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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Roof Sheathing Shear Wall Framina lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat lrlaso n ry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif . , FINAL /tl?/tf ,.*1f,.l4 tl Certificate of Occupancy /'"'-a-tt/ Notes, Remarks, Etc. OWNDT BU!I-DER DELCARATION I hscby amnn under pâ‚¬nalry of p6jury lhar I d .rchpl ann rh. Conltactots l"iccnse l iN for lhe rolkrwidg tNn (Se 70l l 5 Busins a.d Profeion Codc) Any Ciry or Cou y shich requt6 a rEh'l !o cocttu.l. a[6. ihprovc. dâ‚¬molish or repâ‚¬n ,n) srucluc, pior to ns isumce. ale râ‚¬quiE Ihe alplicanl lor such Fni to nl. . si8n.t srlremenl Ihal h. or sh. is licm!.d pumel lo rhe povisiotu oarn. conlraclois Lic.nsd Law (Chapts 9. Colnmcncins *nh S$'ion 7000 of Dirision I otlhe B$iness ed Proa.ssions (-ode) or thd h. or shc is qmpt lh6c6om trd lhc bdsis for llt all.lcd.rd0ion. Any violation ofseclFn 70115 b, e, ipplicafl lor a p.nnil subjstslhc applicanl to.civilpenahyolnor eorcnm 6v. hundted dollos (t50o). -1. d o*nd oflhc prcldy. or nyenrploys rvith Nas6 &s rhcn sl. coinpffilion. $illdo lh. $orl.nd rhc srudm G .or inlodâ‚¬d or ofis.d ror salc ( sd 7044. ausind Md Pmlsions Code 'l h. conlroctoa s l.ic4* I.w doâ‚¬ nor .pplv ro an osna ol rlt. sopdy Eno tril& or nnpov6 rh6o( tnd $no.h6srch sllll hiDsctlot h@lf orfimuSh nis or hs oM cmployâ‚¬6. provid.t rhat such nnlnov@.s dâ‚¬ ml inlddcd or olrgcd lor slc. li hoN6's. thc h]ilding or nnFovam iseE Nnhin, n. @ of.onpleliotr rh. O$Td Duildg will harc lhc h!(kr of Forins Ihll hc or sne did nor build or Lnpio\. thc p.lFly for th. pul,r oa l,6owns olrhc ropdly, mlxcllsn.l}.ontraLlin8 $nh Lcc6.d conl.aclo6lo corl{tod lhc projd' iSc. 70,1.1. RNIns ad Proftssion ftde: Th. ( onrrocloar Licc.s. Law do6 nol apply lo e o*ner oaltroren), Nno builds ot impov.s thdsn. and who contmcls fo. such prcjsG sirh a Con!.acto(s)liceEcd lluu.nr lo lhc Conrra.lofs l.icâ‚¬.k La{) I m crenrpl undq Sdio ]loaEDSSlCAllSEliAlIOrp&c!484!!,ll I hscby sflirm under poaltyolpsiury onc orlhe loll$vi.3 dslmrio.sl I have drvillmainrainaCcnificatoacoMnrroself-ldur.foruor!.6.onlp.n.ttidtr,6 providcd fot bySclion 1700 oIrh. tibo. Cod., for rnâ‚¬ palo'l1ucc oi thc NorI for rhich lh. psnn it su.d I have and vill moinlain *orkera .on!.6ario. irerrec.. s requtâ‚¬d by 56l ion 3700 ol rhc Labot Code, for lhc paiomecc oi lhc work lor which this pâ‚¬n.il i5 istlcd. My wDrkdt mnpmdion iNurmc tmiq ed Folicy nrmbd dc: Policy NuDb6:-Elpt6: lcoliryrhalinrheperfonn.nccolrhâ‚¬woIkaorwhic[thispermilisissued,lshallmronployoaypssninantmdncr $ s ro bffomc subjsl to lhe vort6 compsalrcn la*1 of Calilomia. rd .B@ Ihal il I should bâ‚¬..mc ubjd lo lhe worlm'conpâ‚¬nsarionprovisiontofSarionlT00olthcLaborCode.lsh.ll.ionhrvilhcon,dywirhrhor!rcvisions WARNINC Failure lo sue rorl.u compeBal cov@s. is unlnNtul. dd shall subjct m dnplolq lo 6nin0l pmhi6 md civil llnes up lo onc hundrcd rh.usd doll6 I ). in addirion ro rhc.os olconrp.marioo- dlhasd 6 providd in rhc S(hotr.1076 orthc L.bor Codc. imcr6r tl -t-t g ,..-t omag M a cedo I heby amiln unds p@lry o I pajury rbal i e lic.6.d indd prcvision olChopls 9 (commdcnr! *nh Seclion 7000)ofDivision l of rh. BNins d Prdfsions Cod.. ad ny licse is intuU forcc tnd cr(t. r^vYLZa+ GooF ia ck uol.f-.p-gl*",11- l:1t Poof + I bqâ‚¬b, artrm undq pâ‚¬nahy ol !.rr!ry I icsucd (Se.1097, Civ. C.) consrclio. Lndins lscncy lor rh.ldlonnancc.flne *tk ior whicn thG p.mn is ASIUCANLIICIABAIIA! I hqc6y a]lhn undâ‚¬r p.nahy of p.rju4 onc ol Ih. follo$ inB ddldarions: Dmoliriod Pmns-Asb6ros Notilication Fedral Resulalion! (1 irl. 40. P,16) Required Lcltd ot Nolilicalion dbâ‚¬slos r Dral rc not aprli.ablâ‚¬ ro rhi\ pror<l c (lrar rlt aluc nrlonn.rion t cotrsr. I alrr xr'.onplyvnh ou city&d counl, hisCnyed Counlyto di6 ulbn rh. ^",1l-):18Mqr Subf loor/VenUlnsulation t-f-