullio.c€ad€u€cr <br />Li.cdc( ldss: Licens. Ntrmber <br />(axilaucuox-LEllM-ac[Ncv <br />I h6cby artrn und6 pcnahy oi psjury lhal lhac is a codtru.lioi L.dii8 ae6.r lor the pafommcc ollhc wor[ aor *hi.h this Fnnn ir <br />isu.d (sd. 1097. ci! c ). <br />ATTII(ANIIEII,AAAIIO! <br />I lEltry afiN trndd paahyoapqjuryonc ofth. follorvins ddlaalions: <br />D€mohion Psnirs-Asbdros Nolificarion lj€ddal R.glhrions (1ille 40. Pan6) <br />-Req!ted <br />l-clld of Norifi.aion <br />I r€gu lar o.s Estudi.s Nlrstos rc,noval a e nor applic abl. to I h is rmj (l <br />rcad rhis applicntnrn dslarcr h.omply \rirh trllCnyand ( ou.ry <br />c h\s clarin8 ro huilding oarhis CnyMd Counlyro cnrs trr.. lh <br />,"*,,*""vl <br />,.,",/t/tr/< <br />T-Bar <br />FINAL <br />9 (conmcn.inB eirh SElion 7000) orDivis'on l