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BUILDING- INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNER BUII,DER DEL('ARA'I'ION <br />I hdchy atfinn unds p.n.lty olpsjury lhal I m cxcmpt lro lnc ConlracloB License tiN aor lhe aolloNins rc{sn (5(.?011.5 <br />AusinBs Md Proasnrn aod.)r Ant Cny o. (ou.'y *hich rcquic a p6rir ro consltucr. alt6. inpror., denolish o' rcpat ,ny <br />srtu(1uc, pnor ro ns issu cc. also requtB the applicel lor su.h Fflnit lo filcasi8n.d $atm.nt $al h. or sne is licosd pu6ua, <br />lo lhc Fovisiom ofth. Cont.actor's Li€.npd kw {Chaprd 9. Comhocios wirh Ssrion 7000 oaDivisio, I oa$c BosnBs md <br />P(f€sionsCod.)orlhalheorsheis.xcmplths.irommdrllch6sislorlheall.gcdcxsnplion.AnyvnarionofsdionT0ll5byaoy <br />applica lorapo.il subjEls th€ applica loscivilpen.hyolnotnorethMfivehund,.{dolltrs(ti00) <br />l.6 o*ndoarh€ pmpeny, or m) drployG silh N.t6 4 'h.i $1. composlion. lldorh.$orlrldrh.indwisaol <br />i aded orof€r.d ior sl€ (Sa.704,1. tlusins and Prolssions ('od.:1hc Contracl['s Licos. liv do6not opplylo oowndor <br />thc pispdy who hrilds or introvG rhmn. ed sho dc su.h Nlri hinslf or h6.lf or rhrouSh hit or hd oM.nplot6, <br />provid.d rhat su.h inp'ovmdtsftnol inrnd€d o oars.d aor*1€.l( how€vs. rhe buildinB or inl}xovoat is $ld wirh'n onc )w <br />oaco,npktio( th. (xn.r Buildd Nill htve rh. hrd6 ofprolins lhd lE or d'. did nol build or iDpm\ c rhe FoPsly lor lhe srFs or <br />,1.dorndofth.Fop.ny.m.xclusiv.lyconrB(ring$thlic.Jc6 hdo6r'odru.lth.Fnj.<r(Sa.704.4.B6in6 <br />Md R!ftsio. Codc: Th. cotrlr.dols Li...sc l-aw do6 nol applyro so*ns olpop.rlyUho builds or nnprove rhson. <br />d sho conlmds aor such pmj6k wirh tr C.nrhcro(s) licmdl ptr66r ro rh. (lonrr.crois Licd. k$). <br />I m ercnro undd S(rio <br />Drrt (h!n.r: <br />]!!lt[E!N]l-ol!tE!t !-t!oflDrlr-Brj&t <br />I h.ch) xllnnun rrlknrh) of |ElD.n.of(hrn,lL\,tr,! dc(ln (rr <br />_l hav€ dd rviu mainuin a Cdificate ol Co6qr to Scltlreule for workdi onr!,.isdrio., d pmvid€d fo, by Selio. 1700 ofrk <br />bbor Code lor i he psforrucc of lhc sork lor tr'nicn nE pmir is isued. <br />Ihavc.nds,illnraiman,mrk.rscolld$rioniEurance.asrcquredbyS4rionlTmffrhel.aborCodr,lorrh.IEfonnan.col <br />rhe sork nv $hi.hrhlqp@n is isru.d M) wor k.E' comp€Nar Nn insurdce cdicr dd F,licy nuhbs dc: <br />-l <br />cn,fy lhar in the pslorn.nc€ ollh€ so.k lor which lhis pcrmil is issu.d. I slullnol dDloy any pmon in a.ymdn* <br />e 6 lo b€(odc subjdt lo th. *orkm' compeMrion laM of Caliromia. ed aem rhar r I snouh b..on'c srbjdl lo lh. <br />sork6 comp.nstion provisioB oas.clion 1700 oath. Lahor cod., I shall. lodh\ h codrply wnh lhoE provisioB <br />WARNINC: Faillr.lo suc *ork6 conp.Nrion covqruc ir u.lawtuL and snaU subjd tu oployd ro cininal p.naki6 md <br />c il 6.es up ro o.c hudnd rhoutud dollaB ($100.000). in addnion to rhc co$ of.omp€MtnJn. d@ascs a prolid.d for ihc <br />sern'n 1076 otlhe llbor Codc. inld61 dd ,nom.,'s fG <br /> pplieol,_ <br />IICEIIEII(:ONIBACIOA <br />DESI,dAAIIO! <br />I hdcby amm undcr pd.lty ot pdjur,- lhd I m Iic.EEd undc prcvision ofChaplg 9lco'nmdcin8 silh Selion 7000) olDivision l <br />of lh. Busin6s dd Prolsions Codc. and ry li.cis. i. in lull lo.a ud .ffdr <br />(a!fiauLroNl.lNDrN(i_&cExcr <br />I h@by amrn nodcr !$alty o f pegury rha lhsc is a consr rucrion lcndins aaocy ror lh€ p€ronnsce of rhc so' * for rvhi.h rhis dmn is <br />issu.d(S( 1097. Cir C). <br />ATILKANLDECI.ABAIIO! <br />I is.by armn u.d€r p.naly of tdjury one of rh€ tollorvins dcletio.sl <br />Demolilioo Pmils-Asb6los Nolificrt ion [.n6al R.8ulalions ( ritE 40. Pu16) <br />-Requt.d <br />L€it6 ol Nolifiation <br />-l <br />cdifyrnd rh. f.ddal r.aularioB r.g6nin8 db€ros rdnoval r. nor #i.abl. ro rhG pojd <br />-lcslilylho' <br />l hav€ rmd this applicorion e sktcrh0tdcabov.i.ronndioniscorccl.l.rrrtocomplysithallCnya'dCounly <br />ordinancB 3nd Sralc Laws Elalin8 ro buidiq coBttucliotr .nd h.rcby aulhonrc rcpr.st.riv6 olrhh Ciryad Counlyro ntd upon the <br />aborc maiioncd pmp.ny lor irepa.lion p6Fos6 <br />,1pplicanl or,\Eorl Sigmlurt: <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsu lation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lr,4asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />,,\ <br />FINAL .-1\- lq ,\"\uul <br />Certificate of Occu pancy \J <br />Notes Remarks Etc <br />I I R? <br />-'tl tr ^t <br />I 7 <br />J <br />SITE-WORK <br />\ <br />Lic.N CIN:-Lic.@ Nunbq: <br />- <br />D.t.: Connr.tor: