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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />ln s u lation/Ene rgy <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 />,4, <br />FINAL 5 -e7't1 x.wu) <br />Certificate of Occupancy <br />LOF- baL <br />Notes, Remarks Etc.S-:t-\ N,\ODY 7T- <br />OWNER BUILDER DELCARATION <br />I hseby afiifln undd p€.alr, ol Frjury rh.l I dn cx.rpt frcm ihc Conl.acloF l-ic.nsc Las for Ihc tollouins rcen (56.?03 1 5 <br />Busio6s and Proldion Cod.): Any Ciiy or Coutriy $ hich rcqunB a p€rnil to coNtrucl. alt6. inprole donollsh or npar uy <br />sltuct@, p.io, ro irs isu&cc. also r.quir6 rhc applicant for such p.r,il ro file a si-ln€d $aod rh3r hc or shc i! lic6*d p6uer <br />to lhe pmrisioG olth. Conlraclorr Liccns€d rjw (Chaprd 9. com.ncing wirh Setion 7000 ofDivision I olthc Busincs sd <br />ProfBn,ns Codc) o, rhar hc or sh€ is cxempt thq€fioo and lh€ basls lor the allca.d cxsnpton anyliolarionolsdionT0rl.s 6, uy <br />applicanl lor a Fflni subjec rh. applicrm to a.ivilpcnnhyoanor morclhan five huodr.d doll6 (t500). <br />l. 6 own6 ollhc pmFeny. or ny €mployc w h sa86 s $cn sb competrsl ion, *1U do lhc Nork and rn. studm b not <br />i dd.d or olle.i aor ulc lsc ?044. Bulins bd Prollrsiore Cod.: rh. Conlrlcloi s Lictre l,w do6 nol apFly lo d oMd ol <br />lh€ pDpc.ty sho hrildsor iop.or6lhEoi. &dwho do6su.hrcd hiosclaor hd.lfot rhrcu8h his or nd o$n.mploy.6. , <br />provid.d lhar such inlro\ffin @ not nlnl.d or ollacd aor sal. I[ ho{6 E $. h]ilding or inll,o\ffir is $ld eitfiin on€ rEr <br />of.onpkiotr ih. ol,Dd auikk NiI navc rh. bud6 olpro\ inA rhd h. or sh. did nor build or inporc thc Flpqly for lh. purrDe or <br />l. asorn.rolrh€propdr. ancr.lBiv.ly.ont.dins xirh liccB.d .o nt..r 06 r o .onsrflrcl rhe projst (S( 70.14. Uusn6 <br />and Pnrfsion Codc rheConlracloas Liccnse Law do6 nor applyro an osns ol prop.rly who builds or imprord lhson. <br />and *hd codncls lin such Fojcds wnh a Codracto(, licdscd puuml ro rhcco.r,ctois Licosc La$ <br />l:urc\c tr undr SLrrkl <br />,rrr",'/l-2 -20tR <br />I lr.rch\ x,lnh utrJ.r t{n.h\.lpli ro.n.rl(lr.lnllLr\n,g dcrll'lhons <br />I hav. ed will maimain . Cdin.ar. ofconsdr ro s.fiBur. ior rcrkers conrp.nsarion, 6 prcvid.d for by Strlion I700 oalhc <br />tibor Codc, lor lh. pqfor@.. ollhc sork aor *hich rhc porn is isu.n. <br />I havc and rvill m.inlain wo(.ra comp.Nalion iNumnce,6 requn€d by Selion 1700 oflhc l-abor Cod., for thc pefomdc€ of <br />lhc solk ttr qhich lijs p.mil i! isucd. My wdkds comp.nsalion insura.cc cmicr and rolicy nunbd e: <br />I cdilyrh.t in the pBiormancc olrhc $o.k aor $hi.h rhis p.n.n is issued. I shallaol onploy any peN). in any meno <br />e s ro bqnn€ subjct to the s!.k6 compsarion laws of CalifomiA. aod 3ra€ rh ifl sk,uld hcto.'. slbjmt rotl'. <br />sort6 comp..sationprevis'oBofSeclionlT00oflh€LltErCodc.lshau.fo(h\v h codply {nh lhos piovi.ioB <br />WARNINC: Fnilure lo seure workds ornpo&rio. covease b unlarful, dd shall subjdt m mploy€r lo qimi.al Fulti6 aod <br />ciril li.6 up to o.c hundrcd rhousdd doll6 ($l i. addirion ri rlE cosl of ion. danqcs 6 r,ovid.d lor lhc <br />\.dn[ 11176 !]lll'c l lln' (.11. .'d liJ <br />\9,\. <br />IECI,AAAUqX <br />I hftby amnn!.dcr pmlryof Fjuryrhd I m liccN.d undd Fovision olChafld 9 (commcnciog wirh Scdion 7000) oaDivision l <br />of rhc B6ins dd Pblerioc Cod.. ad ny li.@ is in aull lor.. dd dlInt <br />Lic.Nc CIN:-LiC.M Nlmbd <br />caN auquaNr};dlltaliaclilcl <br />I hcEby arlim undd p.nelly o t Fju.y rhar lhoc is a consrruction lodi.s a!d.y for rh. pdfonndcc ol Ih. Nork fo. which lhis pqmil is <br />issued (S( 10q7. Civ C.). <br />-l <br />cdiry tha{ I lavc rsd rhis applicalion dd slar€ lhd llrc.bov€ inlomarion is corccl. I asre b .!tuply *nh .ll Cirya.d Counly <br />odinanc6 and Staic Llws r€lalins to buildins coretructioG md hd.by authornc r.lr*'nalir6 ollhis cny md Courylo ente uFn lh€ <br />abo\e mcnrioned propoly tbr <br />\pplir il or \r.rr Six it <br />CC L <br />-l /:2o:1fl1& <br />I <br />COMMENTS <br />Flood Zone Certif. <br />tr-"ru <br />Policy Numhd:-EipiB: <br />- <br />o"t!) Q.p:2016 <br />AITI.IIAtrLDI]CI.AIAIIO! <br />I @ affm und.r pdalty olFrju.y on€ olrhc lollowins dal{ations <br />Demohion Pcmirs-Asb6ros Nolification Fenaal R+ul.tions (l itlc 40. Pan6) <br />-Requiren <br />Glt6 of Noti6caliod <br />_l c€n,ly lh5l thc Gdsal '.xulations <br />resedin! dbGros e ovdl ae nor ,prli.rbl. ro rhG prqd <br />I <br />I