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BUILDING- INSPECTOR RECORD SITE.WORK DATE COMMENTS OWNERBUN,DER DEI,CAR TION I hs.t? !flinn under p.nalry or prjur! rhat I dn c\.mpr liom lh. (ont.cto6'license L.!r lo, rh. follo\rin8 r.Mn (S(.7011.s Busin*s tui Polsio. codâ‚¬): ny Ciry o. Counry \hi.h r.qrn6, pef,nh to coNlrucl. alt6. nnprorc. don.lth or rqur an) ,rudrc. prio,lo ns issu cc. dso r.{tuts the applicad lorstrchpcflnitlo fileas,sncdnal@a rhdheorsh.isli.srdl puBu,nr ro rh. lm\isiois ol tu ( onl.rclo.s l-iccnsd l-aw (( hapro 9, commcncins wnh Sation ?000 of Division I orlhe Busin.ss and Proicsions Cod.) or thar lE or shc is â‚¬x.mpr thsclior.nd rhâ‚¬ bsis lo! lh. allc-!.d c\qnfln n. Any riolilion olselion 70rl 5 b, a.y applic.nlforapennilsubjeclslhenprlicantloacivilpcnaltyolnol'nor.rhanfiv.htrd4ddotlrs($100) l. 6 ow.d olrhe prcFen!, or my dnployG \rilh $ a!6 .s r het $le mnlpâ‚¬Nlio!. \ ill do rhe *t'h and lh. srtud c ! nur Dronled or o ft6cd lbr sl. (Ss 704{. BusinN and lto l6sr6 Code 'l h. ('onrDcrois l-icss. I-r$ 66 nol apply to 6 o$ncr o t rfupNpd, \hobuil&ori,npov6$mn.dd*hodo6such(o himsell or hdscllor thrcush hG o! h6 o$ dplo).d. pmvid.d thal such imprordenrs e nol inred.d or orred lorsak. tf, hoK\ 6, lhe buildi4 or ihpruv.mdr is $ld $irhin onc yw otconpldiotr fiâ‚¬ Otrnâ‚¬. Buildq trillha\â‚¬ thc tudfl ofpro\ ins rld hâ‚¬ or she d'd not boi o' nn'Iot rhcpopd,lor rh. porlxi* of _1, 6 o\s cr orrhc propdly, &n c(h6iv.ly c.dracrin! r ilh l(seJ .onn a.b6 o ..rsttud nr. roid (Se 701J. llurnAs otrd Pnfission ( ode: The Conrraclois Licâ‚¬ns.l-aw do6 nor applyro an o\ ncr ofp,opqly $ho builds or nnprorcs rh.rcon. and Nho conrracls ro. such pmjds tr nh a Conr8cro(s) licoEd pu, sudr t) (h. conlr.clo. s Li.ms. kw) -l m crcmpt uodssdrion-. B &lC hr$isrmon D.l.r Orn.r: j!AAKIiES_.CA}I![!-!Aj&B lECtAAAltg! I h.rcby afinm tr.dd pdralryolpdjuryon. ofrlr follo\in8 dc.lararions I lw. and $ ill mai.iain . Cdificar. oaco.hr ro scltlcur. aor \ork.6 conlpensaiioi. 6 pmvdcd aor by sdrhn :t70o o i r,t titxJr C.de, aor r h. pdlonnanc. o a th. \vorl for whichrhcpo i( a issuo.l I ha\â‚¬ and$ill minlnin *ork.rt com!â‚¬nsaiion insurance. as requEd brsc.lnJn:rr00oltlt Lr&t(ode, forrhcpehnnanceor lhe soll nn $hicnlnisp.n.il is isu.d. Myworkdt coDpe6alion 'nsuranc.c.rid ahdFli.r trnrbd dcl Policy NuD6d-Erpnâ‚¬sl _lcenifylhar in rhe pEaoroance orllc *ork ior \hich rhis lrrmir is issu.rl. I snall mr enploy.n! psen in ary nranno e s ro b(o,nâ‚¬ subjd to the wortm' .ompeNar ion l.ws of (-aliromia. aod asr.r rhar il I should b..onc s'bjd to rl'c NoltsrconlPdelionpovisionsofSc]1ioDlT00olrhâ‚¬tiborCodâ‚¬.lshdLronh$irhcohDlyri(hrhor ovirions w.{llNlNG: rainrc lo src rvorkd mnpderio. covsasâ‚¬ is u.la*ful, and slrll subjd' & anployq ro siminnl IEnah'6 od .ivil lines u! ro one hundred rhousdd dolh (tloo.(x)o), in addi'ion r. nr cosr of corp.rsalion. danases 6 prlvidd id lhc Sertun:10T6 oirh.lltrr Cod.. inrod ed anomcv s 16 r.lcElsElcoNtaacroa IIICIAAAIIO! I hs.by afiimr und6 p.flally o I pgjury lhal I an licas.d urdr Fodrion of ch,prd 9 (.orrnocitS qith Sdion 7000) ot Dir isnrn l ol rhe ausinN dd Prolsions Code. rd my li.6* is in full force dd efrccl Li.cns. Cla$ Lic.nscNunbd coNslBuquolL[lD.lNi;rl(rI(I I heeby !fii'h und6 pcnalryoapojotnlal rho! is a co,srtudN lcndin! agdR, for Ihe pglomarce of the work i)r\hicnrht pumir i3 issucd(sc l0!r, civ. c ) ATILI(ANLDICIASAIIO! I hrdry amnn undd pdahy olDcriury on. olrhc l.llowine daldarions Danolirion Pmirs'Asb6ros Nolifi .dioi Federel Regulaxoc (1n1.,10, Pd6) Rquir.! Lelrs olNorili.alion I cdilyrllal the ledoalrcsularions rcsarnins esbBlos râ‚¬nF\alarc nol applicablc lo rhis pn,i4r _l ccniry rhal I lrlc qd rhis applicarion dd n.rr rhar rhc atxr\â‚¬ inaomarion is.ond I aBletocomplywilh allCilyandCounry odmancs B.d Srarc ln*s rehins ro bui ld ina .onsr.ucr io n, ed hc' eby aurlrriz. q,*nlariv6 ofthis Ciiy dCounrylo ord uponrh. ahrve nErio.ed proDdy lor iNpdion pu,los ,\ppli.atrl or genl Sign.lure Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/VenVl nsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat i/a son ry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL elilu 7t t9) Certificate of Occupancy rl AI Notes, Remarks , Etc ID/SIG.