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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE rD/srG.COMMENTS OwF Build.r D.claration <br />I hereby affm, undcr peMlryofp.rlurylhll I ao,.r.nr aorfl rh.Contrdors Lrc.ns.hw forrh.follosrng rason Ge 7011.5 Bosin.$ <br />and Profsion Cod.): Any Cily o, Cou.ly ehich r.qoic r pdnn ro.oBkucr,ah.r. i,bpN!.. d.molirh or r.piir any srrucrs., pnor lo ils <br />issuance. rbo r.qut.s th. rppli.am aor su.h p.mt to il. 3 sisncd narocm rhlr hcorshc ir licctrscd ,ursua.t rorhc p.orisioBoflt <br />Contraclo.s l-'c.ns.d l-!w (Chipts 9, Commencing wnh S(hn 7oo0 ofDrv6on I ofrh. BBrnd3 rnd Prof6nom cod.)or rhd h. or <br />sh.is.xcnpttficr.fiomrodthcbasisforrh.oll.8.d.x.mprion.Anyviot.rionoaS.crionT0ll5byaoyipplicafllorap.mn3obj.ckrh. <br />appli.rfl lo a.ivilp.nahy 6anor hor. rhan fiyc hundr.d dollic ($500) <br />I.6o*nr6rlhcprop.ny,ornycmploy.cswilh*is.sierhctsolccoop.hsarion,$iUdorhc*ortr.drhcstrucru.i!norinr..d.d <br />orof.red lor*1.( Sec 7or4. Busi..ssand Prof.srotuCod. 1'h.ContictoasL'cens.Lawdoenorirplyto.nownerofrh.pmp.ny <br />qho buildsor implovelh.r.on. andqho dodsuchaork hins.lf or hm.lf or through hk or h.ro\rn rmployes. provid.d ihar such <br />inrrov.mcnh ar. nol iil.nd.d or.aLr.d aor salc. ll howcvd. rh.6uildins or improv.mcnl is sold wilhin on. y.sr ofcompl.lion.lh. <br />Ownd-Builda willhrvc rh. burd.n ofprovine rh h. or shc oot build d, inlrov. for rhc purro!.6fsil.). <br />l. ao{n roflhc prop.ny. r'n.xclu$r.lycontradine trilh licctrscd coalrocloc to coNlrucl lh. protcd (S< 70,1,1- BBr6s lnd <br />Prcf.sionCod.'lh.(-onhcroisL'c.neclrwdo6notapplyro.nownerofpror.nywhobu'ldionn,provGrh.r@n,sndwho <br />cont&ct aor such prcr.crs *irh r Contrcro(s) l'..ns.d puuunllo rh.Co.kacrors L'c.n3. hw ) <br />I d ex.nfl und.r S.crion .B & rc lo,this r.oson <br />roaxEal.larlrErs llar-DEcLAaa.I9! <br />I h€tbyaflirm und.rpemlryofr.ri,'ryon.oath.a.lloNin!d.clararn,ns, <br />I hlr. and will hrinr.i. ! Cdificar. ol aod.m ro S.lf-l nsur. for *ork.6 comp.Mr'on, ds pro!'ded lor by S.cr'on3700 olrh. <br />hbor Cod.. f.r rh. pgformnc. olrh. sorl forwhich thc r.dir ii ilru.d <br />I h.v.and willfrarnrarn wo.kcra onDensrion rnsur.nc.. ds rqur.d byS.cr'on 370Oolrhe lnbnr Code. aorrhep.domanc.ofrh. <br />work lor wh'.h rhB p.rnr i r rsu.d My w6rk.E @mr.nsl'on 'nsuranc. caftir ,.d poli.y nunhe ir.: <br />( llris scclion ne.d nor bc conrpl.lcd ialhe pennn is aor Oi. h!.drcd doll.6 lll00l or l.s) <br />I c.nify thal in rhc pdlornhnc. ofrltc wd for shich rh's p.rmir <br />'s <br />issu.d, I shall nor.mrloy 0n, n.^oi in a.y 'n.nn.r $ is ro <br />b.Gmesuhjdr ro (h. m,ke6 con,penstrrLon lawsofC,l,fornLi. snd !a'e. rhat 'fl should becomcsuhrecr rothe Borker- <br />cor.p.osrion provisions olS(tion 1700 oflh. tnbor Cod( I shrll. lonhwilh complt sirh t <br />eftrl. znd shllsuhre.r rn en,rlover ro .ri,ninal pcn.hi.s and.i\ il <br />lin.s up ro on. hund.cd tho6Md doll6 ( $ 100-000).in addilion to rhc cosr ofcomp.nsarion, damlscs 6 provid.d ror ln. Serion -1016 of <br />rhcbborCod., ihler.sr lnd ttomeyt fes <br />LICENSED CONTRACTORS DECLARATION <br />I h.r.by ifiinn undcr p.nally ofpcdury th0i, am lic.ns.d undcr rmvisio" ofChdpir9(co,nm.ncins vilh Scdion 7000) ofDivision I oi <br />rhc Busin.s and PmfcssionsCod., md my lic.tr. is in folt [or...nd.ft cr <br />I hdcby arm und.r p.,rll, olprjury rhrt rhoc i! ..oBlruclion l.ndi.g .8.m, lb. th. pdromlnc. oflh. wor* aor wbicb rhir pmi i! <br />issu.d (S( 3097. Civ. C.). <br />4r8UClrr.l9EC!AAAL&! <br />D.rolirFnPermns Asbc osNorific.rion Fcd.ral Rcsuhrtuns(lirlc40.Pan6) <br />R.qutcd ldt.. of Nori6calioo <br />I c.nifr rhar rh. a.dml r.*ul!r ions r.strdiu abdrosrchovrlrc norapplicabhro rhh pioj.cr <br />I c.niay rhd I h!!. r.ad ihisapplic.rionands{crhii rh. ibo\. inlom.rion is.onc.r I 4r.. ro .omply anh all ciry rnd Cormy <br />o.dinanc.s.trd SI.l. ti\rs r.lalins ro buildins coBrrucr ion. rnd h(.b, aurhort. r.pr.s.nhliv.sofrhis ('irr.nd Cornly lo dl.r lpon lh. <br />abole n.mi...d prop.ny fot <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUlnsul <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL oiltAh<-r19{,. -t vuht, <br />Certificate of Occupancy -l'- | V U u-/ <br />Notes, Remarks, Etc <br />M:\WP51\Pormil-lnspeclion f orms\A!ilding lnsp6clion Record doc 03.31 06 <br />Brown Coat <br />-t\<ft+w(Y5 <br />-----r-- t