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BUILDING. INSPECTOR RECORD <br />SITE-WORK OATE ID/SIG.COMMENTS OWNIiR BtJILDEII DEI-CARATION <br />I h&chy amfln rndd t naliy oi psjury that I m c\€npl fioi lhe ConlEctor L'c€ns. t $ for lhc lollo*ins r.en (S( 7011 5 <br />Busincs and ProfBsion Codc): Any City or Coudy shi.h icqut6 0 pemit lo coBlnrcI. ah6, imp'nlq d.molish o! !ep.1ir uy <br />sttudu,.. Fior ro irs isuarc.. also .equir6 $c applicdr lo, such pcn to fil€ a sisied slatuncnr Ihar he or sh. b lic sd puEudl <br />ro rhc provisilG of$c Conhclo.t L'censed l-3v (Chaptq 9. Connnetrcins wnh sdion 70c{ ol Division I of'h. ausin*s md <br />Pmacsions Code) or thal hc or shc is .xcmp! lhd.6om ard lhc ba.is ao. rhc alleged cxdrllion. Any violarion ofsc]1ion 7011.5 by an, <br />applicanl lor a psn subJ*rsrhc applicam ro acivilpenahyolnol nDrethan fiv.hondr.ddolltrs($500) <br />I. s ovflcr oflnc prcp.ny, or dydployc $irh yrs6 s rhcir $1€ $nlpasalion- silldo lh€ wod( Md Ih. struc1E is nol <br />nrsd.d or ollqdd lor ele (se.70,14. Businss dd ltolsbns Code 'lic ( ont.ciois l-icas. Ijs doB nol aprly ro d o$nd of <br />the ,,opely who boil& or inD.ov6 rhdo., and who do6 such *o,t hins.lfor hcellor rhreush his or h( otrn.nplorc6. <br />providal rhar s*h nnprovonols G ml inlod o, o,f6.d lor sL. lr. h.N6{, lh. hlildin! or irytorffil is sld witfiin nn. )w <br />olconpEion, rh€ O$nd Buldd will h.r€ tnc br&f, ofpr oving $d hc or snc did rct boild oi imprcve rh€ lropGq lor the DurIDs or <br />-L <br />s otrn r olrhc pmpdy. dn cxclusiv.ly_ conrad ins $n[ liceNd conlhcrou ro .o.etud rhc frej.d (Sa 704'1, Busin6 <br />d ltlrsion Cod€:'lhe cDniractols Licss. tl* nos nor aprlrro an owno ofp'ops1y who builds or inprovcs thqsn. <br />and \ o conlmds fo! such !trojds with a cod,rto(s) lic@d puftuer ro theconlra.lois l-ic4se liw). <br />I m.xmd u.d.r Sdtion .B &P.C ro.lhs@oD. <br />D.t.r O*ner: <br />loatr&[lt(ollfrN-rarla! <br />IECIA8AIION <br />I hs.by altrjn undd p..ally of rErury onc ol rhe iollowins d(ldarioN: <br />Ihav.mdwillmainl.inaC.nificatcofCotuolloSc,ll6u,.ro.wotkstcon,peni.rion,6p.ovidedforbysdiotrlT00oflh€ <br />Lrbor Codc, foi rh. ,6aonmcc o f th. {olt for which thc psmil is iss!.d. <br />I hare and wiu mainrai. work.rj .o,npc6arion idsuancc, s rcqrircd by Set ion 3 700 oarh. Lab.r Code. for th. pdforr@.e of <br />thc lvo lorshichthisp@i n is.d. Myworkft comtdMrion insurecccrnq ad poli.y nunbe. de: <br />I ccrlitlhal in rhc pBlonnan eollhcwor* for whichlhis pmn is issucd.l shallnol anrloy any pdson i6any,nMnd <br />e 6 r becomc subjd ro rh. s ort6' conpds.tion laws o I Colifomia. od ard tha if I should b..omc subirl lo th. <br />*ork6 compderion pmvisioNofS..lion 1700ollhe libor Cod.,I shall, aonhwth conDly silnthosprortsions <br />WARNINC: Failurc lo s@ \trkds .onp.B.rion orsasc is unlawtul. dd shall subld m oployd to qiminsl ImahE dd <br />civil fin6 up kr onc hun&ed Ihousdd dollm ($100,000), in addiiion to lhc cosl oi.omFm.rion. dma8€s s providcd for Oc <br />S6lion 10?6 ol r h€ tibor Cod., intod ed anomcy: fG <br />1 Z <br />DECIdIAIIaN <br />I hq.by atfin. und6 Fnah, ofpdjury lhal I m licds.d undr prevision ofchrpld 9 (.onmmcinS wiih Strtion 7000)olDilisio.l <br />oa lh. Busin6 md PrcfsioN Codc. &d ny lic@ i! in full fora &d cr(l. <br />Li.cm. class:-Li.cd. Nlmber: <br />oc.N7- <br />cQNirnucllQNLExDlrictctill.y <br />I hercby aflim u.d$ lcmlry oi psjury lhal lh6c is a coNlruclion lodins agdcy aor rh. Pdfonmc€ .rlhe wotl( for *hich this Fmh b <br />issu.d (S(. 1097. Ci!. C ). <br />AIILICANLDECIABAIIO! <br />I h6.ty aifim undd pdalry ol pr.jory on. ofrhc lollowing dEltratiotrs: <br />D€,nolition P6rnirs-Asb6k's Nolificar{n F.<tdal R.Utrlariotrs Gnle 40. P.n6) <br />-R€quned <br />Lcl16 of Norincarion <br />I.diryrhar rh. a.ldal lcsularioE rqudins 6b.slos.dovd c ndr appli.,bl€ lo lhis prci.cl <br />I cdify thal I luvc rod lhis applicdion tud starc rhal lhc ahvc i6a.mDrion is corccl. I ssra lo conpl) wnh,ll Cilyand Counly <br />ordina.cG ad Stai. Larvs relatins l. buildios.onsrrucrio.. arl hdcby aurh.rize rep.Mrd iv6 oflhis Cnyed coonry lo cnts upon lh. <br />aho!. nolion d pr.pdly fo. itrp€.lio. puros6. <br />App,icmt.rAsmrsrsn.rurc:* /tmA f-el <br />P$mile nrme(prinl): <br />'ol -1F <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB FIoor <br />Subfloor/VenUl nsulation <br />Roof Sheathing lt 1 tk €7n?n)I K2--.-' <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL -116 b.f.) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />o*. // - O/ '6 <br />or", 4'a/ -/F <br />I .'.J.' ! {J i$.. <br />-------r------