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BUILDING. INSPECTOR RECORD <br />DATE ID/S!G.COMMENTSSITE.WORK <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enUlnsul. <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/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 />Engineer Final Report <br />Flood Zone Certif <br />f -94. 11 JJ.Sz bGr\FINAL <br />Notes, Remarks, Etc. <br />of <br />I lucby rff[m uoda pcillty of psjury rtut I u oxmpt form thc Cotra8dotr' Li6ro lrw fot thc followitrg roon (rrc.703 I . 5 Buinor <br />and prof*rioo Codc): Ary City or Couty which rc{uirs s pdmit to oEtruct' tlt6, improw, dcmolilh or rrleir rny !trug1ug prior to ii <br />itrut8!,rlsotcquirBthorppliontfornchpqmittofilcrtiSncdrtetmnt thathaorlhciliccNcd pulwttothoptovitiouofthc <br />Coilncror's LircruGd Lrw (Chrpt6 q Commcncint with Scction 7000 of DivirioD 3 of thr Buitr{ &d ProforbB Cod.) ot thlt hc or <br />shc is qcmpt thscfrom rnd thc brrir for tho rll6?cd qcmption .Any viohtion of Soction 7031.5 by any rppliont fot r Pmit subjcrt! the <br />tppliant to r civil pculry of not mrc tlln fivo hundrod dolhn (t500). <br />_I, I oms of thc proporty, or my cmploys with ugd r! thcir rclo comlcutio4 will do thc mtk md thc rtruawc i! not intmdcd <br />i?idtrcd for slc ( Si.zO44, AuilK ma Profqrions Codcr Thc Contr.Gtor'3 Licffi l:w do6 not rpply to m oma of tho proporty <br />who buildt or improva thao4 rnd who doo ruch work hiruGlf or hanolf or through hir or ls om ?mploy6, providcd lhrt ruch <br />improvcm@B r; rct intcndad or ofrdcd for slo. Iq howcv6, rhc building or improvcmcot ir sold whhin onc y{ of @mpletion, tlE <br />Ow.Buildq will hevc thc burdm of proviry that hc or rhc not build or improvc for thc purporc of rlc). <br />_I, u oma of thc propsty, tm qcluivGly ootrecing with lieucd @otfrctott to oilttuct thc projca ( Scc. 7044. Buinqr rnd <br />ffi'fcion Codq Tho Conmaor'r Liroc Lw dc mt rpply to u ow of propaty who builds or improva thcon , ud who <br />ontrras for ruch protcE with r Contr&tot(3) licmtcd puBuntto thc Cotttnclor't Lic@a ttw.). <br />-I <br />u cxempt unds Scciion & P.C for thi rcen <br />Date: <br />WORKERS COMPENSATION DECLARATION <br />I hocby rffum unda pcrhy of p<jury ono of tho follo*ing d*lentiou: <br />_thrvoudwillmrintrhrCcrtifiqEofcotrctrttosclf-IEutcforwr\ttr' @mpcMtiortu providcdforbyScaiotr3T0oofthc <br />ilbor Codc, for thc pqforronrc of thc work for which tho pcnit ir irsud <br />I h.v? ud will roitrtrin workan' @mpffition iNunDca, u 4quircd by Scction 3700 of thc lrbor Codc, for thc paformne of tho <br />-rcrk for which this pemit it i$ucd. My workd' omPcffitioE'irourane mkr rnd Policy numbs sro: <br />Clhis rclion mt bc @mglct d if thc Orc hundrcd or lcs) <br />t sdiry thrt in thc psrfomn* of thc wotk for which thir pa'mit ir imod, Ir}dl oot mphy roylmoa in anyMq rc r to <br />bcomc rubjcr to tho wrko ' ompcnltlon Lu of Crlifornie, rod rgre that if I rhouH bcom tubjst to thc wotk6' <br />ompcnruion proviriou of Scction 3700 of thc Lbor Codc,I rhdl, forthwith omply with thoro provilions.. <br />WABIYING: Priluo to rcor6 mr&o' compsustion @w.gc ir unhwful, ud shlll tubj@t u Gmploys to Gimiill ponltis rnd civil <br />fina up o orc hm{rcd thoud dousr (81 00,000),in rdditiotr to thr olt of compcrutioq drmgcl u providcd fot tlE S*tion 3076 of <br />thc Lbor Codq intqBt ud rttomcy't fs, <br />I,TCENSED CONTRACTORS DECLAnATTON <br />I hssby rffirm undq pculty of pejury t}at I m lieucd undc provitbn of ChrptGr 9 (ommctroitrg with Sstion 7000) of Divirion 3 of <br />thc Buriru rod Profcriou Codc, rnd my liccuc ir iu full fore rnd offccl <br />chs: Licoroe Numba <br />ihacby"ftirmundup.Dltyofp6juryt,ht*,ffirronmofthcworkforwhichthi!pqmitit <br />i$uci (Se. 3097, <br />Lcnds'r Ntmc: <br />Civ. C.). <br />knda'r Addrru: <br />AITIJCANIILDECIiASAIION <br />Dcmlition PamiB-Arbstor Notiliotion Fod.nl RcgulstioB (Titlo 40, Prn 6) <br />_ Rcquircd lrttr of Notifiotion <br />to thir projoct <br />with ell City ad Couty <br />rbovc mcntioned <br />Applient or a <br />Pcrmitt€ Bma v <br />for <br />rcgrrding aro <br />rrd to 6ts upon tho <br />!