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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION <br />I hcr.by a,ioD unds pnalry of pe.lury rhal I an.xc,npr Eom rh. Coit{ro6 Licdsc tjw forlhc lollowinS r6on (Sd.7011.5 <br />Busin6s md Pron$io. C$L): A.t cnv or ('ounty shich r.quir6 a pcnrn to coNtucl. allq. inprove &molish or rF6tr uy <br />slruciu., Fior ro its isu a, also rqut6 th. .pplicanr for such pcmir ro fiI. a sisn d slaldd rhar hc or dr is licaed pNdr <br />ro lhc prov6io6 ol (h. Conracror\ Lic..sd tiw (Ch.prd s. Commfl.iu wilh S€lion 7000 of Division 3 ollhc BBin6 d <br />Profcsions Cod€) or lnal h. or sn€ b €rcmpr rhd€6om md th€ bsis for rne allcscd exdplior. Any riol.rion olssrio. 701 I .5 by any <br />npplicanl tor ap€n.il subj*lslh€ appli.antloacivilpcoaltyoanolnor.thdfiv.hundr.ddolles($500). <br />I. 6 oMcr of th. FotEny. or my .mplolG with ras6 6 rh.ir $lc .o'nposnion- will do lnc worr dd Oc niud@ n @r <br />inrodai or orcEd f.r sL (se.7044, BGins dd Prc fBn,a Cod.: fi. conta.loi3 Li.c. tnq do6 not .pply to m own6 oa <br />the porql, who hrild! or Lqrov6 th6on. dd vho do6 ech *ork hi'm.lfor hdclf.r rhoush hir or hd oM dplor.6. <br />pmvid.n rnal such iDprcvormls e nor inloded oI ofi6{n for elc l[ nowdd. rnc h]ildins or imFovd@r ir sld snhin on ]a <br />of.omtld6., the Ome Buildd will h6!. lh. brd6 oapro\in8 $d he or shc did not hrild or nnlmv€ lh. pDpqly for lhc purpose oi <br />_1. * oM6 olrnc prepcir. d dclurivcly .ontraqing snh licasJ coffadoE to onsltud lh. FoJ..I (56 7044, B6iIB <br />md PEf€sion Cod.: ThcConkactois Licmc Ls* do6 nor apply lo doEnq ofpropdlywho buil&or inpro!6rt6@.. <br />a.d *ho comGds tu such projdsvirh aCoddo(s) li.Nd puNmt to thcConrractois Licsc Law). <br />I m.k.mpt u.ds s-tion ,B & P.C. forrhis r.6on. <br />ORnerl <br />EQtf,EBS:t0llt[lldr&! <br />DES,ANAIIQN <br />I lEcby.firm unds p.naltyofpdjuryonc oflh€ followitrr dElualions <br />I havc ud will mainrain a C.nincar. olcoMt ro S.lf-lNur€ aor wd6 comrqEarion. a povid.d for by Scrion 1700 olrhc <br />Lrbor Cod., for rh. p6fomdc. oirnc wort for which lh. pdmit is isu.d. <br />I have and vill mainrain worl€6 comp.nsar io. iBurancc. 6 rquncd by s6rio, 1700 ot rh. Lrbor Cod., for lh. p6fomm.€ ol <br />!h. sorl rorvtu.hrhiepomn is isucd. My sork6 <br />.,-- * Sl"^iz f,- d <br />"^n *, *J 3Zlqlln <br />contposdion iBud.c .dia aod policy .@bd q.: <br />-l.diryrtat <br />in rh. pdloroan .ollhc wor* for ehi.h rhis pdnil is i.su.d. I shall not mplo, ey p6on in any mannd <br />$ 6 to lx.one subjd lo the wor*6 .onposrio. laws of C,lifomia. md .s@ that if I should bcodc slhjel lo t <br />wo 6 compsMlion provisioN of Sel ioo l7O0 of lhc l,b.r Code I slall. ron <br />o.plo)s ro Eiminal lEnallis ud <br />ior, danqgcs 6 provid.d Ir lhc <br />WARNING: Failor. ro scurc $olkds .omp.MriDn covmBc is <br />cilil fin.s rp lo one hundrcd rhousand dolltus ($100.001)). in addit <br />se.li0n 1076 oflh. ll}rr code inr66r and <br />rz ln l 11 <br />I heehy.mm unds pdnlryofpcrjury rhat I @ licm\cd unda provision ofch,prc 9 (commmcinB with S€clion 7000) o <br />of lhe llNifl6s d Pror6sio6 Cod.. d <br />'ny <br />lictuc B in full fo(e dd clT(r <br />\7 L r( <br />I hftby amm undd p.nalty ol pojury rhar rhd. is a N.srtud ion lddinB .gd.y for rhc pdfomec. of th. work lor rvhich lhis p6nit is <br />istrcd (Sc 1097. Civ. C.) <br />artucaNfD[ctA8Allg! <br />I hs.by arfm !od6 pd6hy olpdjury on. ol $c lollowins d(ldalionsl <br />Dcmolilion Pcmils-Asbdros Nolilicalion fcd.ral Resulations (Till. 40. Pan6 ) <br />R.quir.n L.t16 of Noli6calion <br />I cqlilirhar th. a.d.ral rcsulartuns esdding or appli.able tu r[is l)rcj..1 <br />H;"r*:"ll I hi\c rc.d rhis applic.rion ion ie c.tr..I. I asr€ ro @npl, wnh 3ll Cnt and Coum, <br />arc Li\$ reLriru ro buildin olrhL cit) dd (i)unirro orc upon rh. <br />aolc,ndlioncd ropdy lor <br />,tpt,liQtrl or AB(trr SiBnhlu 4 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq t &+trcx v) <br />lnsulation/Energy U\ <br />Drywall 7'l-;iltt*t,Dq) <br />Ext./lnt. Lath U I <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 />FINAL 4"r.6r-l ,a/ <br />Certificate of Occu n <br />Notes, Remarks, Etc <br />BUILDING. INSPECTOR RECORD <br />tl?4@n <br />'gra(