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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUITDER DELCAR,{TION I hd.br rftnr unds p.nalty ofpdjury lhal I M cr€ rpl arom rfu Contdo6 Licds. Lw forlhc lollosing r.en (S(70.11.: A6in6s dd Prol6sion Cod.): Aoy Cily or ( ounr, shi.h requts a pomil to coNruct alld, inptolc damlish or Epan my srrud@, pim b ns irsuMce, .lso rcaunB rh. applicst tor such pcmi !o fiI. , .isn.d ddar thrt fic or dE b liccns.d plNall io rlE FolisioN ofrh. Conrackr's Li.c.s.n tjw (Cfiogd 9, Commcncins *ith Selion 7009 of Divbion I oflh. Busins md Prcfesb6 codc) or thd n. or sh€ is cxcmrl ths€fron uJ the b.sn fot Oc all+.d danplior. Any viol,lion ols.clion 703 1.5 by dy appli.afl fora p6nir subjetsthc applic&t ro a.ivit pc.alryof.or,nor.thm fiv. hundr€d dollas {$500). l. s ornr olrh. FoFny, or oy .mplor6 with *ae6 6 rh.ir el. compeis.iion. will do tlE wo.l &d lhc sME b m' mhd.d or o,Is.d for el. (S* ?044. B6ins 6d hlf.sioN Code Th. Contradoa3 LictM tiw doe rol eply lo d oM6 of rh.p6Fiy $ ho hildr or improvB rlE6r ad who do6 $cn N& him.lr o' h.&lf or ihmush tis or hq oM .mDloy.6. providcd lhll ruch iiFovo6a e. rcl inraddl or oftdql for sl.. ll hows. th. tuiBiir or i"'prD!.nd t $ld qitnin on ,Er ofcompldr.. th. Owos Builda sin havc rh. bu.do otFoviis thal tE or !n did lot hild or inFov.lnc FnDdy for th. Ftrpoc of I, ar o\vnd nfrhc prepsly m cr.lusrrcly cohba.ri.e sirh li.msed conlractos io mNlrucl lhc Foj.cr (s(. 7044, BcmN and PlDa6ion cod.: Th. Cont.cro.s Liccnsc Laq do6 nol applyto e ov.6 oatropdywho builds or impro!6 thq@n, a.d $ho conrrds tor such lrojcrs *irh a Co.bac'o(, lic.is.d puuml lo lhcCo.'l,elu s Lictue La*) -l m.rcnpr unddsdnJn . B. & P.C. lor lhis r6on. uaBaEs[cQMtrrsAIIo! DDCIABAIIAN ! hdcby altrm und.r Fnah, ot p€rl!ry on. ot Ihc lollouins dcldalioB: -l have ed will @iniai. 6 C.nincat. of Cosdl to Selil6urc fo! work6 ampderion, piolided for bySelion 1700olthc tibor Cod€. lor the psfomdcc of the {ort for which rhc pmn is issx.d -l ha!. sd will nEihrai. wolkd co,npcnsaliotr insurancc, s r€quircd by Setion 1700 oarnl rjbor Cod€. fot lhc paaom ccoa t cdriryrhal in th€ Ffomn.. of rhc wor* fo, which lhir Fnil is isu€d, I shall nol Gmploy &y Fson in any msnd s d lo hqo6. rnbjct lo thc snl6' conposliotr laps olcaiifomia. ed aS@ rhd if I dEuld baom. subjdt lo lhc wort6'conp.MrionproisioBoisc.rionl?00oflheLalorCodetsnallfonhwilhcomplrwilhthospmvisioro WARNINC: Failu. ro su. w..t6' comFMrion coldB. is ! awtul. d 3hall 3ubjdt m mplorq ro Eimin.l Frtis ed ciil fi..s up ro onc hundr.d rhousd dollm (t100.000), in addnio. to th. con ol c.np.Ntion. d{886 a prcvidcd for lhc skrnii 1076.frl[ l16.r adl. inrdniandar t< Z..vt 5 I >-z I htr by aili.n uod6 pnalry of pcrjory rhd I ar lic.oecd indd prcvision of Chafld I {cormm.ing snn s..li.n 7000) oa Division l ol rh. BNin6 d Protsiod Cod€. dd ny l(dc is in tull turc. dd.fld. Las qqsE W I h@by omft u.dcr Fmny of pdju.y rh{i ilrm is a connruclion lcndins asdcy for lh. pnfommc. oath. wrt lor whjch this p6nil is issu.d (S€c 1097, Civ. C.). AIfI.TCAI{LDIC]I8AIIOI I hotby aFm undd Fnaxy ol pdury 06. oath. aollo{i,s del[al iors: D€'nohion Pmirv^rbdos No'i6c,tion l:.ddal RcBulatiom (TnE ,r0. Pdl6) Rcqured LdlaolNorifi .ario. I cdi& rhd rhc f.ddal resular iom r.sddins sbBtos rdoval d. .ot agplic.bl. to lhis p,ojdl. I c61i8 thal I havc rdd rhisaprlica'ion od st,tcrh.r fic.bo\c infomulion s cotrecr. I asic ro comply wnh allCilr.nd Counly oldinanc6 dd Srdr.t ** clainE ro hildinS consirucriotr ad aurhorn! rep.Mrarivd oafiis City Md Cou.ty lo qls {pon lh. ab.ve nBlioned pmpe^y tor l2tqt n,\pplicint or,\Eent SiEnnltr o €.r:y Forms/Steel/Holdowns Erection Pads LJFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathing Shear Wall Framinq lnsulalion/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif. FINAL z/z;z/24),tMt;- Certificate of Occu nc Notes, Remarks, Etc Set Backs "ilrz+n/ I \ a"."*a,*. t I,,,. :1zJg1 8 A c.l\ fT