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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation t <br />Roof Sheathing tiloclw ,M1,1t) <br />Shear Wall I -r' <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 />l <br />FINAL /L/lt/ltr ) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />OWNI'R BUILT'€R DET,CARATION <br />I hd.br aIlu,n undB paally of ,€rjury thal I @ .i.'npr fmm rh. (onlracloB Ltcns. Llw for th. follotr inE r@n lS( ?01 I 5 <br />Busin6s d Prof*io. Cod.): An, Cnt or ( ou.ty which rqun6 a p6'nil lo .onslrucl. .lld, inprov.. dcnolsh ot EPar y <br />slrucruc. prior Io irs irsu&c., aLo r.qun6 lh. +plicMt for such p€rmit lo fiE a sigicd $ardol rhd h. or sh. b licdN.d p6udt <br />ro rh. pr.\i.ioB of rh. Contrado.s L'ccn$d Law (Chaprr 9, Com.rins wilh Sction ?Ulo of Division I oarh. Blsin.s ed <br />ProLsions Codc) orrhat h. or lhc ts crcfrpi rha.fron Md rh. hsis fo hc all€s.d €xoplion A.y violrlionoascclion 7011.5 by lny <br />apphoa aor a prftn subjds th. applicantloacivilpcn.ltyofnolmor.rhdnv.iundr.ddollds{1500). <br />-1, <br />s o$,r of rh. FoFny. or mt cmployG wilh r5s6 s lbr elc conp@rion, will &r rh. Bod ed lhe su1u. is nor <br />int6d.d or oird.d fo! sl. (56.7044. BBin6 dd AoiesioN Cod.: Th. Conrraclor'! LiccE tlu d.6 nor Apl, to m o\vnd ol <br />thcIropdy * b bril& or improv6 thqon. dd sho doc such \srl hims.lf or hm.lf or rhtouBh his or hd o*r @plot6, <br />provid.d that such inprcvoEE ft @r inrdd.d or oradl for sL l I hor6E. lhc tDildins or inFordmr h eld rirhin onc yw <br />orco,npl.1i.o rh. O*fld Buildd will hov. ttE hrdo olproving lna h€ o! shc did @t tuild or introv. lhc propdy lor rh. F,D.- of <br />I, s ownd ofrh. propqly. m cxclusi!.ly conrracling wirh licaE d co.tmto6 to conslrucl lh. proj.<r (St 70'14. ltErlB <br />dd Pls&si.. C6d. Th. Conlrrcloas Licmc Lou do6 nor apply to d os.d o f prop.ny sho builds or improrc rhd66. <br />and f,ho conlEds for such Fojdl3 wnh a C6nrdo( s) li.ft.d puRumr lo lhc Contddrs Lros. ljw). <br />l a c\c!,pl undcr Sd <br />llr]EEESLCalItErl l.lo! <br />OECI,AIAIIQ! <br />I hseby afi.m undr F.ahyolpejury on. oithc iollDNin$ dddorioN: <br />-l <br />havc arj * ill nainrain a Cdificdr. ot co6dr ro s.li-lNur. tor slrkEa q'nrp.neriDn, s Folidcd for by S{tion 3700 of rh. <br />L.b.r Codc. for lhc p6fomdc. o f lhc vol! for rhich th. pdmi t i$.d. <br />-I <br />hak and will nai.rain wolt{J conp.Nation insu!.ncc. 5 r€qut€d hy Serio. 1700 ofrh. bbor Cod., foi rh. P6aonns.. oa <br />rh. *oili lor *hicb this Fnn is isucd. My workdi composdion iNure.. .dnd d policy numh.r {c: <br />PolicyNunrbdr-Erpi6 <br />I cenilylMt in the psfornanc. orlh. sork aor which rhis pemn is issuen. I shallnol mployeypmn in any,nanns <br />v, sh b.ronc subd ro rh. $orrds .onp6s.tion laws oicalifomia. dd agc lhar ifI should b.comc subjsl lo lh. <br />worlsJ compcNtion ttrovirioN ol sdion 1700ofrhe tibor (odc.lstq l- <br />U/,- <br />WARNING: Iralltrre t. surc *orlc6 .ompasaxon corcmgc is u.la\dplola kJ diminal fgm <br />cilil fin.s up 1o on. hundEd Ihosand dolld (J100.000). in ion. .lrnr8.s a providcd <br />fi inr.r61 ud atdrn.r's rs <br />0 I <br />IIiC|jBAIIO! <br />I hocby amm undd FaI, ofprjry thd I m [c.ru.d ond6 pmvision olchapld I (coftnacinS wnh Scclion ?000) ofDilkio. ] <br />ol ih.BEinsed PrclsionsCodc, dd mylic*.6in luu foic. and.ilrl <br />(o 5t .",,."",".,(- <br />colEullcuoll.LE Dlllc.AcElcl <br />I hmby aflim undd lcnalryoft{ju.ythal ln6. is a cotr(rudion lcndins alocy lor rhe rdfonnMcc ollhcuork tu \tichrhh pdDit is <br />issuen (S( 1097. Civ C ). <br />ATIIICANI-DES.AAAIIQ! <br />I hod, aIIm uidd Fnalty olFjury on oalh€ aollorvrns d.rldaiio.s <br />r).molition Prmils-Asberos Notification F.ddol Rcaul.lions l1.nE 40. Pan6) <br />Rdlun.d L.1t6 oa l',rolification <br />I cdl ilv that lhe leddal rcxular os elrdi <br />-l <br />cali& that I lmvc rsd lhis apDl'carnrn dd . inlomalion is cotrd I arr€ro.onp ly wirh all Cily rd Couniy <br />ordinancB and Sratc Lass Elarinr ro bu,ldi ourhorirc rerrMlarir6 o f rhir city dCoullyro <br />abov. hdrtioned propdy for insp€clFn <br /> ppli. tor Agenl Sign.lurc -,,, Lot!'/ <br />II <br />Flood Zone Ce(if. <br />I <br />or al)pLicable t,) rhis trojdt <br />t.'