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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION <br />I hq.qL alrm uid6 pdah, of rojr.y lha1 I m .rcmpr trom lhc Conlra.lo6 Licffi Lae aot lh. fouo{inE tasn (S;.?Ol l:5 <br />Busirss d l'lo,i6sion Codc): Any Cny or Counly shict rqun6 a pinn ro @dtud. .116, inprov.. &moltfi ot rcpotr ey <br />slrucluc. pno! ro rls isuec.. also ,.quic rh. 6pplicer for s!.h pcmn ro 6L a sisncd sralmml lh.l hc or sh. $ liccns.d psudt <br />ro thc pNvisioB oathc CoalEctois Li€cnFd Lav tcluprq s, Comfln.ing wnh Sdrion 7000 olDiviSion I otlhc A6iflcs ed <br />Prolcsione C.d.) or lhal h. or sne b .rdp fiG.iom ed th. bsis iot lh. all.s.d cxflplion Any liolarion of Sdio!701l 5 by e, <br />appiica.rror.p.f,nitsubjdlslh..pplionlloacivilp.n.hyotnolnoElh&fivchui(tudoll6($500) <br />L ,s ownq ofl hc prcr.rly. or ny eoploy6 $ilh wa!6 d lh.tr $1. compcNrio., will do rhe work dd lhc nruclu. s nol <br />mrod.d or ofidcd ror eL (s{.7044, Busines dd Prc lsioB codq l'he (nnrrcrois l-i.qsc I-!N doe not ttpl, ro d oM.r oa <br />Ihe [repqly who huild! or inlprovG rh.on. dd eho do6 soch worl hiNsll or hGcllor throush hG or h.r om .npbr.6, <br />lrovid.d lh such i,rFllnds de nol inlard€d or ofiscd lor el.. I I how@, rh. b(ildine or improvancnl is sot wnhin onc yw <br />alconrpl€rion, $e Oud Buildo will hav. rne bud.n ofpoving lh h.orshc did mt hrild or inplov€ lhe plopoly l rh.purpo*oa <br />I. aowhdoalh.pmp.ny. mcrclGivclyconra.lifl! wirh licds{j coord.ro6 ro co6hd tfi. Foid (Se. 7044. BNns <br />d PDlesFn Codc: Thc Conra.bas Lic.nsc Law do6 not apply ro mown6 of propBly wlo buildr or mpiov6 th(@.. <br />and wh. conlds for ch Ftrjds wilh a Contcclo(s) licscd nu6@r (o th. Comr.croas Li.m. kw). <br />, m cxmfl unds Sdion .ll & l'( f{n rhis rr3on <br />Iaa6EBS:lAUl[tslATION <br />DICI,AAAII(I! <br />I hscbyam und6 poalryoaFjuryon oflhc followin8 dclralio.s <br />I havc u,i w' lllBxdrm a Ccnrficarc or CoMnr ro scll lsu.. for workds conpsotion. s prcvid.d for by Sdlion ll?00 oafic <br />Lrbor CodtH6. pdlomM.c ol rtc worl lor trh(t rhc psm 6 su.d <br />- -lii. u,a *' r, -a,nl''n *r,16' comp.c'l <br />'on <br />LNUrm.., s '.Iuir€n by serion ]7oo orrhc Llbor codc, ror th. psromarc or <br />rhc sork fd $hich rhis r.mit is ilsnoi My work6 .onposdion <br />csi6: :\a)e- Co J a UI <br />l9qQQoZ -2o <br />I .6ti4/ rh3l in rh. Florm cc ollhe work lor shich rhis p.flnn t 6suaL I shall nor mploy any p€Mn in any mend <br />$ 6lo b..on. subj{t to th. worl6 @npdsaion lass ofcalifomia. Md asr thal ifl should b.cooc subjd lo lh. <br />*0*6 codrctuarion p(vi.ioB of sdio. 3700 o a$. Laurr Co.le l sh.ll. lonh$ilh codply wilh lho* pDlisioB <br />W.{RNINC: t'ailur.lo suc wo*s' @mpNlion .ov6agc ir unla*tul od shall subjer d oployd lo qtninal poEhis md <br />cilil lincs up lo o.c hundrcd lhousdd dollffi ($100,000). in additio. ro rh..osl of.ompcroation, dmscs 6 providcd lor lhc <br />"".., L- 6-tC L Va,r0n C <br />I h@by allm u.do pc@ny o t pdjury that I m !cc.s.d mdB pmvision ofchapls 9 {omedci.r *ilh Scdion 7000) oi Divkion l <br />of thc R6in6 dd Piolsio6 Cod€. dd ,ny licN is in foll aorc. dd cfiat. <br />c-11 ?rq3 <br />(.> - z-'--t C.L-A Ufi/ <br />U <br />I h6€bt aflin, undd Fnalty ot pajury rha! lh6e is a consltoclio. Lnding a!.nc, aor the pdaommc€ ollh. *ort lor Nhich this p6nn ! <br />isual (Ss, 1097, Ci!. C ). <br />A.tg,ICAILD&CIASAIIQN <br />I hody arm und6 F.ally or p€rju,, o.e oflhe rolo*ins d€lettioB: <br />D.molition PdmnlAsb.slos Notificarion Fcddal R.suhion. (Tirlc 40, Pan6) <br />Ratutcd Lltd otNolifi calion <br />rcgul0tioN raedin8 GlEios ronovalare nol apDlicabl. to lhis prcjd <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUlnsulation <br />Roof Sheathinq 4- lo'ro ;#/ot <br />Shear Wall <br />Framing <br />lnsulation/Energy <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 />Enqineer Final Report <br />Flood Zone Certif . <br />FINAL z-t -20 El'!lr, r6'i <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />I