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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OTVN ER BT]ILDER DELC RATION <br />I h.rcby drlinn Lndd p.nahy oi p.rjury rhar I m er.rB i.o lhe Conlr.ctou Licsc Law lor the lollowins rc&n (Sc.7011.5 <br />Buvn6s . d Proitssion Codc): Any Cily or Couny {hich rcqun6 a psmh ro co6rtu.t, alt6, inp.o!., d.molnh or Epan my <br />strudue. pItr lo s issuec.. als rcqure rh. aptlicer tor ruch Fnbt b filc a si8ncd statdEnl thal hc or sh. G licd&d pusudl <br />ro rhe provi,ioN of th€ Contacto.s Liccns€n Las (Chaplr 9. Cohmc.cing wih Sdrion 7000 of Diviion 3 of$c A$in.s ed <br />PolessFns Code)or thar he or sh. is.xe6pt th6.noin md rt. h6i. lor lnc ollcs.d .xmplion. Any violationoiS€dnJ.7031.5 hy dy <br />.ptlica for a pnnil subjds rhe spplicanl lo a civil pcnahy.f nol morc lha fivc hudrcd doll&s ($500). <br />._l.6oqrnfrh.Fop.rrt.ornycm.rmwnh{as6srh.n$tcompcNttrtriUdolhcwoltadlh€sIndu!Bnor <br />'dddql or ord.d aor sl. (sa 7014, Buins ed Prcf6io6 Coder 'nE Contra.tois Licce I av do6 .or appl, ro d ome ol <br />rhepFtEly who boilds or impro!6 th6en, -d who do6 slch wo* himsclfor h6*lfor lhhugh hh or hft own cmploy.6. <br />providcd rnd such nnprolmars {. ml i 6d.n or oll6Ed for ele lL hou dtr rnc bildins or imFov.fur a sld * nhin on. ,ur <br />ol conDl€riol rhc OBnd Bulda will hav. lbe hudd olFovins rha h. or shc did .ot hrild or imForc thc prcpqly for thc purrbs ol <br />I, ddwn6ofthc ffopcny. m.rclusilcl, conraclins *nh licmcd contraclosio conslrucl lh€ ptojEt (Sec.7044, BB'o* <br />d ADtsion Codc: theContretois Licens Law <106 tur apply ro d ownd o f propdly who builds or nnprovcs th661 <br />and *ho .o.r,o1s aor soch projds wirh a Co.ltuo(, licms.d lursuanr ro thc Conrmcrors Lictue Liw). <br />I d.r.,ng undd Selion .a & P.C.forlhisr6on <br />IOBf,!&I.COMIEIIAIIAN <br />DECIASAIIA! <br />I hseb, alfim uid6 p€.ahy ot pdjrry onc of th. lollowinB dcl&arioc: <br />Ihave d * ill mainlEin a Cenifical€ olconsar l. Sclf-lNurc ror wort6 coop.M'ion. 6 Fovidcd for by Selion 1700 ofrhc <br />#d; <br />for rhe lsfonndEc of thc $ork ior qnich lhc pflril is issu.d <br />will nEintain work6 comFrealion iasu@c€. 6 r.qu;cn by S€lion l70O of th. hbot Codc. for ln€ pafo,Mc. o I <br />A <br />this pcnnit is isd. My worlss conrp@sarion i6urd.c cei.r dd lolicy nunrbc dcl <br />r1,r9/r (An I n 5!2'(44!e-/5 ,_o4 1o.l-Zt2 <br />I cqliryrhar in lh. psfomn.. of rhc {oik flr shi.h rhis p.nnir is issucd.l shall nor dnployanyps&n in.ny nldicr <br />$ 6tobcomc bjdro'hcwo 6s comF.stion laws ofcalifomia. d atrdlhai ill3hould heoN subjd' ro'hc <br />wo,k6s'comp.sario"prclnioNolSetionl?00ofrhcL{borCode.rshall.ronhrvirhcomplr$irhrhospmvisio.s. <br />$ARNINC Failurc Io scu. $r\c6 .o,np.nsatio. covdasc is$ful, dd shall subjdt e mploys lo oininal Fuhi6 od <br />civil I'nes up ro one hundrcd rhousdd douds ($100.000). in .ddilion ro ilE cosl of comp.nsalion. dmascs 6 provided lo.lh€ <br />S(rNn 1076 olrhc rrbor Codq imd6l dd anomcy's fc <br />l- <br />I hcrcby arfim utujd poalry of pcrjury ilal I @ li.s!.d u.d6 Folision ol Chaptg I (..mhocios wnh Scclioo 7000) of DNnion l <br />ol rhc Dusins Md Protsioas Codc, drd my liccM is F full for.c d cftel. <br />' Ith/),o Qzzo tt'd <br />1-31:76 <br />co!$aufiloN.L[latlc-ac.Elcr <br />I hdby altm undr Fnalry of p.rjrry lld th6. i! r s.{fl.tio. k din8 asdcy for lhc pslomdcc oflh. wort lor which lha ponil n <br />issu.d (Sa 109?, Civ. C.) <br />AfIUCAII.DICIABAIION <br />I hertry afmi u.d$ poahy oapdj!ryo.c olrhc lollo{ine dela.lions: <br />Dcmohion Pdils-AsbGlos Norilicarion Fcddal Regularions (TnL 40. Pan6) <br />Requu.d l,.lr6 of Noi6crion <br />conNl I .ffe to.{nply wirh allCiryend Counry <br />olrhis City d Counlylo dt6 uponth€ <br />abovr Norioncd pmpc(y tor iNpdionp <br /> or ,\gent SiEMlu <br />fr'un (.:s( a lltat , r b <br />tJL-Q <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 />Framing <br />lnsulation/Energy <br />Djyuvall I <br />(Ex).ttnt. atn */t /*'tc El '.'rz/ d y <br />Ere*n€eat 3tuu-o Ll I 2- 19 -'2r b-//\t <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />h-L^ &u.:at 4'l L-lr -2- <br />FINAL a -r g-?. <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />-)