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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DOT-CARATION <br />I hcr.b, afiim undr p.nlhy of pdjury rhal I m qc'nfl fsm lh. Coflr..tou Lic.M Las lor rhe follovins ,cen (Sd.701 1., <br />ausin6s md Prolsior Cod€): Any C y or County which r.qun6 , Fnil lo oslrucl. all6, improvq dmolish or rcpa oy <br />nructule p,ior lo its issu&c.. rls. rcqutd lh. applicer for srch Fmn to filc a sisncd $aldntf rhd h. or sh. i. licd$d pusudl <br />b rh. prcvsio.s ofth. Contmctors Liccns€d Law {Ch.pld 9. Com,nm.inS wnh Sation 7000 of Division I otlhc Busin* &d <br />Pmfsioos Codel or lhar h. or shc is .rcmfl rheefrom ed rn€ b6ir lor the allcscd ex@Plion any riolarion .l sdi.n 7011.5 by ony <br />aptlicahl l'or 0 pmil subj.cls thc applicanltoacivilpc.ahy.lnolnor.rhMnv.hundrcddoum(S500) <br />l. s oM{ of rh. Fopdly, or my.mplotc *ith ras6 s lhsr $l..onF$.lion. will <lo lhc wod{ ed tlt nEtw b ml <br />inrod€d or offftd for sl. (56.70.14. B6ins ed PrcfeioB Cod.: Th. Conlractols Licdc liw do6 nol apply lo d omd oa <br />rh. plopary who hrilLls or impro!6 th@n. ed wno do6 such wrL hin*lf or h@lfor rhronBh his or tn oM cnploy.6. <br />provid.d rhat such ihp.ord6rs @ml i dd.dorofiaal forsL ll howM.lhc boildins or inprov@l i. sld wnhin on. ra <br />of.ongLtioi! rhc O*6d Brildd sill h.v. tt bNk olFovins lhd h. or sl'c dxl 6l hild or inFov. lh. Fopory lo. lh. p4.6. of <br />l. as osncr oflh. prlpdy. en cxclusively .ontuing snh bc€ns.d coitmcloB to co*tncl lhc Fsj41 (s< 7044. BBmB <br />and koftssion Cod.r Th. Conkaclo.s Licos. Lau do6 not apply lo d o*nd of ptopdy wto builds or inprov6 lh66o. <br />and who conr.acls for su.h Foj.ds vnh 6 Contrado(s) lic@d pGudt to th. Contractor's Li.tr. I".w). <br />I m .r€nrpr unds S6lioo-, B & P C. aor rhis tson <br />D.re O*n.r: <br />$lr&tr!&5:c()ut!rs41l!]! <br />DECUAAIIA! <br />I hq.by alli.m undr rE dlty ot tejury o.c .frhc lollowinB ddlar.lions <br />-l <br />havc dd will miilan a Ca1ifi.de olcoBdr to s.lfiBur. lor worts s comF6alion, 6 provided for by sdlion :1700 oflh. <br />t b.r Codo lor rhe psaomec of th. voII lor rvhich lhc Donil i! istr.d. <br />a.d willnai.l'in {o.k6 coDFmarion iGuranc.. s r.lut€d bySNlion 1700 oalh. bbor Codc, aor lhc pafomecc of <br />for shich thi5 p6nn i! isu.d. My wort6 conp.Ealion irsu.&cc cmi6 dd poli.y ,!mbd ml <br />\ <trnce Pr-bJD <br />4cn<;ro -> * l\l actz", <br />I c61ify lhal in lhc p.raornEnc€ ofrh€ $ork for shichlhis F.mir s ssudl,I sh.llnot mlroy any Fen in any manr <br />so d lo be&6. subjcd lo $c woikd!' .omr.Nalion laws o f califomi.. sd as!€e lha! ir I should b..onc $bjcd ro the <br />*ork6' coup.@t io. previsions of Sdion 1?00 ofrh. Lnbor Codc, I shall, tonhs'nh compl, *ilfi lho$ povisions. <br />wAtUilNC Failurc ro src trorkd @npsdion covd.E. is unlastul, aad shau subj<l d dploy6 ro .iminal FDhE dd <br />.Nrl fhr up ro on. hunied l\oubd dnll6 {tr100.000,.compt6dn'n. da@g.s 6 prdvid.d ior,i. <br />Sdri.n 1076 olthe l-abn Onle inrcrsrand <br />2zze <br />I lE b,rinrmundd pmh,of ldjury lh.l I an d 9 (commeEinr u'ith Sclioi ?000) o <br />of the BusinB ed P6r6ioc Codc, dd my liceN is i. tull lo,c€ ed €ft€cl <br />rg ctoc ?:-t <br />I hd.b, amrm trnd.r paEhyolperjtrrylhal lhac is a onslruclion lodins <br />issucd (SB.1097, Civ C.) <br />Gnd6 s Nam€ <br />--- <br />L.ndcrs Addr6s: <br />APPLICANT DECLARATION <br />I h6*,ainmuid( pciahy ofpqjury on ofrhe aolowing d*lrations: <br />D.'noliriotr P nirs-Asb6losNorification F.doal Rcluhions(Tirl.40. Prn6) <br />Retut€d L€ri6 ot Norificarion <br />- <br />I.difyrh,! nr f.dcralre6u1dioN re8ddinr 6b€tosronoval e nor rppli.abl. ro this ptojd <br />srarcthar rh. ahov€ intonnition is corccl.l agc lo co'nply{irhaI cnyand cor y <br />rize repl6olaliv6 of rhis Cily ad Co6l, ro 6t6 upon rh.#;*";:t,ffix'^l <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />ln s u lation/En e rgy <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 />Flood Zone Certif <br />,1 <br />FINAL z//t/zj -Z.WJ,) <br />Gertificate of Occupancy ' /--s ?(./ <br />Notes, Remarks, Etc. <br />",,"QJ*/2"rzo <br />alr)\c <br />"rcntioned <br />prop.ny for <br />^,,0J+lzotz, <br />f--r