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SITE.WORK DATE ID/SIG COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns \ ,,tl t7-)Pecl ebtdw Dti&*+-
<br />Erection Pads ,rr\.lHE'? ?erntu;V'-
<br />UFER Ground \I \I
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing /c27
<br />Shear Wall (l\*-?2)Framing t t\,tqvzf'
<br />n)rr.t^-zlnsulation/Energy {t,w -aDrywall Y
<br />"L.r-,6.') ilrclut 'nl. t.lL.Ext./lnt. Lath lt
<br />Brown Coat u\It
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />LoLcl-rl24t {| wc6J t tt)
<br />U t
<br />**a,,l,-?, JFINAL6lu141 -?t,/
<br />Certificate of Occupancy u\\-/
<br />Notes, Remarks, Etc.(=lar-.*i" \n-'",f tx- tlnlrq G,m"ql-,G->)AI
<br />BUILDING- INSPECTOR RECORD
<br />OWNER BUILDER DEL(ATI TION
<br />I h6cby arEm uidr t6alt, of prjury thal I m .rcnrpt frorn lhc Contactors Li.ms. Law fo! thc lollowinr rasn {Sd 70l l 5
<br />Busin6s Md Prcl6ion Codc): Any C{y or County Nhich raun6 a tsnir lo onstdct, alt6, inprore dcnolilh n ElEr My
<br />srrudur.. prior ro ns isslace. fllso requtB th. applicad for sRh Fnii to file a si-lncd slalodl lhri h. o. sh. b lic..sed pu6uul
<br />ro rhc ,rolisions oa lh. Conlractoar Lieiscd Las (Chzplo 9. Connm.inS whh Sdion 7000 of Division .l oath. ausines ed
<br />P,oiesiotrs Cod.) or lhal h. or shc is.xcno lh-.non @d rhe h€sis lor thc.lL8.d €xmplion Any violarion oasdio. T03l.5 byany
<br />0pplicanl 6! a pcmn subjcrs rhc spplicd ro a .ivil ,cnaht oa nor
<br />'norc
<br />dm five hunded dolles ($500)
<br />-1.
<br />6 o(rc of rh€ FoFnr, or my mployG $ilh s a!6 6 lheir $lt ..nlpdsalion, sill do rhc s'ori ed tu slME is nor
<br />i od€d orors.n iorsl€(56 70,14, Bsins dd ProfsioN Codq t hc conta.roa3 Lic@ tfl do6 noi applylouoM.toi
<br />rh. pnpdy (ho t{ilds o, nnsDv6lho@a dd who &6 $ch Mrl hins€llor h€6clror rhtuuBh hi! o. hB oM nploy.6
<br />sovid.d Ihal such inpmvmdls m ml imodal or olls.d for sle lr, hosd6, $. btildin8 ot imprc!tu1 i. eB wnhin onc yw
<br />oacompldion. lhe On6 Buildd sill hav. dE hndd oaFoving rhd h. or s\c dij mt hoild or inpov. 6. pmpdy fo, llE Purpos ol
<br />l. s ownd ofthe prop.ny, @ c:.lusivcl, conrradin! {nh licm.d conlrtto6 lo cointucl th. Pmjccl (S4. 7044. BB'.8
<br />dd PDaBbn Cod.: Th. ConlBcloi3 Licm€ Lav do6 nol aprly to e oMs o f prop€ny who builds or inpo!6 rn6o.,
<br />sd *ho conlacls for such p($t6rs with a conrrnclo(s) licm.d p,Ml lo th. Conlr.clols Ltm. bw).
<br />I dn.x.mot unda S.cnon .B &PC lorrhisr6on
<br />Drt.: Orn.r:
<br />!OBA!BL(AI!,IIN-iAMN
<br />D&CIrA!AIqT
<br />I hreby rmm unda r.nrlty ot pqiury onc of th. folloNina ddlrrlioBl
<br />I have ed will mintain a C€ni,lcdt€ or Co6or ro S.lalBur.lor qorkeB conDenlarn \ 6 rorid€d for bySelion3700 orlh.
<br />Laboi Cod., lor lhc psfol]Mce of the rvor( for *'hich th. p@il it isu.d
<br />I hav€ and vill nainrain vo.ke.r conraMrion i6uoc., s rcqun.d by S.dro. 1700 .f rh. bbor Cod.. for thc Dsfode.c of
<br />rh€ rolk forwhich this p.nnil6 Myuorlsr coop.Mio. iNur ce .eis rd policy number ue:
<br />-l
<br />ccnifythar in lh. pdfom.nce ol lhc work for which lhis poil is isstr.d. I shall not mploy any p@n in any mannr
<br />$ s ro b.ronE subjEl lo th€ rorl6 compasniod la$ of crlifomia. ed ax@ lha il I shonld h.com. subjrl to lh.
<br />sorkss comp€Bation prcvisio6 or sdrio. 1700 oalh. tjb.r Code, I !
<br />WARNING: [ailur.lo su. $oikds' conrpwthn rcvcr.8e 6 u
<br />cilil fines up ro onc hunJ^d rhousdd dollas (5100.000). in add
<br />Secli0 1076 otlhe Lnhn
<br />l) u( l,!lr.\l lQN
<br />I h6€by alfim und6 p.n.lty o a pdj,r) rhal I m licas.d und6 l,olision of Chaprd 9 (connmcins N h s.dt n 7000) of Divisioo l
<br />of lhc Brsins ed Pref*ioE Codc, ed m, lic.M is in tull force a.d €ft€(l
<br />14t1t. t
<br />Bu,W
<br />q)IIIBIJLUA!-LI DllCrrGDNCI
<br />I hcehy amn under p6ahy of pcrjury thal lhsc is a cocrruclion lnding almcy for lh€ pdfoDndce oi rhc sor* lot lvhich rhis Foi is
<br />issued (S(.1097, Civ c.).
<br />AXIUCANLDISIAAAIP!
<br />I hsdy afrm unds Foalry or!ftjury o.c oalh.lollowifls dElsalions:
<br />DcDDlition P€mits-Arb6ros Norification Fcdd.l R.guloiions (I iile 40, Pan6)
<br />Rcqun€d L. s olNotiticaioo
<br />-l
<br />cdrit rhAr rhc icddal regrnarios Esddin-! sbBlos r€moval d. nor applicable tu this pr oJd
<br />I ccdiay rhat I halc rqd $n opplicrtion,rl stalc lhat $c atD* inloanorion i5 cotr..l.I asE lo.oiply *iih .ll Cnydd Counly
<br />ordihm.6 md Sliic ljws relaliru ro ildins connrudio., dd hd.by aurtorize ..!!Mtaliv6 ol rhis Ciry md
<br />rlhve nr$tonLlt t()pdy lir
<br />.\pDlic!tr1or \,lrtrr Si[ ,r Drts Aa
<br />tenlcr'' Ad&6.
<br />-
<br />ltt
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