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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET]CARA1ION <br />I hdeby affim undd laalr, of pdjury rhar I an crdnpl io lte Contrlo6 Lictuc k$ ior rh. aollowoS rcMn (Se.70l I 5 <br />Busi.6s ad Profsion Codc): Ary Ciry o! Counly rvhich requn6 a ,6tn ro co6rrud. .116, inprove. {klnolish or ra.n ey <br />srudue prior lo irs isuucc. al$ rcqun6 thc appl'ca( lor such pdsn lo file r siSned stalmdt that hc or s'r. is licatsoj p@dl <br />to th. provirioB oi Lt Coit@cbas Lic.rs.d Law {Ch,pr6 9. Conmdci.s *irh Sdion 7000 of Division I ofth€ BBi.N Md <br />Proacsio.s codc) or lh,r h. or shc is dcmpt rhgefiom od rh. bas6 aor rhc alLe.d.rdtrpliof,. Any violalion ols..1ion 7011.5 by ey <br />appnc.nrtorapsnrnsubj<rslh.drplicadloa.ivilp.nanyofnotmorcihrnfiv.hun&€ddoues($500). <br />,-i. d oM6 of iE pmpcny, o ny .mplot6 wnh w6s6 6 their elc compq&lion. will do rh. wmt dd rh. srodr is nor <br />ihrdxl.n or ofd.d aor sl. (Sa.7044. Bsins sd PrctsioN Cod.: Thc Cododoas Li..M L.w do6 Dol opply lo in owno of <br />rh. Fbpdy sto tn ds o. nnp.ov6 rlEon. 0d s'ho do6 slct rrc* hiru.ll or h.Mll or rhrou*h his or hd oM coDloy6, <br />prcvide! rhat sdch inrpor@rs & mr intdd.d orolrdEd fo! sE. li no{86. thc buiunts or ihrtovffir i! $ld wthin on td <br />otcomplerion. th€ OMcr Dlilds Nill halc lh. hr!6 olploi.g old hc or shc did Dol hrild or inprorc thc pr$Fly lor lh. purpoe of <br />.l.6o\s6olthcFopdy, m.xclusir.ly contacling $ith licmed contBioE lo mnslru.t trE l'oj.ct (56.7044, Bsr6 <br />dd Ptrn sion Cod.: Tfie Contractols Liccnse Law do6 nol apply to e ow.r o atop.ny who builds or imprcv.s tho@a, <br />and who conrmcls lor such prcjds wirh a Coir6do(s) licds.n puuuml lo lhc Conlnclois Licc.sc La*). <br />I an exemDt undqSdtioi- . B & P.C. for this l6on <br />]IOBKIBICAI4ICrSArAI <br />OECIAaAI,IO! <br />I hs.by amm undo penany ol paJUry one oarhc iollovih8 d(ldslios <br />.-- -l havc mil will nai.6in r cdi6c.r. of CoBol to S.lf- lNurc for work6 aqdsal@n, 6 prolid.d for by Sation 1700 of thc <br />Labor Cod€. lor lhe Ffomdc. o I rhe soik lor which rh. pdmil G isu€d. <br />h.hav. a.d will maimain workm co,rp.Nalion i6ur0ncc. s r€quiEd by sdion I700 oa$. tjb.r Cod.. fot lh. paaolrlrm. oa <br />$6r[ lor *nich lnis ponn is is.d My vorl6 .omp€r6al iotr i6ue.. c&ia and policy ntrmbd e. <br />^' r", *,. ULttC6 f4Q0II b rrpir*: <br />I ccniryrh,t inlhc pBlomanccofrhcwori for vhich rhis p@ir is issu.d. I shall not mpLy any DEson in any mannq <br />$ s ro b.con€ subjct to thc Nork6 onpoErion la{s ofc.lifomia, &d .sre that il I should beomc subj<r lo $. <br />NorI6 comD€tuation rrovirios olSerio.lT00 ofrhc hbor Code l shall. fonhwith comply*ith tho* proli3ioB. <br />WARNINC: Failurc lo saurc workgJ coop€.slion c6v.6sc is onlawlul. md shall subjcct tr ndoys lo dainal Dotlli. ad <br />cnil fr.€s up to one hund€d rhousod dollds ($100,000), in 6dd "'xl**"rcn. dmas6 6,r vidql lor lhc <br />inrr^r Md i dfrv ( lR I <br />r-rc irrsluloFtrirc r otr <br />ULH, R \T()\ <br />I hd€b, aflm urdd psally ol psju,y lhd I m licdts d undd Fovisio. of Chtpi6 9 (commdcitrs {nh S*tion 7000) oa Division l <br />ol rhc B$ms dd Pmfsions Codc. d ny licasc is in tuU lo@ and .It*r <br />CONiIBUCUOIII=EIDIIC.AqENCI <br />I hdeb, amrm und6 rEnally ol pdjurj- Iba! lh@ ir a @6rru.lio. lmdi.g agdcy ior thc palomrucc ollhc sork aoi whi.h rhii panii b <br />issucd (sd.1097. Ci!. C )t ndft'( Nm. <br />AII!rcAI{LI'DS.d8TI]OI <br />I hclby afrm undd poalry ol pdjlr, oncoarhe aollolrinB ddlr.tio.s: <br />D.molition Pnmiis-Asb6ros Norificarion r.dsal Rcgular io6 (Tnh 40, Pd6) <br />R.quncd Lclln of Nolifi cation <br />I cfirry rhar rh. acddal (golarios Ersntine sbahs rooval dc nor applicablc to lhn projdr <br />I .drit rhar I ha!. Md $is application od sratc thar fi. above in fomatio' n codcl I .rr- <br />'o <br />omply wilh all Cny and Counly <br />ordn@c6 &d Srd. Llwi Elari.B lo hildinB coNocrioG dd h6.by a hoir..pr6filativ6 otIhir City md Counlylo olq upoo lhc <br />abolc tnenhoned propc.ly tor rsp.nion <br />appricsnr or .{sor sigrcrurc, X <br />O'", t/4 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathing <br />Framinq <br />lnsulation/Enerqy <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 />FINAL 2/21 /'n zW qt <br />Certificate of Occupancy ' <br />Notes, Remarks, Etc <br />'::"fifu4*LiccB€ <br />c-r.*r"",a\ <br />I mLifl s AJJi6{ <br />Shear Wall