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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS O\I|'NER BUILDER DELCARATION <br />I hdeby amm md6 Fnahy of prjury lhal I m .r.mpt ftom lhc Co ra.ro6 Li.d3. Llw ao. lt followins rc$n (5(.7031 5 <br />Busin*s and Prolsion Cod€): Any City or Counly which r.qutrB a Fnil ro .onslruct. 0h6. imprcve drnolBfi or (pat .n, <br />srrucrue prior to ils issus... also r<un6 rhc arplican' for sch Fmh to filc a signcd statmdt lhal h. or 3h. b licscd ptrBtranl <br />ro rh. FovGions oarh. Conkacior's Liccnkd Lsw (Chapl6 9. Codncn inE Nnh sdiion 7000 of Division I of lhc Busin6 and <br />Protsioos Cod.) or Ihar hc or sh. is crcmpr thd.6om dd rh. b4G aor th. all.B.t ermplion Afly violation o f Sdion 7011.5 by 8nt <br />,rrlic!.r ror , p.mi slbjc8 rh. applicmr lo a civ il p6.hy o anor more tha fivc fiu.di.d dolla ($500) <br />}}tl "qns "hhc Fopdr). or ny .hplo)G *hh *t86 s rnct sk omp€@lioo, *ill do lhc \6rt nd rn inrlE b nol <br />imddcd orolId.d lor eL (Sd 704,1. Busins d Prof6sions Code Th. Contactors Li.as. t wdoBnotapplyloano*ndol <br />rher,lFny reho bilds or ihFsrB rho6( ed wno dG Mh a,l hins.lr or h6dr or rhmuSh his or ha opn .mploy6. <br />prolid.d rhsr sr.h inpmldnflls m aol inlqr&j or oilEed ror elc. ll rave6, fi. hrilding or imprevoc, is $ld *ilhin on. yw <br />or conpunn. the OMo Blildd will Mw th. hrl&n ofFoving lhd h. or shc did rel buiu or idFov. fi. F.Fly aot lhc BrFs of <br />L s oNnd oarhc propcry. m €rclusiv.ly co racrinB snh Ucd!.d .oita.'o6 <br />'o <br />coNrud Ih€ prej(l {Se 704.1. Bams <br />and Pllusion Code: The Contr.ctois Liccffc Law do* not apply lo an oNnr 6lprop.n, *ho builds or implov6 rhs.on, <br />,nd Nho conImds lor such p.ojdrsvirh. Co rad.(s) Iicas.d puGodi lorh. Co raclois l-ic.e lai) <br />I m crcng und6 Sdion "s',I l-zl-10r?,,-.".-A ) <br />DECI,AAAUO! <br />I h6cby a,lim urds poalry of paju.y .n. ofrh. follo{ in8 d{ltrarioB <br />! h.v. md will n.inrair r C€nrficarc of Const lo S.lf'lnsue lor tr$rlm- .ompd$tion. 6 previded tor by Sdrion 1700 o f lh. <br />Lrhrr Cod€, aor $e pdfomance of lh. woi( tor vhich lhc p6nil G issucd. <br />I havcand rvill mainraia workdt co'ntc.sarion insuranc.. ar r.quircd bySeclio..1700ofthc Labor cod., for rhc pdfom.nce of <br />Ihc vorl for *hich rhG rierhir is ilsucd My work6 conp.Bdion iBurmc. carir and Flicy numbd dc: <br />Policy Numbq <br />--- <br />Eryircsl <br />\ 4"Liry rl'd i" rh. p.6,-anc. orrlE work ror which rhis pmir is isued.l shallnor nplo, any p6sn m.ny ndns <br />$ 6ro bc.omc subjcr ro rhc Nrt6'cohp.n aio. laws of califomir. Md aer lhal ifI should bdom. subid to ih. <br />Norkm' conpastion pNvi.ions of serion 1700 oarh. khor Code, I shall. fonhwilh comply wiih lho$ lrovisioos <br />WARNINC: F6ilorc io Kur. wtrt6 .onp.nsalion covdlg. is unl,stul. d shall subid d oploF ro nninal Fnahi6 and <br />cilil fin.s up to onc hund,Ed thoGud douad (5100,000). in rddnion lo lhc cosl olcompsslion. daBa86 as pro\id.d lor rhc <br />Srrion 1076 ollh€ khor (bdc, inr6.d ed diom.y\ fc <br />l)-Lt-1oq x ,t-, L^.1 <br />!,rcErsELcoNraaclla <br />DECI,ASAI.IaN <br />I h.ftby aLm undd tftall, of pdjury lnal I m licas.d und€. pr.vi.rioo ofc.naprd 9 (comacing with Scclirn ?0o0) ol Dirision l <br />ol Ihc Busin* dd Pof*iom cod.. ed my lic€e is in full forcc d cfi*l <br />CONS'I'RUCTION LENDING ACENCl <br />I I'cEby amm undcr p.nally o I pdjury lhd lh6c is r connrucl iof, lcndins asocy for lh. pdfomm.. of Ihc $ork fo. Nhich rnis ldmir is <br />iss!.d (56.109?, Civ C.) <br />a.tt1.tcaxlD[ctdf,alla! <br />I ho4 aftn uidn p.nalry of pdjury on. ot in. followir8 d.cl&atio.s <br />Dcmolilion Pmils-Asb6los Nolilica(ioh Fcddal R+u lal iom (Tnlc 40. Pan6) <br />Requn.d lirr6 of Noifi @ion <br />I .dify rhrt $. f.ddal r.gulalions Esardins 6b6tos roov.l Ec nol alpli.abl. lo this pmjd <br />) Aairr ua I r, " .-a rr,is aprlicarion and srarc rhar rh€ atovc inrom.rion n coft.d I agr* ro conply vnh au city .nd cormy <br />ordin.ncs.nd Sht. ries rcLrins ro buildinE co.sttuclion. ed hr.by althortc rcpredtotivB ofthis Cny a.d Counlylo di6 upon dE <br />aho\ e menrion.il prclrny lN <br />applicrtrr or Asenr Stniru..L\.r I I -2t'1ot1 <br />os e-ir.J 4. { <br />-,k) <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVl nsulation IL <br />Roof Sheathing ul\r A 's <br />Shear Wall ul <br />Framing <br />lnsulation/Enerqy <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 />I I <br />b@ B <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />_, <br />nfll A <br />Flood Zone Certif. <br />FINAL <br />Licmc \ats <br />Co r..lor _ <br />t-+- <br />dc-34-