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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUtI-DER DELCARATION <br />I hqcby amm unds p@hy oa p.rjury that I m eienpl frcm lhe Conrictors Lic.n$ kw lor lhc follorvin! i.mn {S4 70! 1 .5 <br />a0sin6s Md Proa6sion Codc) Any Ciry or Coumy shi.h Blui,d a p6nn to conslrucl- ahE. inpr.!c, &Dolish ot rqun ey <br />slrucrurc. prio! ro ns is$dc.. als r.quic rh. .pplicmi lor srch Fmit lo fiI. a si*nal slatdndt lhst hc or s& b li.d&d pu6u t <br />u Oe rrovisioN ofrh. Contracloa! Licen*d Iaw (Chapld 9. Comcnci.S $ilh Sttion 7000 oaDivision I oi$. BBincs ed <br />ProfNioN Codc) orllmr hcorshe is d.6pl rh@arom dd fi. baris ior lhc all€s.d exmflion Anyliolationofs*-lio.70ll56r.ny <br />.pplicanr for a p€mn subjec rhc appli.ant lo acivilp.naltyolnol more lhan 6!c hundreddollds($500). <br />-1, <br />s osdd o lih. p oFedy. o ny cmplo,6 * irh saa6 as rh.n enc coDp.nsalion. \rill do lhe soi( md lh€ stnEluc is d <br />irrdd€d orofrscd lor slc (S( ?o44. BosinB ed PmlNions Codcr'nc cdnt.clois LicN tiw do6 ool applr lo an own€rol <br />rhc pml6y \ ho hrilds or impo6 rh6o{ d \yho do6 such *dI himsclf or hsFlr or rhourh his or hB oNo coplo}.6. <br />prcvidcd rhar such ihprovsEms e not i od.d or or€Ed lor slc lr, hosdd. rhc t{ildins or impmveocnr i eld \eithin one J 6 <br />olcomrldiotr rfi. OMcr AuUd willhavcfi. hmlal oaprc\'ins tld hc o, slt€ did nol t ild or inprole lhe potEry ior fie purpsot <br />l. s oM6 o I rhc propdiy, @ crclusiv.l, contmcling {ilh lictr.d corrradoBro odrud th€ Foj..i (Sft 7044. Bcms <br />and Profisio. Cod.: flr Conrrador's l,iccnse La* do6 nol appl, to e ovfl6 olpBpcny $ho boilds or improv6 thn@n. <br />and who conrdds tor rn h FojdG wnh a CortEdo(s) lics.d pu6Mr ro thc Cortraclois Lictu. tiv). <br />I nexeDpl unders&rion- B &PC li,rrhisrcGotr <br />llo8alls:c9rlEErldr]o! <br />PEE!A8A],IO! <br />I hercby altmn dndd p.n0lty ol psjury one ofuc follovi.s ddltrarioBl <br />I hrlc md will mainrain a C6i6car. oaconsr b Seli-lNr€ aor erreB onDd!.lion,6 providcd fot by Serion 1700 ofth. <br />bbor ('od., lor lfu pcfomancc oflhc Norl aor ehi.h $c panit i, isued <br />I havc and vill mai.tain workeis compensario! i6urmc€. s rcquned by serion 1700 of lhc Labo. Cod., aor th€ Psfomtucc of <br />wortni .ompc.6lrioo insuid(c cmier md Flicy nlmbd d. <br />t4 <br />COt 4 <br />Icdifytharinlh€p€.lonnaoc.oalhewo forwhichrhisp.mi is nsu.d,l5h l .or entPloy any pc6on in any mmn.r <br />$ s lo b€.omc subjet to th. *ortm' composalion laws ofcalifoftia, &d ag@ that il I should bt o,n. sobjd to Ih€ <br />{0116 compcNrion r@}Bio6ofS..lion ST00 oflh. Laho, Codo l shall. aonhwith comply *ilh rho$ p6!isio6. <br />WARNING: Failurc lo KW wort6 snpdEdion .old8c is rnlasful, dd sharl subj.cr M oplo)s lo odinal PsElris and <br />.ivil fins up to onc lundred rhocdd dollm ($100,000). in rddilion ro lh. con ot <br />Serion 1076 of rh€ hbor Codq inrqd md lltonrey s 16. <br />,t€v I 5 ?glg <br />I}ECIAMIION <br />I hmby alfim undd p.nany of psjury lhal I m licds.d uodr Fovtsiod ofch.pl6 9 (conndcios wnh Salion ?000) or Dilisiod 3 <br />or lhc Busin6s and Pror6sioN Codc. dd my liccN b in lull foEc dn cfiel <br />b <br />^" ilwJ 5 208 <br />caNiragquoNI[xuNclcIlcr <br />I hcEbyarnn unds Dc.ahyofpcrlury$al llEc G a connrudion Endins asocy for rh.Flom ccoalh.*orl aorvhichtht Frnil b <br />issucd (S.c 109?, Civ. C.) <br />ATILJCANLDICIAEAIIO! <br />I not5y anim undn poralty of Fjury onc oflhe loUo$ing dclralions: <br />D.mohio. Pmnn*Asb€ros Notific.tion Fedral Rquldions (Tirl. 40. Pan6) <br />_R.qun.i tnd oaNorifi calion <br />I cqlif, lhal lfic Ld6al rc:ulatioG resddirr sbdtos remval 3r€ nol amlicabl. ro lhis prejecl <br />14 cd'ry lhal I halc rad rh6.pphorion od nat.that the a&iv. infonnario. is coret I astc ro comrlt $nh all Cnv dd Coumv <br />l<dmam6 dd sldc lr*r r.l,rinr ro buildins coNruclion. dd htr.by aulhort rcPr6olaliv6 ofthis Cny Md Counlvlo dla upon th. <br />rblcnEmioned floDeny lor insparioi Drpos. <br />Afpli.afll or 8cnl Silnilurc <br />rr.n* *rprn ): pal <br />,Nov I 5 20t8 <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 />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt4asonry <br />Pool Fence <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL z/mf,>DAA <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />T-Bar <br />tendE ! \de <br />- <br />I