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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE tD/stG.OI{NER BUILDER DELCARATION <br />I hercb! afim unds p.nalty of psju.y lhal I d qcdfl &on lh. cohrtdos Lic.nsc Lae lot $c aollo\i.s rcen (sc 70.11.5 <br />ausin6s od Eor6rbn Cd.l An, ( iry or (root, $hi.h r.qun6 a psnit to coNtrucl. elts. idproec. danolish or Ep6n uy <br />sltuduc. pnor ro irs issudoc. also requt6 rhe applicd aor su.h pdoit lo filc a siEned slalordl lhal he oi $h. is liccGcd pusul <br />lo llrc provisions of th€ Contiacroas t-iccn*d L5w (ClEpr€r 9. Comnrencins *irh s{(ion 7000 of Division I oflh€ Busines &d <br />Prcf€sions Codc)orlhat heor sh. is qcnpt rhacfronr ed rhc b.s6lor rh. allcg.d.rdrption. Anyviolalionofs..lion 7011.5 hymy <br />applicdl LD pcon strbjeh rh. appli.ant ro a .i!il pcnall, of.ol nore lhn livc hun&.d dou6 (5500) <br />-1. <br />6 oNn6 ofrh. !.op.ny, or s, .6plolc $irh $a!6 s rh.t $lc .o p.Nrion. \iU do lh€ \ori dd lh. nMm is not <br />n endol or olrsd for sal. (Se.r044. Busins ud PmfsioN Codq l1le (ontdct s l-ic.nE ll* do6 nol arply to osns of <br />lhe prepsly st buil& or iDpror6 (hd$( md who do6 such sl} hims.lfot horclfor lhrcugh hG or hd o*. mployts. <br />prcviden thrt sxch impmvodls us not i oded or o,Ided for elc I L hos6'6. rh. h{ildint or inpruvandr is snd {i'hin on. ) 6 <br />ofcohplao( rbc Ownd Builda *ill hav. rh. brdo of provin8 tbd h€ or shc did ml blikl or inport lh. pop6ly for thc purFsc ol <br />L som6ofrh. proD€dy. m.rclusivcly co.l,acrina qirh lic@d.onl@ro6r. co.rrud rn Foj.cl (56 7044, B6'.s <br />and PElbsion Cod.: 'I'he Conridols Licms. trw do6 nor .pply lo m own6 of prop.ny wno buil& or inpm!6 rnaon- <br />and vho .o Bds for such Eoj.cls Nnh a Conlra.lo,{s) ltoEd p6uan ro th. Conlroclois Licdsc L,w). <br />l.ncx. t, u er_Ssr <br />""..,41:{. tr <br />I hcrcby amfln utrd( penalry of pqjlry one of the tollos,inr del*atio6: <br />I halc d will rnainrain a Cenificar. ol Co66r to s.ll l'tsur.lorworkdr conD.ns.lion,6 previdcd ror bys(rion1700olrhc <br />L.bo, Codc, lor lhe pslomucc of thc work br whrh lhe potil 6 i$u.d <br />-l <br />havc and will 6.inrain m*.is compensalion icurance, s rcqut.d by S<lion :! 700 olrhc Lrbor cod., aor lh€ ,nlomdcc of <br />rh. wort lor {hich rnii Fmil ii is.d My wortgi .omFNarion ireur ce crid aaj Flicy numbd s.l <br />Itlrcy Nunbtr <br />-tirpncs: <br />I ccnilylhat in lhc p€rfomErcc ollhevo( for which rhis Frnir is Bsued, I shtll nor mploy any !e6on in.ny me.e <br />o d ro b<on subjd & the trdf{s mnrp€tralio. laws oacalifomi4 and asrc lnal ii I should beco,n. subid ro th. <br />\0*6 comFetnr. prolisioB ol Sdtion I700 ollhc t.tio! Code I shnll. tonh\ ilh (nlply * irh lhos pmvisions. <br />uARIlNcr l{ilur€ lo su!. Eo,k6' comp€Mlion cowse is uibsaul. dd sh,ll bjat e 4plo}s lo flB'.al Fuhi6 dd <br />civil fin6 up lo of,€ hundred lfioused dollm ($l $ rh..oi ofconp.Ealion. danapd 6 provideil for rh. <br />Sftrion 1076 ofrh.lrtrr Codc <br />{t)-4 ttl <br />I h@byamm uodd p6,1ry o f Fjory lhat I dD lic.nsa.j und6 Ftrvilior olChapls 9 (comtacins $nh sdion 7000) olDivision l <br />of rh€ A6i.ds dd Prof*sios Cod.. ed ny lictu. is in full ao& and .Itat. <br />Licc6. chs:-LiccN€ Numb6 <br />- <br />Drle Contdctor: <br />corslaucl]oNL[xDlNc-acE!(l <br />I h@b, lmm undd Fmlly oa pdjury lhal lh6c is a codruclion lcndinE 6sa.y for rh. tdaoflMc. oarh. "orl Lr \tich rhi. Fn b <br />Bsu.d (Sd 1097. Cir C). <br />AII!(AdLIIECI,ASAIIO! <br />I h6.byamnnundspoalryolpsjuryoocolrhcfollo\i.sdcldalio : <br />Dernoliliof, Pmils-Asb6tos Nolificdion Fcddl Rcsulnlions (Tnk40, Ptn6) <br />-Rcquircd <br />lilltr of Notifi..lion <br />I .siiiy rhd rh. f.ddal ..8olarions rcgardins sbdlos rcmoval arc nol appli.ablc rd lhir pmject <br />-l <br />cdiiy rhd I hav. rqd fiis arplicattun,ul sratc thal rhc abor inlonnarion is.ordr. I ase lo coDply snh allCilyand Counry <br />ordinar.G and Sr.ic liNsrelar and hftby aurhorizc r.F*nlal i!6 oalht Cny od Counry ro mrd r!.n ih. <br />,bo!. nhrion d pmpdy lo. <br />-*, tl' ( rl.\t,t,lirrtrr or \sMr Sixnarurr: <br />hdo rt=n tuL ra- <br />fu," <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />lr \ <br />FINAL il '1/,I ^rtH4/tCertificate of Occupancy <br />Notes, Remarks, Etc <br />COMMENTS <br />Erection Pads <br />Pool Fence <br />Flood Zone Certif.