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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OIVNIiR BUTLDr]lI DEL'ARATION t hdeb] .fifln undc! pdaly ol rsjury rhar I m .xeht)l lrcn thc ContmdoF l-ice.s. tjw for rhc follosing ,.en (sâ‚¬c 70] l 5 Busin6s ald I'rof6sio. Cod.)r ny City or Coufry $hich requiG a p.mir to connrucr, alls. i6piov.. dsnolish or rqtsn mY slruc1urc, pndr b irs issu ce. also rcquic lh. .ptli(d lor su.h p.nril to 6lc a st..d srilandt thal hâ‚¬ or shc is li.trcd put$anl h lfiâ‚¬ Eolisnrns olrhâ‚¬ Co.rraclois l-iccnsd l,aq (Chlpld 9. Comncncins wilh SdlnJn 7000 olDivision I oflh. Busin.ss dd Pm f6sions Cod.) or rhar ne or sh. is cxmfl rhoc6.d ed rn b6is aor rhc nll.lcn.r.mflio. AnvviolalionofscdionT0ll5 bvanv ,prli.anrforapmirsubjErslhcapplicamioacivilp..ahyoanlmo,eth&nrchtrndr.ddolla,s($500). l. as os ne. orllt In)pclr, or my .nlPlol6 wnh was6 ar rhen el. .onposlion. NiU do lh. Nolt dd Ih. stnnd. iq mr inrdd.d or olTdcn aor sL (S<.7Olr. Budns lnd Profsio.s Cod.r Tfic Conlnclofs Li..6. riN dos nol agply lo d os nd of rfuplrpely trho builds 6r i'rp ov6 thdon. rnd who do6 such erk himsclaor hdsclfor lh,oush his or hd o\s.mployc6. nrovidcd rh.r s'.h i,npovorots N ml inrdddl or off6nl tdr ele I[ hoN6'6. rfie tuildins or imFdloMr G $ld s'nlia on. ]6 orcoryUbn. rh. O( n6 Builds rvill luvdhc bordor orrnd\ids rha h. or she did nol hild or iqnor. $e pmr<i, for lhâ‚¬ purIDE .r L s oNner o lllE propeny. tun .rcltrsivcly conlraclins silh liccnsed .o.t ados ro .onslnld thâ‚¬ ptui&t (S( 7044, Brnn61 aBi hnhsi,n aod. Th. ( .ntacrors t,ic$sc t-as do6 nol dppl! ro .n o\rnq ol proFny trho btr ilds o! implov6 rhreon .nd Nho conr,rcrs lor lrh Eojers Nilh r Contacto,ls) licrr*! pu4uanr rorhc conradoas l-i.eN l-as) I d. .rcnfl mdd sdtion tl &P( i$lhisre6on .\I ORKNRS' COI\IPENSATION oceL &ula} I hocbj aflinD unds poalty of prjury onc oa$. aollotri.8 decld.lions: I hNc md {ill mainrah a Cenifi.ar. of Consdr ro s.li-lnsorc for Nork<s co,npderiofl. N ,rolidsd ror by S{rio. I700 ollfie Llbor Code, fdr rh. p.rtoflnancc oalhc \od for *hich lh. pdnil is issued. (/lk* -u *u,."ror *o,ksrco De sa,ioni.sor.n.c. rl,..(,{kror\\rhrhrnm s Nsd M\$orls ornrq SI.Jq c.J 1700 ollhâ‚¬ liblr (nd., for lhc pdtoman.cof 4i''b"r,., *.,*,, 6](o19$.04+ I ccnifyrhar ii rhe pdionnan.eoflhcqort lor shichlhis pdnn is issud,I shall nol onFloyan!loson in anv manner $ .sro hccotrtr srbjal to lh. NorI6 ..npms,rion la\s ofc.lifomia. nnd arre rhd ial should h.cone subjd 'o rh. $o*cs co'npoelionpmvisio$ olsdion 1700 oflhc lih, Codq I slmll. fonhwirh coDplyvirh tliJe polGions. WAIININC l:iihr. to *cure \orkera cdnrp{sarioi .o\cmrc (tril ni6 up h otrc [undrc lhonsand dollars ($100.0!r(l). nr Co&. inrcd turdatoma."'s lB 2o c(, I hdehy allt tr6dd p.n.ltyorpcrju.yrhat I an li.LaBcn undd pro\is prd 9 (.onm6cins sirh S..lio. 7Oo0) of rir ision l ol (h. RNntra\ d Pnncs\ions(odc. a ,ny lic.ns. is i'r fi !l iltco eliecr * 'C4s lxf"^z Iolgt II h,--.AC:\&o-l ""t1 CONSTRUCTION LENDING ACliNCY I hmby slIm und.r FMlry of Fjury lhd rhde is a oNrtuclion kndins ,sft, fo, th. Ffomancc of lh. \ott lor *hiâ‚¬h this Fnh G isrucd (S.c. 1097. Ci! c ) A.E&(4ILIECLABAIIOT I ho{+{ amm nnds poah) ol psJuiy o.. oalh.lolloNi.B d6laralions: D.mlnion Pomns-Asbclos Norin.arion t'eddal Re8rldions (f illâ‚¬ 40. Pan6) Requtcd 1..1tcr ol Nori6!aion l.eliirrh rfu fcJdal r.sulalions rcs&di.s arhdk{.enomlarc nol appli(abl. b rhis pr.l.( .o1i& rId I havereadlhtrapplicainn i('fl iscoa(r I atre ro couply .virh all (-irt .nd (-otr ry lnd srdr. t.assrcl.ri.8k, buildi authori.e rcrra$u n 6 olrhk Cilr and Co )\ '/2-4\i\97- ^l"l-" Set Backs Forms/Steel/Holdowns UFER Ground SLAB Floor S u bf loo r/Ve nt/ ln s u lation Roof Sheathinq Shear Wall Framinq lnsulation/Energy Drylvall Ext./lnt. Lath Brown Coat N/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif FINAL z/tl/zt'*W") Notes, Remarks, Etc ilr 01N. nrnli(,ned proped! lnr insFcrion Alplicr or/\genisiqnr(urr Pcrnrne n.ne (prinl): Erection Pads