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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNTJR BUILDER DELCARATION <br />I hflchry 0,Irr unda paalry or r.rjury $ar I dn ere,npt lrom rh€ Cont.cto.s' Lic.ns. Lav for thc aouowin! l@n (Sa.7oll 5 <br />Ruin6s dd Proa6io. code): Any Cily or County $hich rdlliG a pdmn to conslru... al!6 inprov.. d.nolth or rqln dv <br />tucluc. p.ior to irs issudc€. abo requn6 rh. applicad nr srch p.mit lo file a sisn d slahal that fic ot shc n licds.d puBu t <br />ro rhe a/olisions of th. Conrmcbas Liccn*d liw (Chatr.r 9, cofhencing sith S{lion 7000 .l Division I oflhc Bsincs &d <br />Pol$ions Codc) or th.r he or s& ir excnfl thdenom md rhc bGir lor ln. all€scd .&nprion A.y viololion olstclion 701 Ls by tny <br />applicont lorap€mil subjdtl& applicmt ro acililp.naltyofnot morelhd n!. hundred dollars (5t00) <br />-1, <br />6 6qno of rh. p,oFny. or m, cmploye $ h waN6 d rh.n ek conpgsation. rill do th. $ ort od fi€ srudd. is n.' <br />i, mled or .iId.d for elc (5<.7044, Blsin6 dd Ptoasio6 Codc Tn€ conlhctol s Licm. tIw do6 nol ,Pplt ro e ownd ot <br />rh. p@Fry sho bdl& or impmvG th66c a.d who do6 such srrk him.lf ot hmlf or lhroush his or hd o*n cmPloy€6. <br />prclided Ih such i'nrrov@ts d. mr inl6den or oitqld ao! sle. lq ho\s6. rh. ttuildins ot iryro@r t $ld ethin on€ t@ <br />of.omplc{ion. tlrc Owncr Buildr *ill hlve lh. bordd of pro!i.8 th,l h. or shc did nol bnild ot nnpove thc proldy for $. pulos ol <br />I. sos,n6ofrhcpropqly, @.xc[sn lyconraclins wnh licds.d coitador <br />'o <br />codrucl thc prejdr (s( 704a. Buins <br />and Potissnn Codc:1h. Contracrois Liccnsc Law do6 not apply ro M owas ofprolEn, vho builds ot nnp,ov6 rhron. <br />and vho ontBcls lor slcb pmjds $id. Co E€rods) licd$.d pu6udr r.rtu Conlmdois l.ic.e tn{ ) <br />! un e\en\n undd s.rrion ,8 &P( nvthisreason. <br />.EAa[};tsS:l;O!!!EA!AuO! <br />AEEIASEIIO! <br />I hseby amnn undq rmalryofpdluryoneoflh€ folloNins dalrari.tu <br />I havcudwill dainran a C.nilical€ ofconsmt kr Scl[l6u.. lor mrke6 cohg.nsarion,6 tro\idcd tor bv Sdioo 3?00 ofrh. <br />bbor Cod.. for rfi. psfomd.c ofrhc work lor <br />"'nicn <br />thc ponil is isu€d <br />I haleaod $,llnaidrrin workeri conDmarion i6uran.c,6 rcqunal by S(rion 1700 ollhe kbor (bde.lor the irfonnanc. of <br />er. codFMion irsumce csid d policy numbs tr.: <br />A <br />-l <br />ccnilyrnar in th. pdformAn.c ollhc sorL aor $hic[ rhis permil is issued, I drallnot onploy 3ny p6en in an, 'nannds 6 lo b..one subJdr ro th. sorlm' cor.p.ffalion la*r or Califomia md aBE lhal if I should b..om. $bid to lhe <br />*0A6.oopcerionpmvisioBofS.clionlT00orlh.tlborCod.,IdEll,aonhwilhcohlly$irhrh.FlrovisioN <br />WARNINCT tnifurc lo suc {ork6 conp.Btrioh covd.Sc is unlavtul. dd shsll sobi.cl e aploys ro oinina] FEhi6 d <br />civil fin6 up Io onc huni!.ed lhoMd <br />s4rion 1076 ol th€ Lnbor Code. inld6r "" - <br />H;:; ;i;* <br />e'"idd'l"' "" <br />-t uglNrD_rc[taag.ll!urlraarrlol <br />I h@byanirm und6 pdalyofpcjury lh.r I m lic s€d undo ptuvirio. ofch.pl6 9 (comnBcils rYnn scrion 7000) ofDiririon l <br />of rh. Bsins md Prcl*io6 Codc. dd,ny licmc is in full lorc d.fidr <br />78-S z6 <br />,nA /t 7-g <br />colslaucuqNi,ElDllcicENcl <br />I h6€b, amm und6 p€nally oI p.Dury $d rhr€ is a onslrudio, k dins agn.y for lhc Pslo.ruc. ol rh. wo.l lor Nnich lhis pdmil b <br />islol (sd 1097, civ. c.) <br />AIIUIANLDICI,ASAIIA! <br />I neruaflim undr poalty ofpdju.y on ofrh. follo*i.s dc.Lratio6l <br />D.nDlnion Pdmils-Asb€slos Notificalio. F.ddal R.Bola'ions (Tnt 40. Pan6) <br />Rdton d L.ltdolNolificalion <br />IcdliryrlturhcrL{.mlrc(trlalionsre!adinsasLr.hsrcr)vdla,cnolaflrlirabl.brhisProid <br />I cslii! thal I have rcad lhis aml <br />ordi.ancB ed Sr.tc La\s r€btins ro <br />icar6! ed srolcnlat $c atr\c inromarion is codd lasrelocompltwirhallCilyandCounry <br />n6 ofthis Cn, and ( ounlyl <br />iluc nrDrknui f (,rnl aot <br />\pt'liMnr or \[urSiA rl l(- <br />md,ntqlby aurhnP. ftprMht <br />Loor^bz -l r <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loorA/ent/lnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing iL/n /lQs f,l\#{ <br />lnsulation/Energy <br />Drywall <br />(E4)tnt. latn 'L/tq/lc AKd <br />Brown Coat <br />Masonry <br />Pool Fence <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL (\ 1\\1 //4A(n <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />T-Bar <br />ror,ynu^noL. /Q0O0O Zl{7 np",",t-t4q <br />6.1tr <br />I end..s Nam. <br />- <br />L.ndc, s <br />^J.lrN <br />- <br />=