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SITE.WORK PATE rq/srG COMMENTS OWNF'R BUII,DRR DEL('ARATIoN <br />I hdcb' .illrm und6 pmally of p€rjuN rh.r I ron cx€rrpr 6om th. ('ontrccios l.iccNe Ia$ ror ltc ,illo* ils t.d)i (sr70:rl5 <br />tlusitr6s d Prof6sion Code) Any Cily or Counly which r€!ut6 a ljnnn lo c.nstn'd, .nd. imptuv.. danolish or rqxir any <br />aodurc. Iruro irs isn'anc.. aho r.qun6rh. amlicdr lorsuch p.dn h fil.0 si8n€J sl.lmdt thd hcor shc G licmrcd pusuanl <br />ro rh. FovisioN ol lnc (onrractois Liccnscd l{* (Chaprs 9. Comm.ncins rirh s..tion 7000 of Division I oarh. lrusins and <br />Pror€ssions Codc) orrhar hc or shc is.xmpr rhn.Fom ed rh€ b.sis for rh. alL{.d.rdption Any viol.lion olSdkrn 70:11.5 b) any <br />amlicafliorap€dnsubj(rsrh.appli.anrloa.ivilFnalryofnormor.rhdn!.hundr.ddolles($500) <br />L a o(nd o irhe F.,xny. or my cmplorG \ilh \va*6 a rh€t $lc composalion. lill do thc rvort ud lh€ slulft Ls ior <br />inhdcd or olls.d for ele (S( 7044. BNin6 flnd frefsions Codq thc C.f,tad.is t-(as.I-a$ doa nor applr ro o o\ns oi. <br />thc propay qho tiil& or in1lrov6 rn@n. md sho doe strch sork himsclfo. hsrllor lhrotrCh his or h.r o*n.frplor.6. <br />provid.d rh str.h inpro\ ddt dc nor idod.d or olldqr tu sh lf. ho*6 d. lhc h0ildin8 or imrovml is sld $ilhin f nE t.r . <br />olconpl€rion.rhcO\rrBuildqwillhavcrhctudoofprovirgrhdhco.sh.didto build or inlro!. E pm!€i, forIh. purposof <br />L d os nq olrhc prupqir. d d.lusir.iy conka.r inE {ilh lic{sed .onkach6 ro .o.slnn lhe projat (S( 70.1,1. Bus,nss <br />md lbision ( ode: th. ( onkicr(r's Li..nsc L.$ do6 nor atpl\ ro an o\nd olpropcny *ho builds or nnp'.\.s rhd6n, <br />and \vho.onrractsfo!suchrojchNnhaConrracrons)licosedpuBr6rrorh.Contactnsl-i..m.Ld$) <br />I a'n e\.'nnt undcr Setfn <br />D.t. Orn.r <br />woRxrqs'con PENsATloN <br />[Ecldaalto! <br />I hmby rmm und6 poalty of poiury oE oflh. fouo{'inn ddlmlioE <br />I hav. md will mainrain e C€rlincarc olconsr to S.lt-lnsur. aor *ork6 compoaario.. 6 Foid.d for b, Sdion I700 oflhe <br />hbor ( od.. for $. pdfomm.. oaih. wort aor Ntich r h. pnnn i! isucd <br />Q(hor.una"'n.o'nru,n"orrs'(iimnnsar'onrsuranc.-6r.quncdbysdrionlTooofrh.Laborcodc.forlhcpsfonnarc.of <br />ihc qort lo, qhrchrtirp<rnr s su€d M) | or 16' (omp(tudrcn 'nsu,tn(rcmn MJIshc) numbdfle <br />Ct 14-<:11> Lo <br />1^qr9'.)3?1'L a-r,*, \'\- \3 <br />I cdifyrhat in rh. p&Lmecc ol rlE \eo.L aorshi.h rhisp.nnn is Gsucd.l shallnoi flploy anyps$n in an) nannd <br />$ 6 ro b(o,n subr(t to rh. s o 6' comp.salion lnws o I (alifomia. d asE rhar irIshould h.comc $bj(l ro'h. <br />troll6s comp.NrionprovisionsofS.clion lTmoathc t:borCode.l shall.lonh\ h co'nply s ilh rhos JrovGidh <br />WARNINC: Failurc lo sur. work6 conposaton covsasc is unhsful. dd sh.ll subidr an €npl.y6 Io oi,ninal p6ahi6 and <br />.iril fin€s up (' onc hun&ed rhousand dollau ($100.000). in addiri.n ro rh. co$ of comp.Garion. da'.ages s pr.v'd.ii for rh. <br />sAl'.r ro-b ofrh. tib..' t odc, inrd6r eddromn c f6 <br />>-\o'\ / <br />!l!!L.rRrll()\ <br />I hftby amm tr.dd p.fl.lty ol pdjury lhal I m lic€.s.d under pror ision oachaptd 9 (c.,nmocins *nh sdio. TL{o) ofDivision l <br />.f rh. Busindr and Pmf6ioB cod., a.d m, li.@ is in lull foic. md.lT.cr <br />6 41t l,o, <br /><- \, . \-1 .-,.-,.( c D <br />COIiIBIJI:II(IN.LI'IDIIG-AC!!(Y <br />I h6€by a,Im und6 Fnalry of p€urr lh, rhd. is 6 coisltudnn lddins a8ft, lor lh. pafommcc of thc $o!k for wtich lh6 p6nn $ <br />issu.d(Sc 1007. Civ. C ). <br />A!!!]CANL!EC!AAAI!O! <br />I holtr allnb undd p6alr, oi psjury onc ofthc followins d(lffalions: <br />D.nohion Pdnne^sb6td Norificarion F.ddal Regularions (1 irl. 40. Pdn6) <br />R.quircd L.ud oa Norifi.ariDh <br />lc6rifrrhar rhe fc{ral r€gulario8 rardin8 aih.srs rsn.valtr...r applicrbl. io rhis pNjd <br />lceriirrhar I ha!. rcad rhis application.M starerhar r1r.h)\e irfonnation r cor.d l ,Arc h .o'npll s th tll( irr, andCounl! <br />ordin.nc*.nd Sratc Lass rchr inf ro hildins consrru.1t,n. dh6ebyaulhoriTe.elrsnrdn6olrhis(irrand(ounrlloo16trponrhc <br />drvc 'nLnrn,.cd rx,trdr ifr ilN ,{- CBApplicr rorA*.n(Signdu.. <br />Chr', 4.rl,.^! <br />{l*17 <br />Set Backs x 1 \lr'l )Ll <br />Forms/Steel/Holdowns fl 1 ll tr!\t/ <br />E \1 \[!)q <br />UFER Ground ii 1 I 1 VI\J 3,-l <br />SLAB Floor a 1 \1 VIV jLl <br />Subfloor/VenVl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coal <br />Masonry <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL '/ -r ,3t z 7 4n r-^z*.-6rl <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />a*.- 4-z -L7 <br />BUILDING- INSPECTOR RECORD <br />Erection Pads <br />Pool Fence <br />I