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BUILDING. INSPECTOR RECORD SITE-WORK DATE COMMENTS OWNER BUILT'EI DET,CARATIoN I na.rrL .mrn undr Fnahy ol ldjtrry rhar I m .ronpi frcn rh. (bntdo6' Lics. Ijw for th. aollowin3 rcasn (56 70ll j Busi.6s and Prol6ion Codc): Any Cirr or Counry $ni.h r.qut6 a p6mn ro consrruc1. ahs. in$ov.. ddolish or q,an ,ny srrucluc. Fio! to irs su&c., d& r.qut6 lhc appl'c.nt lu such pcrnir Io 6L r qirn d n.rsfl rhar h. or sh. is licfised pu^udr 10 the provisions ollhe Conlraclors Licensd Law (Chaptd g, Commencins rvilh Sdion 7000 of Division I of ih. ausin.s a.d ProLssions Code) or rhal h€ or 3h. d el.mpl rlErcno'n and rhe h6s$ lor rhc allce.d .rmplll)n An! \iol.rionotS€clion 7011.5 b! any ,pplica aor a pnnit sobi..ls lhc applicanr to 0cirilp.dahyolnor,nor.lh.n fiv. hun&cd dollrs (S5q4) l. 6 o\rr orrh.pmpcny, or myeniployd wirh \ra!6 ss rhct sle.omt.Nrion. si[ do tnc uolt Md rh. stnrclu€ is nol intfllal or oIr..€d a.r sl. (Sd 70'14. BusinN and Pml*ioN Code The Conlrado' s Liccns La* do6 nol dmly ro an own r .l rhc p6ps1y *ho builds or impmv6rhd6n, and sho d.6 sh $olt hims.llor h6clf or thrcu8h his or h6 own cmplorcE, pr.lidcd rhar such imro\@nt d.nor intdrlol.r ofiddl lor eL lf, h.\'66,lh€ hrildin3 or imprevmdl is $ld wnhin on. )@ ofcomplelion. lhc (lhr l,uildo rill harr lhc hrd6 of rmrins tha hc or she dii not build or iqrove lhe propdr lor rhe lurpo* of I. ar o\nr o f rh. ropqry. d crchsn€ly conrra.r in8 Nirh lictucd .!ntrdo6 r. coNrru.r lhc pmled (S( 7041. B6irs ed PDf6io" code The contracrois Licosc L*! doa nor appl, ro .n or n6 of propFly who bu ilds or impro!6 rh.r.on. and who con[acts for such lr6j6ts $ irh a Conr.rdo(s] li(d.d pu6uMr kJ rnc Contado.s Li.oe Las) I dn e\enrpl und6 Sdion I lrrebv r,h'n uDder t1f.ky oftol,,.y (hr nlll(N i! dr.lrmr$n\ I har€ ad $illmainlain a C€ni,icate orConsdr lo S€lll6urc for rvorkd compdsrion, d providcd lor b! Salion 1700ofthc Labo! ( odc. for rtc p€fonn&ce of tfi. \eor( for \rhich the pmil is issu.d I hav. rnd will msimoin rvorktri co'nt.Balnnr insur.n.c, 6 r.goir.d by Scr ion I700 otlhe Inb.r Codq fo, th. Faamecc oa lhe ro.t aor which rl& tmril is isu€d. My $orlm co6p(1grio. itrurdc€ cmi6 dd p.licy numbr 6e: PolicyNumbd I ccnrtythal inthcpqioldanccofrhe{ork lor vhich this l)€mn is Nsu.d.l shallnor mpl.y an, pdson in.ny, mnnn6 $ a ro bdon subjN ro th. $0116' ..6r.nsari.. la$ ofcaliiomia- dd arn. rhar it I slsuld b..onE subtat lo th. s.rk6 c.mpdstion rmvisions.fs..lion:lT00oirh.Inhor Code,l shdll, lod h{ hh .o'npl! rvilh lho*provisbns. WARNINCT railur. ro Kur. \ort6s mmpmdion cor6as. is unlasrl|. and shall subjd d mpl6)d ro dimin.l porahie and cnil fincs trp to onc hundr.d lhousand doll.6 {tl .m0). in addnion to rhc cosr orconp!.erion, dm.t6 a prolidcn f.r rhe Sccriotr 1lr7r,.frh.l rhn (.d.. 'nl.rc( u:LI -8n!1! I teby artrm uoder p@lly oa pdjury rhal I a'n limsd undcr !.ovision olcha|r6 9 (coDndcins Nnh s6rlon 70tr0) ofDnhion l of rh. Businei md PmfsioB Cod., Md my lic6s is in aull for.c .nd citsr CONEIBUCIIONIIIDIIG-ACENCY I n6cby amm und( p<aalty ot p€rjury lhal rhrc is a conslrudion k dins asdcy lor rlE p6aoman.. ofrh. sork lor *trich ihis pflnit is issu.d(S< 1097.(iv C ). AE8IICANLDECIA8AIII}X Ihqd,yaltr trnd€rp.nahyolpsiuryoneollh.lollosinxdEl.ralions Dcmolnnr. Pdmirs-Ash€ros Noli6..tion r'cd6al Rclnhrion! (Tnl. 40. kn6) Requncd Iit6 of Noli6calion 6b6ros rooval ee nor dlpli.abl. ro 'his pmj*l .rhal rht atov. infomarion is.oE€cr. 108!eto mmply with all Ciry and Counry hs.6y. hoirc rcprBflrativB ofrhis City dd Couoryb dr6 rFnrh. ,\tllio r or \At t Sis xr &.,""C X=- *" r"y'e /r7 Set Backs Forms/Steel/Holdowns Erection Pads pltbltl 14 t ^,-fr,4 D UFER Ground 0 I SLAB Floor Subfloor/VenVlnsulation Roof Sheathin s Shear Wall Framing lnsulation/Energy D rywall Ext./lnt. Lath Brown Coat Irila son ry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL iltfl/s ia *k+c,-r',-7 ,)rrTrCertificateof Occupancy Notes, Remarks, Etc ID/SIG.