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BUTLDTNG- tGpecron REcoRD <br />COMMENTS,SITE.WORK DATE OWNER BUII,DER DEL(]ARATION <br />I hscby amm undq poally of pdtury rhal I an .r.mq nom rh. ConrracloE l-t.n!c Las ior tnc tullowi.8 r.Mn (5{.701 1 5 <br />Itusinss dd Profs'on Codc): Any Cirt or Counry *hi.h r.qut6 a ,Emn lo cotrrrud. ahs. improve. dmolish or ?Aan &y <br />ntucue pnor ro ns issuancc. also rcqunB thc applicanl lor such pemil lo lilc a si[..d srdcmbr lhal hc or nrc is lic6.d pusul <br />ro rh. provisioB oarhc Conkacror s Lrc€nsed Ijw ((haprs 9. Commcn.nrA w h Sdrion 7000 oaDivision 1 olthe BNinN dd <br />Itorsions Codc) or lhal h€ or shc is c\€npl ll,@&om ud lhc bas6 tor rh. all.sed crsprio. AnyriolarionolsdionT()ll5 byany' <br />dppli.dt lor.p.nnn sdbjd8lhe applicet ro.civil!.n.lryofnot morc lhm 6\€ hundlen doll6($500). <br />-l- <br />6 owoo oflh€ propoly, ornydplo,6 wilt vas66lhcir sl..of,peBarion. willdo th. "ort dd tfic nnElrc it ml <br />iddrd.d orordcd for saL (Sc 7044. Busin6s and Prof6sioN Cod€ I h. conractor s Li.@e L.w do6 not rpply ro ar own6 oI <br />rh.rmFny $h. hiil& or inpro€ thq6n. and who .106 such sork hnmclt or hcelf or lhruush his or hF oM dnployB. <br />pmvid.d lhal such inpmldHls d. trol htdd.d or oilc€d lor sk. li ho\rds. tlE trildios or inFo\tmr L $t wnhin on. tw <br />olco,npl€rio( rh€ ()Nnd Duilds "ill harc lhc btids of provins th.d hc or slE did nol build or iiproe. thc .,ep.rry for lh€ purFk of <br />,. s o*nd oarh. propdy, m .x.lusi!.ly conrracrins snh lic4.d conttacroE ro .onilrucl rh. Foj..1 (sd 7044. acins <br />dd ftlft3son Cod.: Thc Co.lracrois Lic..s. Law dos.or apply to o owns ofpropdy sho builds or impov6lbnon, <br />and who com@ls for su.h pmj€dswnh a Codmcro(s) ltd.d pGunt tolh€ Conracror3 Li..N trw) <br />I an.xcmpt uods Sdion ,B.&PC for this r€6on <br />\l)!uEa$:(orrrlsa]t0-N!!c!a!]{l!g! <br />I hecby omfln u.d6 p.Tnlty of psjury onc ollhc 6ll.si'l3 d<lalaliotrs <br />-l <br />have d rvill mainrain a C.n'ficrle of Coent ro Sdr-l6urc ror lorksr onrpensotion, a pmvid.d aor by Sclioa 1700 ol lhc <br />Labr Codc lor thc prfommce o i the work fo! which lhe p6nil t issrcd. <br />l ha\eand\yill mainraia sorldt c.npens.hon insurance.6 rcquied by S<r ion I700 olrh. bb.r Codc for th. p6lolrMcc ol <br />ion iaure. caha md polic, nrnb< e.: <br />o I <br />-l.difyrhd <br />inrh. pdaornmc. of lhc worl for whicl thk pd,nir is issu€d. I shsu oot mploy any p.en in dy mMd <br />s 6 ro beom. subjdt to the so oJ omposarion lavs ofcalifomia. andisdthar ifl should hecor. subjnt lo thc <br />so*6s comlrdstion pmvisioN olsdion 1700 of thc t bor C'ode I sh{ll. fon h* ir h coiply tr ilh tho* prolisions <br />WARNINC liallurc ro src *.rkds comlHsriofl co is ulaslul dd shsll sunjd ontlo)f ro dimmal FElri6 &d <br />ion, d na8es s pro\idcd for rh.o.e ntrndred lhoxsand dolla,s ($10{).00l]}. <br />intsdadanomey's l€6.-il <br />I h@by afiDn u.d6 pcndry oa polury thar I d licascl udd pbvilioi ol Ch,9'6 9 (comacins {ilh Salion 7000) ol Divition l <br />ot the Busins and Pmf6ioB Codc. ad niy lic.nsc is in lull lor.r dd cf@r <br />o r: <br />I hebt afiim unds lpnalr, of t-Ejury tllal llEc is , coNrudio. lodin-! !s$cy ior rhe pslom6ce ohhc sorL lor $hich rhis F'mir is <br />issued (S.r .l0!r7. Civ (.) <br />AITIICANI.DICIAEAI]OX <br />I lEet, 6Jtm und6 paehy oa p<lury 06. oalhe aollowing ddldd ions: <br />Donohion PmilsAsbdros Norin. ion Fcddal Regolarions{Tnb40, Pd6) <br />R.ituiql Ldls ol Notifiorion <br />sb6kr removalaE nol appli.able t' rhB pojdt <br />I asrelo omply h aU Ciry <br />iliv6 ollhis City and Count) I <br />ai{re mentincd propdy for insp(rion <br /> DplicMl or ABcnl Sipnrlure: F <br />ol".-- ,.---)*.(t,\l2i ( <br />"*.;,**."1p.r";, F}{ <br />fi( <br />Set Backs <br />Forms/Steel/Holdowns I <br />Ereclion Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coal <br />Masonry <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif.+) <J"4 ffi;[*71-rq /?-.2-7 <br />FINAL <4-tq K4?:7 <br />Certificate of Occupancy <br />Notes Remarks, Etc. <br />ID/SIG. <br />Pool Fence <br />L.n'lq'r Ad&s: <br />- <br />(n'li rhrl I hi\rrcad rhisr||h.nrnn, d <br />xf(lSrxt l xN\.cxri'i! r, btrikli'r! <br />I <br />I <br />= <br />I