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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS OWNI'R BUILDER DTLCAR,\TION
<br />I h(cl,y arfim und6 psahy or pc'ju.y rhar I an er.mpr from rhe Conlrictoa Lic.nse Lrw for the lollowins rdin (5$.?0l l .t
<br />Lrusir*s d Prol6sbn Codc): Any Cil, or Coutrly Lvhich rcquir6 a pflnil to co6rrucl alld, nnprov., dcrnolGh or repat my
<br />srortuc, pnor Io ns issu&cc, abo rcqund rhc appli.rd ln such pcmrn lo fil. a siSn€d slahor lhal hc or she is I'cm*d p6u l
<br />ro rhc provisioB ofth. Conrracroir Li€.ns.d Lav (Chaprs 9, Comm.n.ins s,nh S<tion 7000 of Divtion I oi$c alsinN ad
<br />Pntcsions Codc) or rhar h€ or sn€ d €rc6pl rhs€lion ed ll! basts lor Uc ,ll.sal .rmprion Any violationolscdion 7031.5 byany
<br />apph.&nfoiap.mnsubjd8rh..ppli.anlroa.ivilpcnrxrolnormorerh fivc hundrcd dollrs (St00)
<br />l. 0s own6 ofrlE prop.ny. or my employes wilh was6 6 I het sle .o ,Nns!rio., will do rlt wol{ dd th. strucluc is nol
<br />i.rodd or ollq..t ror el€ (Se 70,14, Businds,nd ProlBnrd Cod.: The ( onrrocl{ s LiccN. Lav do6 nol al]ply ro d osnu of
<br />Ihc pNldy sho &ilds or i,nllsv6 lhron- od *ho &)6 such *orl hinrsellor hdclfor thoush his or h$ osn dnploy€.
<br />p,ov idcd rhar nrch i,nprovorors e nor inrqkj€d or ofisql tor sl€ Ir. InN -6, rh. hildins or imln)vffir is sld $ifi6 oo. yw
<br />oacompldion. fi€ Ovn( Buildd Nill harc thc budcn of provins fid h. or she dn nor boiu o, in[rov. rh. popd, lor rh. F[Fo* ot
<br />-1,6o\Ts
<br />olrhcrmpsry. d€rclusiv.ly.onrlacrina with lic@d co.radou to costnd rhc pojd (Sd 7044. B6in6
<br />d PlorBion cod.: Thc Contlctois Lic.nsc kw doB nor applyro downq ofp.openy who builds or inpro!6lhdmn,
<br />and *,ho conrBcls tor .h projcc$ $nh a ConlEcro(s) licdEd pasudr ro rh. Conlrucloas Licm. ktr1
<br />_l u crcmpr unds Ssr'o
<br />Drlq oRtrer
<br />\,lORXSn.S' ({)NTPENSATION
<br />DECLARATION
<br />I bdcby amm u.dd p.nalry oipdjury onc ofrh.lollo\vin8 delddioosl
<br />-l
<br />havcddrvill rnnainr(cniar..reoa(in$ntroScllrlNur.forwork.6 convcnsatnn,. d previdcdforbySdrionlT00oatlE
<br />lilDr Code. ror rhe pglonr ceoalhc*ork lor {hich rhc runit is i.sucd
<br />rnd $ ill mannanr vortcrs comF6.r io. iBur.nc.. s ,equftn b, Ssl ion 1700 of rhc libot Cod., for rnc pdfomtrc. of
<br />" b*)iy *'k.t -.e-"rior iNurecc t id ad poricv .udbd de:.kt
<br />l4 oq q1 .i - ZZ ./f
<br />I cdiay rhd in rh. p€rfonnmccoa$e $ort for $hicn rhis psrn is issued. I shallnol snploy any p@. in any m.nnd
<br />s 6lo b€onr€ subj{l to the work6 compcBatioo la$r o|Califomia. dd agN ihat ifl should b.comc subjdl ro lh€
<br />workgd comlEnstion provisioB ofSelion 1700oalh.lib.r Codc,l shall. fonhwnh comply eilh lho* provisn,G
<br />WARNING: Failr. ro seue workdl conrpasalion covsase is unlavlul, dd shall subjecr an onplot€r ro dimi.al Fmltis d
<br />cilil fin* up to o.c hondrcd lhousud dollos ($100.000). in additioo lo rhe.on of.ompcBarion, dma8cs a p,ovidcd for lhc
<br />Sedion 1076 ofrhc hbor Cod.. inls6l and anomer's ls l*-ltu/*-.'J' '/o 'l'l
<br />r !cENsFrtcoNTi[a-mR
<br />IIiCIAAAIIQ!
<br />I t.rcby aflifln undcr p.n.lly o I psjur,- lhal I dn licosd und( rrovision ofChaprd 9 (.ormd.ins wnh Sdion 7000)olDivisnrn l
<br />of rh. Bcins d,t PmlsioB codc, rnd my lic* is in tull lorce dd cfid
<br />a4/3 ESSq 3L
<br />-z 6i A7'*)'nl"1Y-
<br />co!$alcu1llIENDINGTIG[rcr
<br />I h*b! amm unds p.nany o f psju,y lhal drft is . conslddion lodins asorcy lor the p6aomd.c olrh. "ork aor thich this psnn is
<br />issudl (Ss. :1097. Cn. C )
<br />AIiLICANLDECIATAUqd
<br />I hct!,allnnundd tmall, olp€rjury oncof thc followin8 dccl alions:
<br />Demolitun Pmrrs sbdros Notifi.arion F.d6al R€gulalions ( riit 40, Iran6)
<br />Rcqun.d Ln16 !a Norir,cdio.
<br />-l
<br />c€n ili thar lh€ f.ddal rcsulalions erddins 6be1s removal dc hoi a!)l]L'rohlc ro rhis !rutc.l
<br />-l
<br />cenifyrhat I havcrad n'is applicarion and srarc lhar lhc abovc inrondnJ. is.ondr IaSreroco'nply*'ilhallCilydndCoun(y
<br />odioancG snd Slate Llws rclarins ro buildins consrucrion, dd hseby adhort r.prMhlive oflhis Cny d Counry lo old uF. lhe
<br />above mcnlionedprop€dy for inslE l '7'**l--L-3"2u^ lf
<br />apnlic!nl or a8.nl Sttr!lu'c
<br />K,2y'1 el, s
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing \41 -t"i,
<br />lnsulation/Energy (\/\4)
<br />Drpvall l I
<br />Ext./lnt. Lath t1
<br />Brown Coat
<br />Irila son ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL tt ttllt4 ''?rln"rotd 'lrg)
<br />C ertificate of Occupancy U\
<br />Notes, Remarks, Etc
<br />A
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