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SITE.WORK DATE ID/SIG.COMMENTS OWNt]II IIUII,DER DELCARATION <br />I hr.by amm undd p.n0liy of perlL'ry rha I n.rdrr iom rhc Conlraclon- Li..n* ljw for tn€ followin! ia$. (S( roll 5 <br />Btrsin6s and F ofBstun (1'd.) Any city or Connly trhich Equtrd a lEmil lo conslrucl. axd. nnProtc ddnolish t! rcFn anv <br />strudur€. r,rr lo iis isuan c. also !<ut6lh. alplicdl lor su.h Fmrit lo fil€ a sisncd naranai lhar h.or sh€ n li.dsed ptru(ml <br />lo rhc pmvisions oflh€ Co.k.ctofs Liccns.d Lau (Chapr6 9. Cofrmm.in* wilh S.clion 7000 ol Division I ofthe Busin.ss tnd <br />ProLssmns Cod.) .i lhar h.orshc iscr€mpt lhocturm dd rhc basis ao.lh. allcs.rl .imprion AnvliolarionolserionT0:rl 5 bl anv <br />dgplicanl aor a p.mil sub.,trls rhc aptli.a toacivilpcnallyoanolnor.rhMfivchundrcddoll&s(5500) <br />I, a\ o$nd of rhc prcp.ny. or my mdolc wirh {aSB d rh.ir $lc compdsrion. *i11 do Lhc $ ort Md lht siMr. i\ mr <br />inrsdcd or ofiGed lor sl. (sE 7044, BusinN and ProfdioN Codc: Th. Contacrois Lic€B ks do6 nor aPply to ar o\r{ ol <br />rhc p'np6ry * lk) builds or impro\6 th@n. ud {k do6 su.h \tri( hinscll or h6el r or throtrBh his or hd om cmtlor_.6. <br />prorid.d rhal sucn improvtuB e nor idddal $oft(cd lor slc lr. ho{da. rh. hrildins or i'n{rov.ffir s $ld sirhin on. I6 <br />.f.ompldion. lh. own6 Buiu.r sll hak rh. hnd.n ofprovinS thd he or shc did nor build or irprorc lhc ribF y for fi. purr{r or <br />l. d o$n(ofrhe rrol<ly, mcr.lusiv.lyconlraclirs N,th lictucd .oitados to connrucl rhc rmler {Sa. 7014- Bsina <br />and Pn Es.nn C.d. Th. Co mroi s Liccns. t,arv do6 ..r aPp\ to .n ownq oflhp.ny who bu ilds ot imprcvd rhd.otr. <br />rnd {ho conhcrs lor such rmjcca rvnh a contm.ro(s) licdscd punuanr ro rh. (tnlractois l,icas l-atr ) <br />I m.impl rndr Sdion .B &PC forlhisr.6on <br />Dir. ()*ner <br />EABXEB!:(OMrEl'/tflO! <br />DTCLAAAIIO! <br />I hd.ty afirm trnd6 Fmahyofp6ju.y06.ofln tollowiB ddlaratiotrs <br />I har. dd $ill m.inrain a C.nificar. olcoMr ro Sclf- lNu!. for rvorkd comFErio., d lto dcd lor 6, Selion 37i)0 of rh. <br />hbo. con.. for lh. F6fome. ollh! *ork for whicfi th. Pdmn 6 isu.d <br />I hrv.!.d$illnaidr.inaoikds compsts.lion i6urr.., s rcqritcd hyS.di.1700 ofrh. kb.r Cod.- foi lh. Faonroncc ol <br />rhc work aor which this pmil i! isu.d My {0116 .ompaeion i.surmcc c&da .*1 rolicy .unb6 s.: <br />Icdilyrharinrhepdformanceoflh.xrkfds'hi.hrhisp.irnirisissued.lshallnoronployanyp6$ninantn ns <br />$ sb b..onr srbj(t tolhe\ork6 .onp.Balion l.ws olCalifomil ed arR rhd ifl should bccon. $bid torh. <br />$orkdl .omp€.erionprov6io$ofsernJn1700ofrh.tnbor(od..lstu'll-ronh$nhcomply$ hlhoBlmvisi.ns <br />WARNINC: FailLrE lo sur. trorlds conposation co!s.!c ,s uhla$tul. and shill sub.,(t a. mpl.vc 1o o'niial Imhi6 and <br />cnil fines trp ro on. hun&.d rhousond doll.6 ltl()O.Oo(]). in ldd ion ro rhe co$ or comp.nsarioh. dama36 ar Pdvid'd nY rh' <br />Sslion 076ofrhc bt r (_odq inlcr6l and alloms)'s fL$ <br />DlclAaalo! <br />I h@by atnm utuid poaht ofpdiury rhar I Mr lica<d undd tmvGion ofchnpls 9 (comdd.inP \irh Salion 70m) 'rDnislon <br />I <br />oi rh. atrsin6s ond Pror6li.s ( od.. md nry lictrc is in tull torc. dd .rd <br />,.^rrr"r",.ru\<42-> <br />colsraucIlolu.ElDlNi.ac.Er(f, <br />, hftby amm und6 Fnax, of pdjury lh.l rhq. is a coNltucrion kndinB 6socy for lh. pdfomsnc. of lh. *ork for trhich $is p.f,nit i5 <br />hsu.d (Se.109?, Civ. C.) <br />AIILITAILDECI.A.B.&IIOI <br />I hd!t', afim u ds p.nalty orrnjury on. ollh. aollosi.3 drl.ralions, <br />D.froliion Pdmhs-Asb€sros Nohri.,tio. F.d6al R.rularions I l illc,10. Pan6) <br />R.quir.d lnia of Notifi calion <br />I ccnily !h lh. fiddd r.-lularioB rcsrdins 6b6ros rdoMl tre nor applrcablc lo rhi! Pojd <br />I.dily lh.r I hrvc red lhis apDhcrlion ad nai. rtot rhc abov. infomarnrn ir.oftd.l asre lo conply*nh.llCilvand Coun'v <br />ordinan.e ed Sr.rc ,jqs ,.lalins ro building connndioh. aid h6cb) iurh,trEJ Fpr$rdtr6 orrh$ ctr, ed Counrvlo dld upon rh. <br />ir-,. nan.n.rtbmnd! ro, '6 , /l <br />^;;;,;.;,;.:;"",..", l\\4.r"-l*-/ 4*--,,,, //-/-/? <br />Pemire n. d. lprlnr ): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathinq <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 />Engineer Final Report <br />Flood Zone Certif <br />FINAL t-7'tg .JJJt\?v\ <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />BUILDING. INSPECTOR RECORD