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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENIS OWNER BTIILDOR DI]LCAfATION <br />l h6eu affirm undd p€.alty of psjury lhrt l an cxc'nfl fton the C'onta.ro6 Lic.ns. Law foi rh. aollowins r.Nn (S8 7011.5 , <br />BusinBs and Ploisioi Codc): Any Cny or (!uly shtch Equir6 a ldmii ro coGtrud, altr, nnprcre. dmolish or rqiin My <br />srtuduc, rBr ro ir! iasud.., aho reqlt6 rh. applicer for su.h pdmn ro 6lc ! siSn€d sl.h6l lhal hc or sh. is li.G.d pmumt <br />lo the provisions of the Cont,cloa! Li*nsd lrs (CMprcr 9. Conn€ncins wnh Serio. 7000 of Division I of lh. Busi.es ed r <br />Prof6sio6s Codc)or rhal h. or sh. is.ropr rhd.fto,n ed rh. bsls lor rh. alleg.d amprion. Any liolaxon orsdrion 7011.5 hy my <br />applicanttoraptrnitsubjelsln.applicanlloacivilpcnaltyofnotmor.lhanfithundr.ddoll6($500) <br />-1. <br />s otrn& olthc prepcdy. o. my mplore wnn wa!6 s fi.ir slc comFGaliofl. \eill do the \rcrl ed llE srndm i! ml <br />inlo(H oroirftd aornl.(Sa 7044. Dusin6s and ttolsions Cod€ rh€(ontic(tr'st,'c..scLa*dodoorarplytoanoN.6ol <br />rh.rmrEr, *hoh il& or inD.ov6fi66n,.Id rho do6 such wol( hnnsclaor h.Elf or ih,oush his or hs osd dp1oy.6. <br />piovided $ar such ihprolddts m nor inrnd.d 6r oll.r.d ftr elc Il hotrda, th€ t ilding or imF ovmd G $ld silhi'r on )s <br />olconDlcliotr ttc O\\ ns Duikl6 "ill hav. $t hrda oap.ovins thll he or she dkl nor tnild or inprol. fi. pmpqly for lh. purFE or <br />l. s o*n$ o f rhc propdy. dn ercl$iv.ly contm.linB wnn lic.ns.d conrados 1o onsrruct thc !troJ(r (sd 704,1, Rusin6 <br />dd h!f6t n Codc: l he conta.tol s Liccns. Las do6 nor ar{,ly ro a owns oltrop.ry $ ho builds or inpro\ €s thsNn, <br />,nd $ho Nnk,.rs lor sudr ltol.cls *ill a C s) licmsL{ luuumt torh€cohrradd s l-iccnse l,aw) <br />-l <br />an crempl under Scho <br />ulcl.^&llllll <br />I hoebr,l am.in undd rmahy ol p<rjury onc o <br />-l <br />hav. .nd will mai.rain a Cdifica!. of aosd ro S.Emurc for worksi @nipthern n, 6 p.ovid.! f.r by sdion 1700 ofdrc <br />I-abor code. lor the psfom c. ollhc si( for shich llE ponn i5 i.sud. <br />Ihav€and*illmai aitr wo*€rr compeB.lion i.srmncc. s rcqutcdbySedion3700oilhcLaborcode.lorthep6lonn ccol <br />lhe \!rl for which <br />'his <br />p.mil is is.d. Myworkds- .ompcn$lion iNuran ..dia dd polic, nunbs d. <br />I cenifr rhar in lh. pBaormanccoalhe wort for which this p6mn is isucd. I sliau.or cmploy any p.rson in any mmnd <br />e s ro bc@mc subr*t to thc Norl(6 o'npeelion laNs oi C.lifo6ia, 6nd agK $.r ia l should b€.o'ne subjdt lo lhc <br />*ort6 .ompNtionprcvisncofSddion1700ofrhc shall. fonhRilh.oaDly \ilhlhoF pmvisions. <br />WARNING: l_ailurc b suc sorlcm' conD€Nlion rtrlo$ful. aM shall subjtcl d dtl.y.r ro dioinal Fnltis and <br />cilil lin$ rp ro on. hdn&.n rbous d dollm (tl ition to rhc con ofcohac.sarioo. d@Es s piovided for lhe <br />Sdion 1076.1'rtu t?bor <br />I <br />I hcbt .innn lnds taahy of psjury lhal I m ncosd undr pro ofChlprs 9 {.dnnhti.ins $nn sNtion 7000)oll)tr$(,n.l <br />of the Bain6s &d Por6iomCode. rnd my li.mc is in arll aorcc Md <br />LiccBc Classr-Licee Numbd <br />CONSI'RUCI'ION I FNDING AGI'NCY <br />I hd.6, alttrm md6 F.aky of pdjury ihal lh6. k a connrudion Endins asmcy lo. rh. pnlom&.c oafie $ort tor \ hich lhis Fril is <br />issucd (S(.3097. Civ. C.) <br />AftllcadllEcl s rIoN <br />I h6.byammunds pqahy ofpgjuryo.c oarh. follo*i.s d(ld ions: <br />Demhion P6mns-Asb6ios Norilicalioa Fcddl Rcsularions (l irl€ r0. Pan6) <br />-Requted <br />lil6 of Nolifi calion <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Roof Sheathinq t?l+ld T,K\I6<u(F e) <br />Shear Wall u\ <br />Framing <br />lnsulationi Energy <br />Drylvall <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />l"\ <br />FINAL t"s -\1 Y"V.rul <br />Certificate of Occu anc <br />Notes, Remarks, Etc <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Ext./lnt. Lath <br />\@trx"^,"tLtq4L <br />!inna <br />I Pn,l{ i AdJ'6s <br />I cdiry <br />'har <br />rh. a.dml nSul,tioE rcBsding Bb6tos rmoval de nol applicablc lo lhis prej*l <br />-l <br />cdiry lhar I nar. rcad rhis .pplication dd rtarc rhar the abovc inlomation i5 .oft..1 l,srerocomplywilhallCilyandCounry <br />dmanc6 ud Srar. Liws EIdIB ro bu rldrs colmcr'on. arl h6cby author;c r.Fco$(iv6 ofthi cny Md Counly lo dld uron lh. <br />abo,c uouoned pmpd) rorD>diorlyes <br />"".t"*,* tt *rsa""# -r' \ ort..' ,/./'Perrit@Mn \Dti4f// <br />tt