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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUIT.DER DET,CARATION <br />I h6.b( ailjrm Jndd pc..itt oi pdjury lhar I m .x.mpt liofl rh. Conrodos Lic.6. tiw for lhe aollowi.g r@n (sd 701 I 5 <br />0usin6s ard Pofdion Cod.): An_\, Cily o, Coudy which r.qut6 a p6mit lo cotrnrucl, allq. ihprov., &iolish or r.tan e, <br />srtucruE pcor ro ns isudc.. also r.qut6 thc arplicdr lor such p6nit |o lilc ! sisn d ard6l thar hc or sft is licq*d pNanl <br />ro the ptuviriom oalhe Co.lra.lors Liccnsed tj* (Ch.prd 9, Comcncin8 w h Setion 7000 of Division 3 ofth. BGinB sd <br />Po,issionr Code) or thar lc o! shc is excmpl th(.lioD dd thc bsis for thc all€scd €xqrption Any violation ofsetion 70115 byany <br />apnlicairiorap$nilrubjeurheapplicdolioacirilpcnalryofoor,iorcrhdfikhuidrcddoll&s(!t00) <br />I as osrr )lrhc proFly. or m, mplotE silh raB6 6 rfi.ir sl€ co'np6slion. Mll do tfic wo* od lhc sr.1E b nor <br />i a(E or onir.n for el. (SE 7044. Bsin* dd ltofsio6 Codc I't'. Co.t6cror's Licc@ tlw d66 @r agply ro d o\h6 ol <br />rh. i,o[dy who bdlds or i,q,ov6lh@n. unl vho do6 sch *!rl hins.lfor hGclfor rhough his o. hs om nploycq <br />providcd lhat such inprovdnoa e nol ini6&dorofid.d forela lf. how6s.lh€ t{iHiry or imprcvmol issBwnhino.cyw <br />of.odpldiotr rhc o\wd Build6 ull hlve rh. hrda olpovins $a he or shc dtd not boild or in rov€ rh. popdry ao, rh. pur!.s ol <br />I, asoMroflh€ propqly, dn ciclusively conhacrins wilh licm*d entractou to coNtrucl thc prcjcl (Sd. 7044. Buins <br />rnl h!li$io. Cod.r Th.Conracrors Licsc k* do6 nor apply lo &o*nd of propoly *ho build5 or improvd rhs6n,and *ho conlEcls fo, such projelsvnn. Comrocro(s) lic6*d pu6ml Io thc Conl6clors Lic.N L!w) <br />-l a..rcmpl u sSdiion ll L P( forrhisr.6on. <br />v9a[E[s:cQr!8ElS rIOr <br />olictA-BA-M! <br />I hcreby smnn under penrlrl oiDriury orc ollhc follovin* d(ldalions <br />I hrE ed $rll minlaia a a.nifical. of CoB6l ro SclilNur. for wortm o'npos{lior. a provid.d for by Sdion 3700 of lh. <br />Labo' Cod., aor ihc pgfonnMc. o f th. Bort for stich th. pdmil is i$u.d <br />Equted by S(rion .l700 oflh. tlbor Cod., fr rhc t{tomscc <br />'oD <br />i6u.dccc iqddFli.y numbd d. <br />I"/",/'",,,,,',., <br />Wqlt q9fr61 | \f '.\ <br />I celirylhal in thc psfomancc ollhc work aor shich rhis psmil is issued. I shall nol dnploy oy pssn in any mmnd <br />s a o b€code subjd ro rh. wo*6' mmpwlion laws of Califomia. ed as@ rhar if I should b€.odc subjdr lo rhc*o.t6' conp@lion provisioN of S..lion 1700 otlhc Labor Code I slEll. lonhwilh conply wilh lhos prcvisioa. <br />WARNINC: Falur. ro s@ worl6 .onFn {ion cov@rc ii unla$all. dd !h!ll subjdr d dplorr ro oiniorl FuXi6Ind <br />.ivn fid6u,ioon hu.drcd rho@d dolld ($100.000). in.ddition r rh. cosr of .onFerion, datug6 a providcd lor $. <br />sltriln:r07b nfrhc hl{r O L! tr.rL:rnl <br />",," "h/zo ^I,ICETSED.CONIBACIOA <br />DICIJI{ITON <br />I h@by arm u.d6 p@lty o I p€.jury that I d liccn&d unds provision ofchaFlq 9 (cohoftins wirh S.crion ?000) of Division I <br />ol the Bsin6 ud PrcfssioN Co&, ed my liccN is in full lorc. ard efid. <br />I <br />(,/// <br />6;k <br />I hcfthy nlflrn trnds Fnally of lrrjury lh3l thse is a conslflcrnrn ldding ag.nq for th. psfomd.e ofrhtwork fd $ hich rhis p6mit is <br />:s$'cJ(Sa 1097. Civ C ) <br />Lcndn s Nimc <br />AIIIIC NIDECLIa UQI <br />I h@h! amnn undcr perahy oapdjury ooc ollhe folloqin8 deldaiions <br />Dchohion Pomns-Asteros Norilicarion Feddal R.grlations (Til€,10. P.n6) <br />Rdtuir.d t.lr6 of No{ifi dion <br />I .diry Oll UE f.dd.l rcgulaioB Esadilg ah.los r@ov.l &c nor apglicablc lo thir projel. <br />Y , cdrt rhd I hav. sd this rp?licaiio. ed slsl. lhd lh! abov. infomation ir coftdl I rgre to comply wnh .U Cily ed Coudly <br />Jdnmoc Md sldtc La*s rclfl i.s lo blildi.s <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsulation i fr(wRoof Sheathing HLl'.lt'4,l)ltr0t"l <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext.llnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />Ir I I -7FINAL4M/r&)Uztln rrrls <br />Certificate of Occu pancy f1 <br />Notes, RpmArks, F{c., <br />'). (Pt <br />Llq/Zo <br />L.ndcas ,\ddrB <br />.r,^,"",tUiU;