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BUILDtNG. INSPECTOR RECORT) <br />ID/SIG.COMMENTSDATESITE.WORK <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enUlnsul. <br />Roof Shreathing ttShear Wall <br />6-{i, tl ffil'/{)Framing <br />I <br />fllnsulation/Energy <br />-4€s</IDrywall-\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 />Alv{ut \llrY,'n er,/ ,cfiffirN vJt1ltrrthFINAL <br />Gertificate of Occupancy ,I <br />Notes, Remarks, Etc. <br />A <br />3 -za-- <t lo( - Ccs:surr E.re . I <br />pA/3*rl <br />I huoby rffirm undo pmlty of pcrjury rhrt t m umpt fom tho ContncoD' Li4uc lrw for thc iollowin8 rootr (!cc7031.5 B{tiEt <br />and profo[ion Codo): Any City or Couty which rc4uira r pclmit to coEtruc( rlt6, improw, dcmolirh or tGPrL rtry rtructuc, Pdor to Ir <br />i$uncq rlro roquiro thrppliom for niclr pcmit to filc r rigncd rtrtmt thrt h. ot lhc ir lioucd purrunl !o rho provilio[ of tha \ <br />Conu.cror'r Li6[.d t$(Chrpta c, Commming with Soaion 7O0O of Divition 3 of thc Butinsr rnd Proforior Codo) or thlt hc ot <br />rhc b acmpt thcofrom rnd tho brrir fu rlo rllcgod ucmption .Any vhlrtbn of Scrion 7031.5 by .ny rpplicnt for r pmil rubJeu the <br />eppliont to r civil pculty of not mrc thu fivo hurdrcd dollr[ (t500). <br />_I, u om6 of tho propcty, or my mploys with ugq r. th?it rolG comr.nltiort will do tho mtlr md lhc nrucu. it not intodcd <br />6iiliccd for t.lc ( Sczol+, Suin;l ria Profo$ionr Codo: Thc Codrrcor't LiBB6 L.w doa not rpply to u oma of tho propony <br />who buildr or improvo thsoq rnd who don ruch work hiuclf or hmlf or thtouSh hit or lP om oploy6t, ptovidcd Olt tuch <br />improvcmug aro not htondod or offorcd for ulo. I( howva, thc building or improvrmat i5 .old withjt onc ycrr of omPlolioq tho <br />Ow-Builds will hrvo thc burdm of provin5 that hc or rhc not build or improvo for thc pupor of llo) <br />_t. s om6 of th6 propqty, rm qsluivcly oauraiag wit,! liircu.d @or&tor. io @utrud tho prcjGc ( Scc. 704d Buinor rnd <br />F6-fsion Codq Tho Conhclor'r Licdo Lw ds mt .pply to u ow of proprty who buil& or improvo thson , rnd who <br />contrra! for ruch projccr with r Contnctot(t) licflod Puru[l !o thG Contndor't Li&ilo lrw.). <br />msmptundsScliot <br />-|8.& <br />for thir <br />I hrcby rffum unda poillty of psjury ono <br />_lhrvcrndwillmrinhinrCortfiotoofCoruttoS.lf-IEwoforuorkst'@mgomtiorlu providodfotbySction3T00ofthc <br />hbor Codc for tho prformne of thc work for ulrir:h tto pcmit it isucd <br />I hvc rnd will mintriD worksr' ompcmtion lruunnco, u <br />6rk for which thb pamil it irtucd. My wortq' compcution <br />rcquhcd by Soctioo 3700 ofth. lrbor Codq for tho pcrformroc ofthc <br />iuurncc mior rnd policy numbc rro: <br />(Thir r&tion not omplctcd if thc pcrmit ir for Om huodrcd dollsr or los) <br />thrt h thc pcrformne of thc work for which thL pamil <br />ofCrlifornie, rnd <br />tr igucd,thlll oot mploy lnv in uy runcr ro u !o <br />th6 workc[ompcutioo Lw aSrco tEt ifI rhould bcc!mc to tla wotkst' <br />proviriou ofScction 3700 ofthc L:bot Codr, I omply with thorc <br />WA.RNINGT FrilurG to t@ro rcrkd' mmPculion <br />fino up !o onc hundrod thourud dotlur (tI00,000),in <br />!h! Lrbor Codo, intqot Dd rttomay't fq. <br />cov*ryc ir unbwful, md rn omploycr to cimiml pcilltig rnd civil <br />rddition to tho @tt demgo u providcd for dp Srction 3076 of <br />LICENSED CONTRACTORS DECLAR TION <br />I hcrcby rfrirm unde pculty of pcjurythrt I m lienrcd unds provirbn of Chrpta 9 (ommmcing with Setion 7000) of Divition 3 of <br />th6 Burinq rnd Profetrioru CodG, rnd my liccuc ir in full forc rrd oficce <br />Lircruo Clu:-Lic.ilo Numbq <br />- <br />D.tc: <br />W <br />I hqcby rffum utrdd pomlty of pajury thrt thsc ir r 6Etruclion londing rgcrcy for thc pctfctmrno of thc work for which thir pormt ir <br />isuod (S*. 3097, Civ. C.). <br />Lcndq'r Nrms: <br />t nds'r Ad&s: <br />Dcmolition PsmiB-Arbqtor Notifmtioa Fodonl <br />_ Rcquircd I.€ttd of Notifiotion <br />APPLICANT'S DECLARATION <br />Rrsulrtiou ClitL 40, Prn 6) <br />_t str& fut t F fodcrl rogulrtbu rogrrding ubgtol rmonl rro aot rPPlieblo to thi, Prcjoot. <br />_ I enify fhrf I hrvc red thir rpplietbn grd Lr! thrt lho abov! informrtion ir orcct I rg16 !o @mply witl rll City rnd Cousy <br />ordiBncot rnd Stlto Lrwa rolrtirg to buildiry carutnrstion Urd tsoby ruttorizc roprolonrtlvtr ofthil City rnd Couty to crta upon th6 <br />rbovo montbrud proporty for Lnp6tion pu+ua. <br />or rgat rig, <br />ilmo (print): <br />,-rl\, y