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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DEL(-ARA'I]ON <br />I hd.b, alltrn und6 pcnahy of pdjury rhd I en cx.npl frc rh€ Contaclo4 l-ic.nse l.as ror lhe aolb*i.8 r.sn(Sd70115 <br />BNin6s Md Proldion Code): Any Cily or Cou y sh'ch r.quir6 a p€rnil ro consrtud. alrd. inprov.. danolGh or repan uy <br />sirucluc, p.ior Io irs suec.. abo r.qun6 rh. aptlicer for su.h Fnn ro fil. a si8n d $dmml that hc or slE t licded a6udr <br />to Ihe prcvisioN of rh. Contr,cloas Li.cn*d Law (Chaprs 9. Commcncins s,irh S<ton 7000 ol Division I oflhc lr6in€s d <br />Pnacsi.6 Cod.) or rhar h. or sh. ir.rmpr rh6.lrom Md rh. baiir loi rh. oll.S.d €renption. Any violaxon oas.crio.70l I 5 by tny <br />opplica aor. p.f,nt srbjeis thc applicanttoacirilpcnahyoanolmoElh&fiv.hu.dr.ddoll&s(!100) <br />l. 6 ou ns ofrhc propdly, or ny .'nployc virh sa!6 6 rhct elc .omp6erion. \ill do th. rvod od lh€ slrucld. ! nor <br />imod.n or olId.d lor saL (Sd 7044, Busind dd Poldsiom ( od.: Ih. Contraclois l-rcose I a$ dr6 nor arpl, ro d o( nd of <br />lhcpopcny who hilds or inprov6lh6an. ud sho do6 ech *!rI hi'.s.lfor h6s.1r.r rhuush his or hd oNn oploy.6 <br />pmvid.d rhar such inporanmrs m nor i *Ld or olTdal for sle I I hoN6s. lhc hoildins or ihp.ol dmr ir $ld $ ithin nnc ) s <br />oacompkiotr rh. own6 Buildq will haE lhc bur&n oarolins lha h. or sh. did mt hrild or i,nprov. lh. propdy tu lh. purr* oa <br />l. 6 owod olrhc prcp€dy. m crclusivcly conl,acl ms silh licoid comr.do6 o co.erud lh. proj..l (SE 704.1. Busins <br />dd Proiision Codc: Thc Conlnctols Li.ds. tj* do6 not applylo m orn( ofprop.nysho builds or mprcv.s thdon. <br />and who .omh.ls fo. ch poj.ds wnh a Conlr.crorls) lica*d purs@r ro rhc ConlrlclDls Licd. kw). <br />_l tun.!.mfl u.dosction . A. & P.C.lorrhsreson <br />raa[!r8tra!!!E!lr!ila! <br />DI;CIAIAIIqB <br />I hoeby amn. undq p.mltyofpqjuryoneoflhe rollosins ddluarnnr: <br />I havc u'l Nill mainrain a C.nili.ale ofconsr to Sd r lnrur lor worken conD.nsal'on. 6 lrolidcd Ir by s(liod :r 700 olrh. <br />Labor Codc. for th. pqfomece oflfi. Nrk lor tr hrh lh€ p6Drt is isucd <br />lhaveandrillmainlainuorkdacomp€nsdnn,nsurance.dr.\tun.dbyS{rion1TLOoflhcLaborCodc.lorlh.Ffomd..of <br />rhc qork for qhich lhis p.mil is isu€d My worlda comrENd n,. i6Lrd.. .mid dd policy.urnbs dc <br />..,'. €J e zL-6-\-- fr..s--uq*.- G <br />*r"r*..*, 5?1 o 2. \ 5* 1 ..0,*2ot <br />I cenrrythar in the psln!@ncc of the so for *hi.h rhir ,.nnir ir isucd.l sh.ll nol cDployanypc6on in any mmner <br />$ as ro b..on. .ubj<t io thc sort6 .omp6erion la*s of Caliaomia, and asre lhd if I should It on. subj(t 1o th. <br />sork6 co'npdslionpmviliosofS.ction l?ctr olrh. kbor Code.I shall. f..lh{nh co,nply rirh rhos prcvisions. <br />waRNlNC I,ailur. to surc qorke6' compcnsaxon co\em3e rs unla$aul, and shnll subjel & Gnployq lo oim8al poshiB dd <br />cnil finB up ro onc hmdr.d lhoMd doll6 (t100.000). rn addnion b rh..oi ofcorp.nstion. dma36 a prorid.d lor rh. <br />S{lion 1076 oitheL.borCod€. inl.r.sr dd tomy'saGN\.\a- L-!--,C'.\ <br />U!Ll-S-U4lI:-t&\(lA-Blli(l,!a ua.t <br />I hdcby aniro und6 F.ahy o I pdjury lhrt I m li..ns.d ondd rovision olchaplr s (com,n6cinr $nh sdion 7000) olDnision l <br />ol lhc gsin6s d Prorsioc Cod.. ed ny ltc. i in full fo(. Md.ll(r. <br />\2 ZGS 4oQ <br />\2-t.3[ r €,"**"-'F--^-L- d<'r\s=rr-<-\--s,\ <br />CONS']RI]C'IION LENDIN(: A(;EN('! <br />I h.rcby amm undd !.nallyofpdjurylhal lisc is o connrudio.lfldins as6cy ior rh. tdtunnan.. oirhc sork for shi.h rhn Fnn n <br />$sued(S.!. 3097. Civ C.) <br />AIIUCANI.IICIJEAIIAN <br />I h€Eby amm und6 rEf,alty olprjury on. oarh. aollo*in! ddltrriions: <br />I)cmolilrcn P€rmirs'Asb..los Notic io. F.ddal R.sularions (TnL 40. Pel6) <br />-R.qut€d <br />lsrd olNoi6cdion <br />I .diayrhai rh.fend.l rc8ulatio6 iexddins 6b6los ronovalEe nol arphcrblc ro this piojar <br />-l <br />ccniryrhar I have lcad ths aplli.dion dd srat. $al rh.abvc infomario. ir coEst I aSrelo omply *nh all('ilyond (-ounry <br />ordimncB d Srate t-aNs rchrins to blrld'n8 consrrucrio( dd hdcryrurhod. rq,corotiv6 oflhis City dd Couhrylo dtd utj..th. <br />abov. mdrion.d prop€n), aor iNp*tion purpos6 <br />}.\-v-= 1-,.,6-io <br />,"", rz( yalr€, <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Roof Sheathino <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />/), <br />FINAL t2-22-ly \s{-sc\ <br />Certificate of Occu n <br />Notes, Remarks, Etc <br />Erection Pads <br />Subf loor/VenVlnsulation <br />Brown Coat <br />Flood Zone Ce(if. <br />-", rz- lr-z lr fe <br />I <br />F---+---