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BUILDING. INSPECTOR RECORD
<br />Own.r arildcr D.cldaiion
<br />I h.r.by,mm und.r p€olhy of p€rllry rhd I m.r.m/ f(m t. ConrdoB Lic..i. La* forth.lollowi.s rcGon Gcc 7orI 5 autin.$
<br />od P.of63io. Cod.) A., Cn, or County *tich rquirB . Fmn b conshd, ah.i improv., d.nolish or rcpan dy shcrur., pnor ro is
<br />isruu€., ako r.qui6 thc rpplicar for such p.mn b fi l. i si8f,d ndm6r rh hcorsh.klic.nsed puuueirolh.proeisionsofrhc
<br />Cnt crq ! Liccnscd Law (Chspld 9. Comn.ncinS wnh Sarioh 7000 oaOivisio.3 ofrh. a$inss Md Profcrsions Codc)orrhd h. or
<br />snc is cr.mpr ficr.fron md rhc bsis rd th€ allcg.d .xcmpdm Any viol.ti@ oa Sedon 70r I 5 by oy .pplictur fq . p.mir subj.cs rh.
<br />.pplic t to n civil p.nrlry ofnd moa lhd fivc hundr.d don6 (5500)
<br />l. a o*.cr of ln. prop.ny, or ny cmployG *ilh was6 s th.t sol. cmF.sarion. will do {h. wort sd th. sttucrc is nor inkndcd
<br />tr ofiatd fq elc ( Se 704{, B6in6 ed P.ofsids Cod.: Thc Con.@tst Lic6s. L5w do.s no( apply b m oMcr oi lh. prop.ny
<br />*ho builds or imForo rh.@., &d who des slch *ort lim.,f d h6.lf r firoleh hii tr h.r o*n mployccs, Foyid.d lhar such
<br />'nprcv@nt!
<br />& not inrod.d o off.rcd for salc Ii how.vcr, rh. blildjnS or imFovd.hr i. sol.! wi$in on. ycr ofconplcrid. thc
<br />Ownd-Build.r will havc th. budo of provins $ar h. o. sh. nor boild or imp.o!. for rh. purp6. of sal.)
<br />_1,6 own.r oathc p.op.ny. d cxclciv.ly @ntdinS wnh licds.d 6.r&to6 to cosltud r,i. prcjer ( Scc 7044, Busin6s od
<br />Prcfdsim Co&: Tt. C@radd s Lic€ns. Llw do.e .ot .p!ly to r ownd of proFny who l4ildi d improrcs $.r.on , tud *ho
<br />conrr&ts ror such prcj.cts wirh a conrclo(r ltcnsd pucuat to $G conrBcror's Lic.ns. L,w )
<br />_l m.xcapt und.r Scction _.8 &PC lordis rc6on
<br />\YORI{ERS COMPENSATION DECLARATION
<br />I h.r.by rmm ona.r p.nllry ol Fjury o. of lh. rollovins d.clerionc
<br />_l hilc ad sill m.intu aC.nificat of Conscnl bS.lf-lnsu!. aor work6' comp.ns.tion, c provid.<t aor by Scclion l?0o ofth.
<br />bbor Codc, for th! p€rf(md€r of rh. work ad which $. p€mit ir itsu.d
<br />hrv. ed will mai.hih *c\6' cmFneriu iNum.., 6 r.quiEd by Sarion l70o oa th. Lrbd Cod., for lh. Fri6m&@ of fi.
<br />work for whi.h rh6 pdm t isru.d My rorLcB conpcns.tion insuruc. cnid d policy numb<rec
<br />*-,.
<br />{,",
<br />.^,!qr cL
<br />Nunb.. [Lf 2U 7 953 U 3'7 9 -/ - ?abl
<br />(This sdrion ned nol b. conpld.d iafi. pmn is for Onc hun&cd doll6 {ll00l d }.$)
<br />_l..nily(hdiinth.pqlm ccol$.*ort for which thisFmnis issu.d,l snallnor.mploy yp6soi.Mym n.rsoaro
<br />b.@c tubjal lo U. woik6 'cmpasalion laws of Califmia ud asr.c tlEt illshouldb6omc subjcd roth.*o.ka'
<br />@p.ns ion Foyisions ofsclion 3700of6. Labd Cod.,l shall, fdhwith comprrnh rhG.protisims
<br />t,"-/("-o
<br />WAR]IING F.il@ to rcw wql6 coop.satio @v.ras. is ul.vful, dd ihsll subjcct u cmployd lo rininal p.n!lri6 md civil
<br />fird up lo n. fiundrcd lnoEEd dollm (l l0o,00o),in oddnioi !o rhc c6l of corpc.sation. ddag6 a providcd td fiG Sccrion 1076 of
<br />rh. Lcbor Cod., itrrc6t dd d'omcy's f..s
<br />lleErsElc0Nrl^eroatDEE!4!{rlo!
<br />I ho.b, alfim undr p..ilty olpciury lhlt I m lic.ns.d unddprcvision of Ch4t.r 9 (comncncins with S.clio.7000) of oivision I ol
<br />lh. Butn*dd P,olessions Codc, ud fry licc.sc i in aull forc. dd.r.cl
<br />;1"..""*, c-s?J r'-,ai.a.. Numh.r lt / /?-
<br />5",., f-/6 -bl ..",.""t <a
<br />CONSTRUCTION LENDTNG ACENCY
<br />Ih.r.b,lmmundcrFdryoaFrlurythllth6.ii.@thctiml.ndinSrgocylaln.Frfom..01ln.wo*rdwnichrhhpcmtit
<br />nsucd (Scc 3097. Civ C )
<br />aE!c4N!.it-a!c!484!9N
<br />D.holni6 Pcmilr-Asbdr6 Norific$id F.ddl l.Suldids Gnl. 40, Pan 6)
<br />_ R.quiEd L.n6 of Nolificrdon
<br />ccnify lhar $. l'<L6l rgulalo.. r.gddin8 ab6l6 r.noval r. iot arplic.bl.
<br />'o
<br />rhn proj.d
<br />_ I ccniry rhal I ha!. c.d $i .p9licrio. &d n tC lh.r $c abovc infomation i. c6.cr I asrcc ro @mply wirh lll Cny .nd C@nry
<br />ordinrn.cs nDd Shrc Ln{s,clrins to bul\lins conn,ucriu. ed hcEby au$onz Epr6cnhriv6 ofthis City ed Colnry lo.nt.r upon ihc
<br />m..rioncd prop.n, for iNp.crio pu.po.6 t 5-/6'o/
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUlnsul
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />ll
<br />FINAL (tln a DftTY )7'--+-5 "'l
<br />Ce(ificate of
<br />s, Etc.5 _-()lJt blJNotes,t
<br />'l'.. (-f A-/1rl . -( n.'\
<br />4rfrr fft N,
<br />R"r;r* A, ^J-etz:zv-
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