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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/siG.COMMENTS OwrcrBlild.. D.cl@tioi
<br />I hd.by smm undd ,..alry of pajury thal I d .xmpr fm th. Conr&loB Licos. Law aor rhc following cson (!c ,,^3 I t Busin6s
<br />&d Prcf*id codc) Aiy Cit, or couty whi.h EquiB a p@ir ro construct. ahd, improv., dmolish o! r.pan oy rh u'r. Driorro i6
<br />isecq slso r.qui6 th. .ppli@t ld such p.frn 10 ,ilc a sisncd tl!,!.6at $.r h! or 5h. is li@ns.d plEuar lo rh. prcvtios oi tli
<br />Cdtr&tofs Licdcd L.w (Chap6 9, C@cing*ilh Scdion TOO0oiDivirion I of lh.Buinss ud Prcfsios Cod.) m rhr h. or
<br />shc i! .r6pt $ftfrom dd Ur bak 16 In. .llc8cd .rnptioi Any violario of S*tion 703 I 5 by ey lpplicmt fd . Fmn slbjca 6.
<br />arplior lo a civil p.ialty of.d mc Ud fivc hu.dr.d doll6 (1500)
<br />_I, a oMd of lhc propc.ty, or my .mployB wi6 wa36 6 th.t !ol. cmpasation, will do rh. work ed rh. stucru. is nor inEd.d
<br />or olf*d ltr ral. ( S.c 7043, BEind ad Prcleio cod. Th. C6nt.crd'r Lienr. L.w doe nor rpply b u owr.r of th. prop.n,
<br />who buil& d imFove thdcM, dd who .lc suci wort hiB.lf or h6.lf d thrcu* hh d hd o*n .hployd, Fovid.d that such
<br />inprovdaE u. not intd&d or ordcd fo. srlc Il h@dd. tc b!ald,!8 d improvcmat i5 sold wirhin o. yE or@mpl.tiq. th.
<br />Ownd-Buildd viu hav. th. burd.n of Fovirg 6al hc d lhc nor build d improv. fd dic pup6. of s.l.)
<br />_1, a oqd of dG proFny, m crclGiv.ly co r&tin8 wiln li@s.n c@E&r6 to @.rtruct th. pEj.d ( S.c 70a4, aB,n6 &d
<br />Prcfssim Co&: Ihc C@r&loit Lic@. t e do6.ot +ply !o e oMr of prop.r.y who build! r inFovB lh.@n , Md who
<br />coE&L! aor sch projsE wilh a conEeqt licm.d pEWr ro rh. coft&rors Licdsc Lr* )
<br />_l6.xrmpt undcr S.cli6 _.8 & P C. fo! this rc6on
<br />lsBaEa!-eo@ErsaIlaI!
<br />I h6.by ailm undcrpcnsl9 of pqllry on. oith. iollo*in8 d.cldalioN
<br />_l hrv. dd wrlsiinhin i C.rtifi(aE of Cmrmt ro S?lalNur. f.! work6 @mp.nsation, a providcd id by S.ation 3700 of th.
<br />Laho CodrTaf th. p.no1rec ot th. worl for shnh ln. pcm N 'su.d
<br />:Jh.v. d will mainuii w6l6' cmp. andi6Bdcq6,cqlircdbyS@don3700oid.LabqCod.,fo.th.p!.fmeccorthc
<br />,o* fd vhlch ttu pafitr tr isud My we*6' cmpaiarm 'Nu .? .frE sd poli.y nuhbd a.
<br />Policy Nunb.r Erpn.t
<br />(Tbis rctioi i!.d .ot bc cmpl.r.d if (h. pamir i5 for On. hud,.d doll
<br />_l cdiry thd in !h. pafomucc of th. Nork for which $is p.mn i
<br />b..m. subjd lo th. work6 cmp.nsario. laws of cllifmia ed
<br />comp@ration prorisio! oaScction 3?00 of $. Labd Codc, l shall tfctq-k -o2_
<br />WARNING Fa'lur. ro s.cu4 *ork.^ conp.nsarion
<br />fin6 up to oh. hundr.d lhoNdd dol16 ($100,0m),in
<br />fi. Lnbor Cod., inrcrcsl ud anom.y s ac6
<br />iiubjec( - nploy.r io cnmin.l po.lii4 dd cilil
<br />6t oa@mp.ns.tim, d@.A6 a provid.a ad (h. S.di@ 3076 of
<br />LICENSED CONTR,{CTORS Df, CLARATION
<br />I h.rcby alfim udd pcnahy oip.lury lnat I d I'coscd undcr prcvBion ofCha$cr 9 (codmcncins wnh S.ction 7000) oa DivNion I ol
<br />4-t7-a z-
<br />I hdby af,im ud.r p.nahy of p.qury lnri in@ is a
<br />issucd (S.c. 1097, Civ C.)
<br />for lh. pnaomoc. ofdr. wo.k fo. which this pcmrt E
<br />APPLICANT'S DECL4RATION
<br />Dcrolilion Pmils-Asbotos Notific.lion F.ddd R.8ul.lion! (Tnl. ,40, Prn 6)
<br />_ R.quiEd L.trs of Notilicdlo
<br />x,|h{ $. fed.ral r.guht,o6 rcSddins ab6r6 moval d. nor.ppli@
<br />r @.cl I !8re to.omp! wnh .ll City dd Courty
<br />rcpB.itrtieg of rhis Cny ed C@nry to mtd upoo t.
<br />lh3l I hrvc rc.d thn lppli.ari
<br />ordine@ d 5l.l! L:wr Elaling ro
<br />.bov. m.rtim.d Fop!ry fo. i q- / Fo2-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enVlnsul.
<br />Roof Sheathing
<br />Shear Wall t
<br />Framlng AlLlot &t I d.DL.
<br />lnsulation/Energy ,r
<br />I
<br />Drywall 5./zz/oz ma Ac-,c r - Ba11 6arl
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar -f-2 3.az m?(1 / ,..co*y r rzz,-
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL g'fu<tz til' /q 1
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />,l A
<br />04-
<br />,/2/0" - n
<br />?'< kLL c
<br />th.Busin.s ed Plofessions Cod., od my licc.s. is in iuiliorc. dd
<br />Pool Fence
<br />Aillrt-' EII- p/a A
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