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SITE.WORK DATE ID/S!G.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns f-22-t ct 11c27
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bfloor/VenUl nsu lation
<br />Roof Sheathing t al--l 6 O t o-h
<br />t- aD^)f;r^)
<br />Shear Wall v II tv-o I 'f l/rt-rr <4^t- th>u f
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath 00tz-rI [Lc At 7
<br />Brown Coat //-/1 I Ec z?I
<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 6_ZL/_fc)lL €-t 3terltsi *27
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.zL-t
<br />T
<br />r hcrchy alrrn, under penarty orpcrjury rhd i'JliX}#lft"lt['.t'"t'ff.l*l'',:,[,." r.aw ror rhe roro*ing rea
<br />x:',',:1",,:;:,llll*"'::;1t';,1,"1;"','*1;.Hi:ilTiJfl"ffii ffiillur'ff1;#T',ffi:';:,i:'ffi:ll:i:il
<br />to lhc provist)ns of the Conlraclor's l-icenscd Law (Chapler 9. Comtnencing with Sccliur 7000 of Division I of thc llusines'-"
<br />l'roltssionsCode)orthalheorsheiscxempllhereirornandthebmisforlhcallegedcrorption. AnyviolationofSectionTl)11.5t7
<br />applic.nl[orapennitsubjslslhe applicantloacivilpcnaltyofnotrnorelhmfivchundrcddollus($500). f
<br />- I. o osto of lhe propeny, or my employs wilh wa86 6 their sle cornfmstion. $'ill do lhe u,ork md the slruclue is not
<br />intadcd oroffsedforule(Se.7044,BusinssadProfeionsCodeTheConlraclor'sl-icflseLawdo6notapplytoanosnsof
<br />thepre[Edy rvhobuildsorimprovelh6on.eds'hodo6suchworkhimselforhmclforthroughhisorherorwemployec.
<br />providcd lhat such improvmmts ae not intfidql oroffaed for ele. Ii horvor. the building or imptovmmt is rld within onc ymr
<br />ofcompluion. the O*,nq Buildq will have the budo ofproving thal he or she did nol build or improve the prcpety for the purpow ot
<br />ulc).
<br />_1, as orvner ofthe propqty, m exclusively conlracling with licmsed contracloF lo construcl lhe project (Sec. 7044. Eusincrs
<br />rud l\rrfission Code: The Contraclor's Liccnse [,aw do6 not apply to an owncr ofpropcny who builds or improvcs lhereon.
<br />and rvho conlracts for such poitrts with a ('ontmctor(s) licensed pursuanl to the Contractor's License Law).
<br />x",:,jii"i; *"ru
<br />/ - $0BI[i[s'coMpENsATt0N
<br />DECLARATION
<br />I hereby affirrn undo penalty of pojury one of thc follorving drlaatiom:
<br />IhaveadwillmaintainaCenificateofConsmttoSclf-lnsureforwork6s'cornp€nsation,o providedforbyS(tion3700ofthe
<br />Labor Codc. for the pefonnmce of the work lor rvhich the pmit is issued.
<br />I havc and rvill maintain workss cornpensalion insurance. o required by Section -1700 ofthe t,abor Code, for the pofornrance of
<br />the work firr rvhich this p€mit is issued. My workes compensation irsurmce caricr md policy numbe ue:
<br />,^,*,,{ vc.re<I ,A.b,\n,u,l T.G,otoca S4.
<br />PolicyNunrrr: J LOOO I5,-:t-O+I n,on* lt/r /t?
<br />I cenify lhat in the psformance of the rvork firr rvhich lhis ponit is issued. I shall nol mploy any pcreon in any nrmncr
<br />m astobocomesubjatlolhewort6'conrpenstionlarvsofCaliftrmia.adagrcthatiflshouldbecomesubj€ttothe
<br />workss' comlmstion provisioro of Setion 3700 of the Iabor Code. I shall. fonhu'ith comply rvith tho* provisions.
<br />WARNINC: Failure lo sure N'orkos'compmalion coverage is unlarvful. and shall subje*t an mploya to oiminal poallie and
<br />civil finesuptoonehundredthousanddollas($100.000).inadditiontothecostofcompensalion,damagesasprovidedforthe
<br />3076 of lhe Labor Code, inlsst and attomey s fs.
<br />I hercby affirm unda pmalty ofpojury that I un licmsal unda provision ofChapto 9 (cornmmcing rvith Setion 7000) of Dir ision 3
<br />of lhe Busins ild Profsiou Code. ud my liceree is in full force md effat.
<br />6l-iccnsc ( lass:
<br />-License
<br />Number:1tz1 aZ
<br />""",1lLLlt1
<br />CONS'TRUCTION LENDINC AG ENCY
<br />I hoeby aflirrn undr poalty ofptrjury lhal lhqe is a construction lending agency for the pcforfiance ofthe work for rvhich this perrnit is
<br />issucd (S*. 3097. Civ. C.).
<br />Lends s Name:
<br />AdrLcss:
<br />,\l'Pl.l( ,\\ I DI!( t.,\lt,\ I lO\
<br />I horby affmn unds p€nalty ofperjury one oflhe follolving delilations:
<br />Demolition Pqmhs-Asb6los Notification Fedqal Rcgulations (Title 40. Part6)
<br />Rcquired l,elter of Notifi cation
<br />I colify that lhe lederal regulations regdding retrcstos removal ae not applicable to this projmt.
<br />I ceaify lhat I have rad this application od statc that the above infonnation is cor(t. I ag.e to comply with all City and County
<br />ordinanca md State [:rvs relating to building coNtruction. md htreby authorize rcprGmtativ6 of lhis City md Counly to mtq upon lhe
<br />above motioncd pmperty fo. iNpection purpos6.
<br />/ Applicsnt or Agent
<br />\Permilm nanc
<br />*", llzultl
<br />BUILDING. INSPECTOR RECORD ,
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