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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMET{TS OWNER BU!LDER DELCARATION <br />I hr€br amrm undcr pcnally oa pqlory rhd I m.xcmfl noD lhc Contadorc' Liccnse Lar ao. rh€ follo{itr8 !.en (Sd.7o:ll5 <br />Busincs and ProfNiotr Codc) Any Ciry or Cou.ry which ,equn6 a pnnn ro coNtucr, alt6, mprolc, tt,nolislr or Ep.n dy <br />slruciue prior lo ils isuucc. also &qun6 rh. 4plicd for su(h Ff,,ril to fi|. a sisn.d sldlmdr th4 h. or sh€ b licr6cd p96udt <br />ro lhe Foviriom of lhe Conra.rors Liensed ks {Chapiq 9. CoNnencins wiih Sction 7000 of Dirision I ofthc Ausincs ud <br />Itot*ions CodE) or rhar hc or lhc is .x.npt ihdcnoD and rhc bsis lor lh€ au.rcd cxonflion Anyliolalionofs.dion?0115 byd! <br />applicanl for s p@it subjels rhc applicanl lo a civil pmlty o t nol moE $& live nu.dr.d doum ($500) <br />-1. <br />ac ownd olrhc pNp.fly. or my .nlployc6 rvnh was6 s lhcir $1. coipderio.. $ill do thc \ort aod thc stMr b not <br />inrdddl or ofrded aor slc (Sa ?044, B6indt dd PrclsioG CMa Ttu ConlD.t,tr-s t,ic@ t * do6 nor apply lo o*nd ot <br />rh. FDpcrry $ho hi & oi,nFo\6 fi@n. d who do6 sch M* hnns.lr or h$ello! throush his or h6 o*. .mployc6. <br />p(vid€d thar su.h improlmmrs ft nor intftddl or.Itutn lor sL ll hos'6s. lhe hoildins o. idForman ir sh wnnin onc yw <br />ot complelion. lh€ Osr6 Uuikl6 $dl h,vc U. bddd oapmriry lhd hc or n'. did mt boild o, nqrolc rh. pmpdy for lhe putpo* of <br />-1. <br />6 osns oirhc pmpdty, @ crclGivcly .onlradins silh Iic.Nej conlrrcro6 ro coBtacl lh. Fojccl (Se. 70'14. BGin6 <br />and PiDlisirn cod.: Th. ContB.lofs Licdr Llw do6 nol6pply ro m o{ncr o f prop.ny vho builds or inprov.s rhdon, <br />and sho conlrads ror su.h pojds with a Coihdo(9licds.d puEul lo !b.Cont.crois LicG Lar). <br />_l a e&mpr un,lo solio <br />raBrDB["c9ugcrs4ll!)N <br />DECIAB^IIO! <br />I lEe6y ailtrn ufldd rEnalty o I psjury on. oi rhc follo$inr dNltr.lions <br />-I <br />hav. dd sill nBimain . C.nifical€ of CoMl lo S.ll-lBu( for workec @nrpensrion, 6 Forid.d tor by Sdion 1700 of thc <br />Labor Codc. fo. lh€ psfonid.. olrhr soi{ lor vhich th. p6nil is issu.d <br />-l <br />hav. and sill mainrain work.*' compssrion !Burdc., 4 rcquir.rl by Sal ioo 1700 or lh. bbot cod€. for the p6lonn&c. ol <br />rhc *orl for \rhich this pdnil is isu.d My sorkdt comp@lion insormce criq ad Flicy 60 <br />9io \e C.:,'a^peosr-frr\ /"'Svr.rn<e G.r\qlr"/17e{3l+t5- lZ <br />I csliay lhat ia th€ p€rfoman .ollhc *orl Io. which rhis pcrmil is issucd. I shall nol mploy any pcMn in aoy ndne <br />$ 6 ro b.ron subjd $ 0. worl6' cor$trarion lass o I Califomia. sd age tha! if I should b.con. subjd ro $. <br />wort6 comFerion lmrisioN of Satiotr 1700 ollhe Labor Cod., I shall. aorlh$ilh omply with lhos. PrevirioN <br />\IARNINC: l.dilurc lo su. vorkm co,npNtio. covqag€ is unlautul, dd shall sutjed onployo ro aimin.l Fuhi6 and <br />civil lin6 u! b o.c ltundrcd rlDusand <br />sdnn 1tr76 ur l,b. ktni ( qdr. 0ro6r <br />D,,c: iTlza/P <br />LTCENSIDIATIAA':IO8 <br />DEC'"AATru)! <br />I hmby allrm und€r !..alry or psju.y rh.r I tu. licats l ondd Fovision otclDpld 9 (.omocin8 *irn Strth, ?000) of Dn irion ] <br />of lhe ausi.e ed PrcfsioB Code. dd my licsc is in tu|l fot. axl elTEt. <br />-7o.:'34a( <br />,*" 1J guont!3 S\:rr- T..l l"t.. <br />CONS RUC'NON I,ENT)ING AGENCY <br />I ho.b, alTmn unds !.nally o I p€rjury lhsr rhrc is a .oosro.rio. knding agqcy fot lhe llqfommc. ollfi€ work lor \ hich rhis ponir is <br />issu.d (S€c. 1097. Ci!. C.) <br />I en.lo \ AJdss <br />- <br />A.TII.II]ANLDICI,ASAIION <br />I hedyrJrmunda p.nalry ofpdjuryonc oflhc followitr-( d{l arion.: <br />Demohion Pmirr'Asb€sros Nolincdion Fcderal Retulations (-l'ill€ r0. Pan6) <br />R.quir.d Lcrl€r of Notificarion <br />I.ditrh.r rh. LdLrrl r.Aularions ratrdins Abrstos reno\aldc nor.ppli.able lo lnis projdr <br />-l <br />cdiryrhar I havc r€ad rhis applicarion rnd sraiclhat th€ above inlonnalu is tohd. I s8ralo comply\lh all cirya.d coumv <br />odinanc* d SIal€ ljwsreLriigro i.8 connodion. sd hs.by aurhorte icpr6mtativ6 ollhis Cny ed Cormylo 6i6 upon fie <br />abo\ e molioncd pmFcny fo! <br />At,!li.rnt or .{s6t Shnalrrc *,"1 4 <br />fe"h /r,1c. <br />lr"/i< <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsu lation/Enerq y <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL I Irl14ID tN^.#r)-z;4 ) <br />Certificate of Occupancy u\ <br />Notes, Remarks, Etc. <br />b+e <br />l <br />t---+--- <br />a-------r------