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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE tD/stG.COMMENTS OWNER BI]ILODII DELCARATION <br />I hreb, altim uhdd p.mhj of pBjury rhd I an .x€mpr &om lh. Conttcroa Li.c. tiw for lhc tollowins rcNn (5€.70115 <br />BNm6s and Prortsion Code)r Any Ciry or Coumy \rhich ..qun6 a pron to colrrucl. alld, ioprov., d.inolah Ep6tr d)' <br />strucruq plor ro s seudc.. ale .equt6 Ihc applicd lor such p€rnit lo filc a sisn.d $ar.mnl lhot nc or sh. i, licNd prsua.l <br />r, rh. provisions of rh€ Conlmclois l-ic€ns.d Law (Chaflo 9, com.ncinS snh S.clion 7000 ol Divison i oarh. Btrsind sd <br />Prcicsions Cod€) or rhat h. or sb. i! acnp thoc&om Md thc b6is for fic alles€d aftplio. A.t violtrion ofsa]1ion 7011.5 by any <br />applioanlforap.mnsubjearh.rppli.antlo.cirilp.nallyofnotnorclhdli!.hun&cddollds{1500). <br />,. 6 orner olthc prorEn). or dy .mplorB Nirh {.16 s rhcir sl. c.mp.Nalion. wiu do rh. *ort od ln. stflf,lue n Nr <br />inrd{tcd or olT6.d aor slc (sc.7044. &tsin6 Md holsiont Codt T1€ ont.croas Li.eM L.w do6 nol apply to d os.6 oa <br />rhc FopqtJ rho bulds or iihptuvB thdon. sd who do4 $ch srt hidsclaor h.Elt or rhmqh hk or hd own cdploy!6. <br />p.oud.d thar such mprc!@ds d€ mr inlddcd or oflaot lor eL. li hoqd6, thc bLrildins or imprc!@€ b e0 within onc ,M <br />ofcompldn[ rhe O{ra Builds *ill ha( rh. htrda ofFovins tnd hc or sh. did ml build or iEpNc 6. p@larl lo. th. purpor of <br />- l. $ o$n r olthe rop6ly, m .x.lusilcly conlracling with lictuctl contac1oc to @ieruct {h€ pmj€ct (Ss. ?044, BEinB <br />dd qotsion Co.L: Th. Conletois Licc.r. Law do6 nor .ppl, to e ownd olpropsly who buil& o. ihprovB lh6on, <br />.d who o.ra.ts aorsuch Foj..s *nh a cotu?cro(s) licc6.d puBur.r rorh. conradols Lic@ L,$). <br />I an.xchfl undd s(rion <br />lloatrlagllaMtENsarIa.N <br />DEqIABAIIAX <br />I hdcby amm und6 poahy ofr,gjury on€ orlh€ rollow',s ddldalioN: <br />I halc ud will mainrain a CcnificaE olcoMl ro S.lf-16urc aor Bort{6 mnptralion. * prcvid.d aor by setion l?00 oa$. <br />Labor Codc, forlh. pdlom c€ ollhe wort lorvhichlhcpmil i! issu.d <br />1l hak d n rll marrau u'orl6 comp.Nat 'on '6uan.., s t.gut d by Selion 1700 ofthc tibor Cod., for t. pdfo'l@ce of <br />rL <br />n insurmcc cArid &rd p.licy nuhbd @: <br />,^,"r^.,*,, % Lt i cAf\BG _z_Z <br />I ccnify lhat ii rh. pdaoman.. oirh. work for vhicn lfiis !.mn is issu.d. I shall not atrploy 5ny p6on in any m n <br />e s ro b<on. subjet to rh. wort6' conp.Ealion la* of Calitomla. ed lge thd if I slbuld bc.ooc subjd lo ll'. <br />srl(6' cornpostion prcvisioB of S..lion l70O olrh. tlbor cod., I shall, lonhwnh comply vnh lhosc roriri.B <br />WARNINC: Faihrc lo su. vorkds' onumsdion covqasc ir u.h{iul dd slEll subjar e 4ploy€r lo qimind p€nahi6 dd <br />.ivil nn6 up ro on. hundrcd rhouend dou6 {1100.000). i. addnio. lo th. .os ol comp.Nlion. daruss d prcvid.rl aor rhc <br />s(rion 1076oarlE tabor Cod.. inlod and allofty t 'ya- <br />r-rc@Eotrinac-rfn <br />/-.aic,,ABtrnor <br />lrc.i'd unde pI oUs'on of Chanrd q (.ommocrnE w h SdDn '000, o l Dtr sdn lI hdcby amr6 undd !.aalry ol pnjury rnd I tun <br />oi lhe Busi.*rod PNf6io6Codc, dd my liccBc is in tull forcc dd.f'sl <br />1]/o5s37/ <br />""", 2r/?/ zo <br />I hmh! afiinn lnrler pcnahy ol D.riurr thal a coEltuclion lddinS r8ocy for lh. psfodec. ol rh. worl lor which fiis pasit i3 <br />issu.d (sc 1097, civ. c ). <br />Lmd( s Name <br />-ATTIICAtrTDECI.ABAIIA! <br />I nolby .trfln und.. p.f,ally oa pEjury on€ of $c followi.e dcl&arioal <br />Dctaolnion Pmtu.tubds Notili.rriod F.d6al R.gulalioN (Titlc 40, Pan6) <br />R.quiEd lrtte of Nolification <br />-l <br />.ql.ry thd lhc Ldral relul,tioc Eg&dins G!6tos mval @ iol .I)rlkabL to lhis prcjal. <br />tr+-- 'ry <br />rnn t u* *ua ,m appl,ca! ion un srarc lhd rh. abov. inronmrion is cor.d. I asr€ lo cospry snh .u Ciry ed Counry <br />o imc6 Md Srarc Lls rcldrns ro buildrns .odtoclio( a.d h@hy.ulnorizc rcp(6s aliv6 of dis Ciy @d Comly lo otr upon tlE <br />above hdrdr.d pop.rly aor rNpdrcn <br />,lmlicn rur,tge lsignilom: <br />,/a-,- I t---)-/t1c-/hc <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <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 />Engineer Final Report <br />FINAL 16la Dlrnfi.?*b'7 <br />Certificate of Occupancy u <br />Notes, Remarks, Etc. <br />UFER Ground <br />Flood Zone Certif. <br />- ,- /-Dd.: ///5 //.o <br />z/3/b