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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR TIOi\ <br />I h{cby affim undq polhy ol p..jury rhal I .rc,npl from lhc Cont.do6' Li.N lls aor lhe lollopin8 rcsn lse.?01 L5 <br />BBin6e dd Poicsion Cod.): r\n, cny.r countl wnich r.qot6 a pmnir ro &nsrrucr. 6llq, inprov., dcnnnish or r.pat dy <br />sr,xcturc, rior ro ils iss uecc, also rcqun6 l h€ .ppli€rnt lo r such penn ro 6le a sign.d sramor rhalhcorsn is li.6s.d pucuml <br />to rhc rrovisioN olrh. Conraclor's l,i.c.*d law (Chaprd 9. Comncncing wnh Sdion 7000 ofDivisiot I oflhc Busincs ed <br />Polesions Codc).r lhar hc or sh. b ercmpr rt*arom ad lh. b6is fo! lhc.ll.s.d exsnplion Any violalion ofS..lion 70.ll.t by My <br />0pplica for a p.flni subjclsthe applicatrtloacivilpcnaltyolnolmorcthefivchundtddoll6($500). <br />-I, <br />ar oMr of rhc pop€ny, or m, .mplor6 wnn waSs s thcir $le comFNlion, will do the wort ed thc sti(l@ is nol <br />intsxkd or oftcr.d for sal€ (Sc.7044, Busi6 ud ftofGiois Codq Ti. Co.radors Li..M Law do6 not rpply lo M ovnd of <br />rh.pNFly who hiilds or i,ryrovdrh@n. ed vho do6 such rr hnns.lf or hmclfor throuch h6 or h6 om mployc6, <br />pnvid.dlhar such mpol@Ma e nor imddcd or olldqi ror el. I I ho$e6, lh. htuildi4 or nnprovmdt is 3ot wnhin onc )@ <br />ofcoftpl6ioD, rh. Osn6 Buil(E will hav€ tn hnktr of Fovins thd h. or shc rlid mt bqild or i$Fo@ Uc FDpdry ior dE Ftrp.* of <br />l.6os,nrofrhc prepsly. d ciclusivclycontadins *irh licd*d co racloB to codrrud d'. Fojd lse. 7044. Arsrns <br />tud Proli.sion Cod.: Th.Conrradoas Lic.n5. Lowdosnor applylo movn6 ofpropcnywho buildi or inp,ov.slhden. <br />a.d who conrracls for sch proj.ds wnh a ConlEclo(s) licdFd puB@r ro thc Cotrt.rc1oi3 Li.@ riw) <br />I @.r.mpl u.dd Selio. ,S & P.C.lorlhisrdon <br />Drl€: Owner: <br />ULaBKI:8S!COM[E!$f!A! <br />DECIAIAIIO! <br />I h*.b, alrm undd pmilryofpaluryon. ofihc following dalmrioro <br />I har dd *iU mainlain a Cenincar. oacoNnt ro sclfJosur. for $ork6s compcNation. 6 pmvid.n lor by S€cxon l?00 ol lh. <br />lnbor Codc, for lhc psfomu.. orlhc work lor vhi.h lhc psnn n i$ud1 <br />I have .nd lill nBinrain workeB compcnsal ion insuEn e. d r.1luftd by Ssl ion 1700 or rh. khdt Codc. for th. p6,imMc. ol <br />.-., y: <br />tuf*, <br />a <br />in rhe prfoflnan.c ofrh€ *orl for shich rhis p.rhn is isucd, I shall not ernployany psson in atry mmncr <br />$ 6 ro b.cofl.3ublct lo rh. *0116' compeNarion L"s of Califomia. d asc thd ifl should b.comc subjct lo lhc <br />vort6'co'nFNtionpmvisioNofSdionlT00olrh.LaborCodc.lslEll.fonhwnhcomplywilh$o*po sioB. <br />WARNINC: FailuE lo s(urc {ortos conp.nsarioi covdasc n lnh!tuI, dd sh,ll subj..r m mtlot€r ro cimi.al Fnlti6 sd <br />lsa {lollos ($100.000). in &ldirkn t rht .ompcNlion. dana8cs 6 plo\idcd for lhc <br />(,t 20 <br />): <br />DECI.dAAIOT <br />alfim un&r pdalry oi pdjury rhd I d ltcn*d undq psvision ol('hapro 9lco.nnmcing <br />Busins d Pml6sions Codc. dmy licenrc is in full forc€ ud cflet. <br />rilh Seclion 7000) oftivision 1 <br />a(a?8C <br />uc..r,^"r.,V-a-t <br />CONEItrUqIIoII.IXDIIGICE!(I <br />I hdcby lmrm und€r p.aalty o I p€rjury Ihar lhsc G a coBtrucrion lcndi.g agmcy for rfi. pdfomtuc. of th. wrk for which lhis p{init is <br />issu.d (Sd. 1097. Civ C.). <br />A.8IIICATLDPCIIBAIIO! <br />I hdtty ailnn unds paalty olpcrjury oD€ ollhc followins d(l&ar'ons: <br />Dcmol(ion Pdmirs-Asb6ros Notificar ion l.d€ralRe8ul.tions (l irlc 10. Pan6) <br />Rcqtrired txlls olNolifi cation <br />r.sul0rioN r.Sedin! sb6tG ranoual ec nor applicable lo this p.oJcclliffi:*have rad tht appli.anon od sute rlFr th. abovc inlomarion is cord I .gE to comply <br />abovc mcnrioncd pordy lor <br />D.l <br />! I 'tt.,,)L <br />-;/,k <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsu lation/Energ y <br />Drywall <br />Ext./lnt. Lath <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 ?/t/,to'iVr,.iln ,lU\ ) <br />Certificate of Occupancy a/ <br />Notes Rema <br />2,.40 <br />--> <br />BUILDING. INSPECTOR RECORD <br />Etc. <br />F