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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DDL('ARATION <br />I haebv rmnn und.i !q.h) oi pdjuly lhal I sn erenrpt fror the ( onr,cro6 License La$ lor rhc aolloNins rrun (Sc 701 1.5 <br />lrusin6s d hoftssion Codc) Any Cily or Counry rehich requn6 a tdnrir tu consrucl, a1t6. nnp,ov€. .tdnolish or rq-n dy <br />srtucru'e, pnor (o irs issudc.. also requts t h. aldi.ant l'.rsuch p€anir ro lilca sisned nalcmmr rhar hcor shc is licsen pusua <br />io rhe provisiotrs ofih. Contd.roas Lic.nsd L^ (Chaprr 9. Comm€n.in8 *nh Scrion 7000 of Division 3 oflh. Btrsina Md <br />Phfelsions Cod.) or rh,t hc or.h. s.rcmpr rhdctrdm md rh. b6n lor rtu alles€d e\dnphon. Any liolaxoi olsdrion 7011.5 by any <br />applica lor a psmir subjds lhc applicanlloccivilpenalrrornormorcrrtufi!.hundreddollds($500). <br />-1. <br />a o$.n of the proFny. or nry enplo!6 s iih \vsg6 6 dret elc cor.pca\arn,n. \jII .h d. wolt dd fie srudw i !.r <br />i.tsd.d or ofl6.d for ele (56.704.1. Busins ud Prcf6ions Code rhe conkcloi s Lic.nsc tiw do6 nol appl, kr e o$ns oa <br />rhc pbtdy rvho bu ds or itupmrc tl*6n. md who do6 s,cn \od( hinBclf or lHrclf or lhroush his or hq .wn crhdoyee. <br />poridd thal su.n i'.p.oveNnls uc no( idddcd or ofleEl for slc lf. hotr.\ e. rh. t{ildin3 o. imlrovaHr Ls $ld vilhin ont Fr <br />ofsmplelion. th€ 6'n.r lruildduillha\.th. hmLn olpr$ in! thd he orshe did or build or iinFore fie prc!€1y for lhe purFls oa <br />l. trs o\e.s olrhc p.opdy. o€xclusnely conrra.ring rirh licdnd &,ntadoB t) coosod rh€ Irqc.t (S(.7(}l.l, aG N <br />ed Plil6sirncod. Ih.(inrrecroas Liccnse LaN do6nor ipplyto ano\rnsofpropeny\ho buil& or imrroves thqNn. <br />rnd sno cotrk.clstorsuchprojsts*ilhaConlmclo(9hcctrsedpu'sud b nt ( onltacu s Li.ctrs. l.arv). <br />I tun cxenrB under sNr <br />l)trI. ()s er <br />.!.!r-8!r!$lLpl!!!lsl-rc:1Dt:('t.ltR\t ()ti <br />I hcrcb, ifll'D uDd.r l,cfaht ofpc'ju'a.n.!frhc nilL\ring drrlxrhois: <br />-l <br />hav.a *ill @inrain d Cdlii.d. o I Corsdn ro S.lf-l6ui. for sorkdr @n[.!sarion. 6 povidcd for by Serion 1700 of rh€ <br />hbor Code. for lh. po fonnec. o r th. {ort lor * hich rh. Ijcnil is isucd <br />)! I h^. an,l q <br />' <br />ll m n worlc, s cnmp.N.r Fn iEdrancc. 6 r€quncd by Sd tuo 1700 {llhc Labor (tdc. for lhe pgiomaocc of <br />rh. $orl aor s hi.h this p.nnil is issud. My workm comp<Mrion iNur ce cans dd policy nunbd e. <br />o< lerl t r^)p lz6\ ^Zcl cl <br />, cdifylhar inrheperlonnan eoilhcwork r(n Nh'chrhis pd,r is ilsuei. lshrll,ror.mplot any lE6on i0 anynrrnnd <br />s asro heconc sbjd ro rh. *ollm cdrpllMrion l.ssof(.lilomia..Dd.sre lhd 'rI should b...r. subjei ro rhe <br />*lrkrd composarnn!ruvi{id6olS.cri.n:l700ollhe L.htr(odc,I snall lonh\vithcouply $(h rlDs p(wisions <br />V,'ARNINC fdilure ro Ecur. rvorlsl ompeq(ion c.w.S. Lr unli$ful. d shall strijd onplqs lo lri'ni,al lmihiB and <br />civil fincs up lo one hun&.d rhoGdd ddllds ($100,0001, in .ddnion t rhc c.$ ol N,. ddn,E6 a Uovid.d lor rhe <br />S(rrcn 1076 orrhc l2horCodc. inrlBtd{lrnorlcv s <br />,",", tt^ 2-r.-(, <br />Drcl/84llo! <br />I hercb, imrm und$ pLylty o a psjury Ihai I an Iicdsed undd provision olChaprd 9{conrmdtin8 silh Scrion ?000) ofDivision .t <br />ol rhe Brsin* dd l\ofsioru cod., and my licere. b in f lforce drd.r$r <br />\or Zlt <br />"". a\Q);^ze.r; <br />COIIIAUCIIANIEIDIIC-&GEIII <br />I hmby amnn und6 p.aalty ol pcrjury rhal th6c h d coNtruclion lddinr ag.n t lor rhe F fonndr€ ollh€ *ork ior{hich rhis pmnn n <br />issu.d(s.. 1097. ( iv c.) <br />AIII.I(AXfDES.AAAII!}! <br />I hdd,r. afiinn und6 poralt] oiptrjtrry o.c ollhe iolloNin8 deldarions: <br />t).'ndl ion P€mirs sberds Norincarion Feddal Rcrularions (TnE!0,l'an6) <br />Rcquted Lcncr olNotifi c.rion <br />-l <br />cdii thar thc lcdsal resulations rclediry 6b6lor ronoEl c nor nppli..blc <br />'o <br />rhis proiecl <br />ff.::lr'llllar I lu!c rcad rhis.ppli.,ri.n mll ndc rhxr th. dhn. innlrl(iotr iscorrccl l as'.! kr comtll sirh all( nyand Couniy <br />ro huildinB coN'trcnor &! hcrcby aur rqnBenlar'vE oarhis Ciiy dd ( ounrylo enrs upon lhr <br />ah.ienEntiorcd propcn_y lor inspsrion tur!.s6 <br />(\t,Dlicrtrl o' \8.trt si!nrlu,.t <br />P".,,'1,*-."trr,ur, p36 lrtcl$ t <br />Zo't( <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bf loor/Ve nV ln s u latio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />ln s u lation/E ne rg y <br />Drpvall <br />Ext./lnt. Lath <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 />./I <br />FINAL 7.2/z <'w/ <br />Certificate of Occupancy ,7 <br />Notes, Remarks, Etc