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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWN gR BUILDDR DELCARATION
<br />I hd.by aIIDn rndcr penalty oi lEiury lhsl I an cx.'npt frcrn lh. Co ractou Licdsc l.av for rh. followinE rcon (S4.7011.r'
<br />BLsinss d Prordion Code): A., Cily or Coonr! whicn requn6 a psnil to co(rltu( and, nnprove, d.molGi or repan Any
<br />slrcrur. !flor ro i5 GstrM... also r.qut6 lh€ applicd for su.h Fmn lo 6t . sr8n.d $armd rh.t lE ot sh. is licostd pl6udt
<br />ro rhc Forisn,os of rh. Coora.ror'. Licc.$n kw (Ch.Ud 9. Co mcn ins wnh S*rion 7000 of Division ! oalhc Busind sd
<br />Pofe$tuns Cod.)orlhat h.orshc is ercmpl th6ci.o dd lhebsis for rh. allcsal.rdrprion Anyviolationols..lio.70ll.5brdi
<br />applicant tor apmil subj4rslh€ applicdnt ro a.irill.naltyol.ol mor.thd liv. nundrcd dollrs (5500).
<br />l. d orno oarh. ln)l{ny, or nry .mrlo!6 wnh v.s6 6 lher elc .d,npolerion, will Llo tt vort ud lh€ slruclwc s mt
<br />intddol or offdcd lor slc (56.?04!. Busio6s ed Pjofdsiof cod. Thc Contr.dois Lic€N lrw doe nor aplly ro an ol$d of
<br />rhc ptur.iy $ho b{ilde or irnpro!6 tlEon, aal vho dod su.h ${& hinB.lf o! hdFl t or lhrcush ht or hd 6s .mploy€6.
<br />prolidedrhqr ruch improvmts d. ml i.loded o! olT6.d for slc. I I ho*6 s. th. buildins or imFovffil G $ld vithin on. ]@
<br />of.ompldion. th. ol,nr AuiB6 \vill hav. th€ bud6 ofFovin! rhar h. or sh. did ,ot hrild or imprcre rhc pioFny for rfi. purpos ol
<br />I, as oNn.r ofrh€ trrop6l!. an cxclusrcly contactin! wirh licm.t contocro,s lo mnslrucl lhe Droj.l (Sd 7044, Bcma
<br />ud llofcssen Cod.: Th.Conlra.loi s l-i.ensc Law do6 nol apply to an ow.er o rpr.ltny { ho tuilds or improves rhson.
<br />dnd Nho contrack for such projds rv h a Conta<ro{s) li.m.n pnBU. lo ihc Conr,elor's t-iccdc La{)
<br />I an.x.,rul und6SslioD-. B & P.C. forthisrw.
<br />:waBK!8S:CarlfElrAMX
<br />oEct4.86rIOX
<br />t hqeby afim undF p.oahy olpsjuryon.6arh. aollosin8 d(ldatiotrs:
<br />I havc md wiu maintain E C€nilicat. ot Co@r ro s.lar6urc fo! work6 omroslion, d l'olid.d aor by sdion 1700 o I thc
<br />Labr Codc, for thepalonn cco|thcwort forwhichrh.pnth is issu.d
<br />I havc ad vill mai.hi. work6 .o,npatsarion iBurance s r€quiEd by S<l ion 1700 oafi. kbor Cod€. for lhe P6lom ccol
<br />rh. \o,L lo, qlx.brhtr lrmn tr srcti Mt sor[6'cunn,Nuon
<br />ccotlsddlo lnutnntl iNurAnc. @id afll policy numb6 rc:
<br />\\t o oo 314ro rf LD
<br />I cdiiyth.t ifl rhcp6fonn0ncc otlhc wort lor *hich lht pomn is issu.d. I shdll nor mploya.y pdson i. a.y mthn.r
<br />$ 6ro becoru subj*l ro thevods .o,npds.lion laws ofCalitomia, ond errd lhat ill should b..omc subjEl lo lhc
<br />\rortc'co'np€erionrdvi.iocolsdionlT00oflhcLaborCodc.lsh.ll.fonbwilhcomplywnhlhosprcvisiore
<br />WARNINC: Failur.lo sre wo!k6' co'np€nslioa covsas. ts unl,waul. md shall subj6l 6I,toy!r lo om,.al Fnahis md
<br />civil li..s up ro 06. hundrcd rhous d dolls ($100.000).
<br />'n addirion b rh..os ofcomp€asalion. d@g6 d pr.viddl forlh.
<br />t
<br />snlr n rLr7.,,lrr( r.,htrr,,Ll.
<br />".,", tzl3llq ,-,,,r- o-$e
<br />lri{r.r.sr:o rtrnrna<ron
<br />DEC!,AIAIIQtr
<br />I nmby amnn undd penalty of p€.jury lhal I @ licss.d trnds Folision of Chapls I (comdcing sirh Sdion 7000) of Division 3
<br />of rh. Bosins and hof6sions Cod., and ny licdc n i. alll aor.c ed crel.
<br />tu Acq{es
<br />1rl
<br />CONSTRUCTION LENDINC AGI]NCY
<br />I hs€byamrm undd,En,lr, oip.4ury rhal rhft is a coNlrucrtJn kndinr atsa.,lot rheFaonn c. ollh€$ork litrrhichihi! pdnn i3
<br />issu.d (Sa. 1097. Civ C.).
<br />Lends s NanE:
<br /> PPLICANT DECLARATIOIi
<br />I holby s,Im unda pe.rlry oapsj!ry o.. ol lhe followins d*lsal ions:
<br />D€,nolition I'.mirs-Asb6tos Noifi calion F.dml R.gulalions Onlc 40. Pan6)
<br />Requted L.lla of Norindion
<br />I cd ily rhar th. acddal resularioN rcsddiDs dbesr$ r.doval dc nor applicablc io lhis pBj6t.
<br />I cgl iry rha I havc 6d lhi. arplicarion &d slalc rh0l lhc above inlomdion i! .od.{ I alre 1o orply wilh all Cny md Counly
<br />odinancB ad Starc Irws Ebrins lo toildinS conntudio( dd hs.by adlDrnc reprcslarivB o frhis Cny dd Couoly lo dl6 uFn lh.
<br />(-"t 3l ({
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<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 />Enqineer Final Report
<br />Flood Zone Certif
<br />I I
<br />FINAL 2-lx u 12tt1.q6L*s*7
<br />Certificate of Occupancy \r
<br />Notes, Remarks, Etc
<br />Subf loor/VenVl nsulation
<br />Lc.dd s Ad&d:
<br />-
<br />abo\.
<br />'nMt
<br />ion.d propdy for iEpriioo purpn€
<br />{pDrc'n, or asenr sisr.,ure N- q{^.L-.^/]Qz!<a
<br />"-.*.-."r,^"r, RhhC F\fl,tfion
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