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BUILDING- INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNER BUILDER DELC RATION <br />I hrcby a,I!,n undq peflalry oa p.rjury rhd I dtr d.nrpt 6om the Conta.ro6' License tlw lor rhe lollowiry .e&. (Sr 70ll t <br />B$in6s dd P.ol6sion aodc): Any Cily or Counly which lequt6 a Fsnir ro codod. all6. improvq donolish or rqnt dv <br />sltuctu., rior lo ils issumce. also !equi,6lhc ag,licel ldr such p.rn lo nh a sisned statsncnl thal hc or sh. is lic.nscd pmuul <br />ro rh. r,ov6ioc of$. Conlrlcloas Liccnsed t w (Chrpl6 9. Conmcncins \rith Sdrio. 7000 ol Dillsio.I ofrh. Busi.s dd <br />Pmfdsions codc) or rhal nc or shc is.r.npt rhd.Fon dd rh. basis for rhesllcr.d cro!!,1rcn Any \ioltri.nofse.lion ?0ll 5 byany <br />.pplicant for a Frnit subjccrs lhe apllicsnllo rcivilpcnallyofnol mor€ lh?. ivc hundr.d dolltrs {150{). <br />l. 6 o$no oflh. Fop€ny, or ny enployc virh $ as6 4 th.ir elc conD€nslion. Nill do lh. \ort m1 rh. iruciu. is not <br />inroded or orcr€d aor elc (Se 7er4, Busin6s nnd Proa6sioN Coda I he ( onrrlciot s Licm* taN do6 not lpply ro M 0$,6 of <br />rh. pr!!al, who builds or inDrov6 lhEol1. Md \vho do6 sn h m* hnns.ll or h6ellor rhroush his Dr her orn cnployes <br />p.ovid.drhar such nF.vmts m d hlui.d o! orscd lor sh. lf. boNo.d, rh. hri[in* or nnp.or.16r is eld * nhin .nc )q <br />ol compbion. ri. ONrcr Blildg will havc thc htrdm ofrrotin! dla nc or slE did nol build or imprcv. $. pnpdy lor lhc plIlre of <br />l, 6 oM€r ofrhc Drcpsly, @d.lNiElycontadnrS wnn Lc€Nd conlBdodio coNtud lh. Fojecl lsa. 7044 BBns <br />dd &lfsion code: Thc Conldctois l-ic€nsc Law do6.ol dpplylo an osner ofproPcny who build! or inprovcs rh6on. <br />and sho contEcls ior u.h Frojds wth, conka.io(s) licd.d ptrsuul lo lh. contractols Lic.nF tiw) <br />I m ex€,ng undo Seci <br />gan6E&r.cllll8ENAlo! <br />DICIANATOX <br />I hqcby amfln undq p@lty of pojur} on. ofrh. tollowin8 del,ralioN <br />I havc and willmainlain a Cdlific.re ol CoBmr to self-lNur. aor workeB conp.nltrion, s provid.d for by Sdlnr 1700 oarhc <br />rjbor codq aor th. pcfommcc of the *ork aor which lhe lonn is isucd <br />-l <br />h.veandrvill mrinrainworkssr compcnsalion insurancc 6 r.quicd by sdron rr0o oa$c Libot Codc, iot r[. Pdfomffcc of <br />lhe \rork f(n shich this pc. ir is MyBork€rs coBposlion ins!,an c .ide ad Flicy ntrmbs de <br />q?-.lltsx s 2G <br />I c€nify thal in lfic Frfoman..orlhc wor* for which this pdtrn is issued. I $all not mploy any p6on in any ndno <br />so 6 to b€.onc subjd lo lhc wort6'composalion laws olcalifomia, ed a!@ rhal il I should b..onc subj*t to th€ <br />!vo*6' NnFelion pDJsios ol S..lion 3700 of the Lab.r Codc I 3hall. aonhwilh comply vnh tho* proisios. <br />F.ilure ro secre Norke'l csrnpssarion covcragc is tri shall subjd d mploys 10 dminal pcblri€ ed <br />lo one hundrcd thoNid dolhs ($100,0001, in addinnr oi (o'np.nsarnnr, daD.scs as t'6 id.d lor rhc <br />D,1", l( <br />lrh. tib.r Code inlsld and artorry's <br />lllq2rx ()! <br />I h6€by aan'n und.r !.nalty ol psjury lhal I m lic.nsd und€r provision dlchaptn 9 (oflnnmcins vnh Sdrion 7C\)0) ofDivision l <br />oi the lrusinBs and Prcf6ioN Cod., ed oy li.@ h id lull fo,cc ad er(r. <br />v,l0lnzt, <br />COlllBUCIlONL[dl]lNCrlC[lCI <br />I n.Eby .mnn otrdd p.n.lry o t p6jur) lhat lh6c i! a annruc1io. lmdi.s atsory ior th€ psfonnanc. of rhc q ort lor \rh,ch rhis Frftir i, <br />6sued(sa.3097,(iv.C) <br />affu(AtlDEclaadllo! <br />I @ arm unds Foallyof pdrry o.. ollhc lolloNina dalaalions: <br />Demolition Psmns-Asb6los Norifi carion F.d6a1 R.gulitioro (Til. 10. Pano) <br />R.qrt d kuer olNorilic.lion <br />I cdilay rbdr rh. f.dd,l resulaliom rcaedins asbBlos rooval & nor sppltablc lo ths projer <br />1l.diI rhd I \ c,qtl rltr,6pfl'.irh n,nl{ar.rhn F is cor.d.I agc ro mmplywilh.ll Ciyand Comr, <br />rcpltsrartr6 of rhir C y ud Caunry ro ard upDn rh. <br />D,'e r(1lq{ty <br />oftli.ancG and Sl.te I iws,elarinr Io <br />abo* ndrioncd proFlly tor <br />Applic rl or Agenl Sigmlurel <br />Y 1 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <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 />Flood Zone Certif <br />FINAL L/lo/lr 5p*{ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />SITE-WORK <br />tfl .".,..",.. lqa <br />l,endefsAddrs <br />- <br />Brown Coat