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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS Om6-Build6 D@lertio <br />I hcby rftim unda paralty of pa;jury that I m cxmF ffim rhc Cmrrctm' Licotc Law fu thc following r6on (16.?03 L5 Buin63 <br />md Profsim Codc): Atry City tr County which rcquire r pcmit to cmmcq altcr, imgovc, demolish or rcpair my rtructuc, prior to iu <br />istucq rlso EquiE th€ lppli@t f6 sch pmit to filc t riSncd nrtqrat ahlt hc ff rhc it licorcd puGuul to thc provisionr of thc <br />C6r&1s't Limcd Ls (Chrptr 9, ComcinS with S61ifi 7000 of Divirim 3 of thc Bqins od Profssiw Codc) s rh.t hc q <br />ihc is cr.mpi lh@from od thc bqir fc thc dlegcd amptio ,Any violario of Sccdm 7031.5 by uy applicot for r pmir ubject! rhc <br />lpplicsn rtrr civil pcndty ofnot tm the livc hmdrcd dollu (t500). <br />D(s mq ot tt cpopcrty, o my onployca with wage u thcir rolc cornporutioq will do rhc work ud thc ilructuc is nor imcndcd <br />or ofiGd fa tdc ( S8.7044, BBin6 sd Prcfsim Codc: Thc CmtrEct6'! Li6rc Lew du not apply !o m omd of thc pmpcrty <br />who buil& or improvalhm, ed who doct trch wdk hiruclf tr h@clf 6 thrcu8h hir or ha own mployo, prcvidcd that such <br />imprcycmB e not intmdcd tr offcrcd ffi ille. lf, hwwa, thc building or improvmdt ir rold within onc ycsr of complction, thc <br />Omd-Build6 *ill hevc thc burda of prwing thlt ha or rhc not build q improrc fr thc purpocc of ralc). <br />_I, u omr of thc ptopcrty, m qcluivcly mtrrcting with li6cd 6EHw to coitruct thc projcct ( Scc. 7044, Butinqs od <br />Prcfdim Codc Thc C$trsctfi'! Licryc lrw dc nd rpply to m om6 of pf,opaty who builds c imprcvd rhffi , md who <br />cont'acB fq ruch prcjct3 with s Conbeto(r) limcd puBuut to thc ContEctor's Licosc Law.). <br />-Im <br />undq Scctim fr thir rson. <br />Datc: <br />I hcby alfim unda podty of psrjury 6c <br />_l havo od will maintain a Ccnifietc of Cmat to Sclf-Iruurc ftr work6' cmpwsrion, a prcvidcd fq by Strtion 3700 of thc <br />Labq Codc, fc thc pcrfmc of $e wdk fc which thc pcrnit ir isucd <br />_Iharcsdvillmsintaitrwc*6'ornpcnratimimmcc,B rcquircdbyScction3T0oofthcLaborCodc,fsthcpcrfmanccofthc <br />wort fr which thir psmit ir isucd. My wort6' mpcn$tin immcc mir md policy numbcr uc: <br />(Thi!ncd not bc complctcd if thc pcrmit it ftr Onc hmdcd doll@ (t I 00) or les) <br />rn my mmn6 3o a to <br />thc wqkcn' <br />Failurc o sccurc workffi' compfirstion covffigc sd rhall rubjcct e mploycr to aimirel pcnalticr and civil <br />Mpalation, dmlgc r Fovidcd fc drc Scction 3076 offina up to onc hu&ed thowmd dolln (t100,000),in ldditio ao th. cdt <br />thc txbtr Codc, intqBt sd sltmey't f6. <br />LICENSED CONTRACTOR"S| DECLARATION <br />I hmby allim uodr pcndty of psdury thrl I m liorcd un&r prcvilim of Chrptq 9 (omrcncing with Setion ?000) of Divisim 3 of <br />thc Buin6! rd Prcfqrim Codq md my licdc h in full ftrcc ed offet. <br />Lifficclai: LicdcNmbq <br />Ddc: CmtrEts: <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby rffim undq paslty of psrjury thlt thqc it 8 c@ltructim lmding sgacy for thc psfmcc of thc wqk fa which thir pcmit ir <br />irucd (Se. 3097, Civ. C.). <br />kndq'rNam: <br />Lodq"AddH: <br />APPLICAIYT'S DECLARATION <br />D6roliti6 Pmitt-AtbBtq Notifi6ti6 Fcd6d RcSulrtiw (Tidc 40, Pur 6) <br />_ Rcquircd Lcn6 ofNotificrtio <br />with rll City md Csnry <br />md County to mtd u[pn thc <br />Applimt or 886t <br />Pcmincc namc (pint): <br />c//zo.€ <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bfl oorA/e nVl n s u lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Requirements <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certificate <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc.l., <br />(a. JC a$S >_q u <br />l/ v<)