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SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/VenUl nsu lation Roof Sheathing Shear Wall ].1/--/1a4Framinqi/a /,rq 9-y.a-,6 lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat lt/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif ^, lr/ f ty' 9Vrc'- FINAL 4-o7zl9 SD '7Certificate of Occupancy Notes, Remarks, Etc -t r,.}i,?jhTlifu if"q'ffi i:k;:,:'::,::iff ["ffi ;il"il slructurc. pri(r'kr ils issuance. also requires the applicanl for such pcrnlit lo file a signed slatenrot lhat he or she is liccnsc,l prrrsill b thc provisioils ofthc Contractor's Licenscd l-a$ (Ch.ptq 9. (lnnrncncing rvith Section 7t)00 ofDivision I oflhe Business and Profcssions Code) or lhat hc or she is exernpt thqeliom and lhc b6is for the allcged cxonplion Any !iolalion ofSeclior 70] 1.5 b]'aily applicant for a pcrmit subjecls thc applicant to a civil pcnalty ofnot rnorc than five hundred dollars ($500). _1. m orvner oflhe prrpeny. or nry ernploym rvith wagc as lheil mlc conrpcmattrn. rvill do the rrork ard lhe slndrre is not inlmdL{ or offered for sle (Ss.7044. I}usins and ftollsions Code: The Conlractor's Licmc [-aN do6 nol apply k) an orvno ol thc pro;uty who luilds or irnJrovc thssn. and who do6 such work hirnselfor heselfor lhrough his or het own empkryecs. pror ided that such improvonmts nre n(x intmdql or offsql for sle. lf. hou'q,o. the buildirrg or improlmeil is solcl $'ithin one 1eo ofconrplaion. thc Owncr Builds will have thc lurdo ofproving that he or she did oot build or improve the pr)lEly for the puqx)se of ele). l. 6 o$'ns ofthe [ropdy. an exclusively contraoing rvith licosed coniractoE k) corolruct lhe projd (S{. 7044. llusincs and ftoftskrn Code: The Contraclor's License Law do6 nol apply to an owner ofpropeny rvho builds or improves lhereon. aild rvho conlmcls for such prejcts with a Corilracto(s) licmed purslant to the Contractor's LiccNe La$ ). -Ianetcmptundgs4tion-.B'&P.C.forthisreron. Dste: _Ohler: WORKERS' COIlIPENSA'I'ION DT]('LARA'IION I hcrcby alfirm undcr pcnalty ofpojury one ofthe [ollorving dcclarations: _l have ud will rnailtain a Cedillc8tc of Consent lo Self-lnsure for workos' cornpensalion, 6 provided for by S(lion 3700 oIlhe tnbor Code. for the pqfonnmce of the work for rvhich the pemit is isued. lhaveandwillmaintainworkss'comFEnsationimurance.6 rcquiredbySstionlT00oftheLaborCode.forthepafonnanceof the work for which this pennit is issucd. My rvorkm' compmsation insurdce cmia md policy number ac: c-i-, ' <+(d' h, ctc' - - t .o,,.r*,,,n*. '-ET\lg z brerloz;* .-du4o. -l cerlify thal in thc perfonnance of lhe rvork for rvhich this permil is issued. I shall not onploy any person in any manner so 6 lo boconre subj(t lo thc workm' compmsation larvs of Califomia. and agree thal if I should becorne subject to thc rvorkm' compsrstion provisions ofSetion -1700 oflhe Lah)r Codc. I shall. fonhwith comply u,ilh thoe provisions. WARNINC: Failure to secure workers' compflsation covsaSe is unlaw ful, md shall suhject an qnployer to oiminal pcnaltiB aild civil fincsuploonehundredthousanddollare($100.000).inadditionlothecoslofcornpensation.danragesasprovidedforthe Selion 3076 ofthe Labor Code. intset and altomey's fe6.,*"ffi_[I 201-[ I hereby aflirm undo pflally ofpqjury that I am licosed ofChapl6 g (cornmmcing s'ith S$tion 7000) ofl)i!ision 3 of the Business and I'rofssions Codc. md nly license is in lirll force ud eflect. l-icemeClus:-L g _[.icensc Number:4ti *", p1\R ,0 7 20lScontrrctor:* J& CONSTRUCTION LENDING AGENCY I hereby alfirm unde pmalty ofpqjury that thqc is a construclion lending aSmcy for the psfomrmcc ofthc uork for rvhich this pernit is issued (Se. 3097. Civ. C.). Lenrler's Name: l-cndcr's Arldrcss: APPLICAN'T DECLARA'I]ON I horby amnn undq poalty ofperjury one ofthe follorving dalrations: Dernolition Pmnits-Asbstos Notification Fedqal Regulations (Titlc 40, Pad6) Required Letlq oI Nolilication lhis pr(iccl. I agre lo co[ply with all City and ('ounly ild County lo enls up()il the atnve rnentioned properly for insp(lion Applicnill or Agenl Signafure:I Permitft nsme (printl, (. -fi-,a-ffi,l.0?20 iB BUILDING. INSPECTOR RECORD