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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />I <br />Roof Sheathing tp.o lJtri-{L h ltltl +XL <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Ivlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />t^ <br />FINAL ///////tr ,'y/'& <br />Certificate of Occu n <br />Notes, Remarks, Etc <br />OWNER BUILDER DEI,CARATION <br />I hdcby amrm ondn pdrlty oa pdtury lh.l I m cxcmpl 6orn the (ontadou' Licens. LaN for rh. rolbwins rN! (S( 7031 5 <br />RusinBs aod Proi6sion Cod.) Any Ciry or Counly *hich .€qun6 , Frftir to co.slnrd. allq. irnprove donolish ur ft?6ir ey <br />srruclur€. pnorro its L$udc.. arr. equn6 th. alp,icor ior su.h p.nnn to lilc . sisn.d stat€mdt lhal hc or she is licos.d Puruel <br />ro nE lyo\isioB otrh€ Conrra.toas Lic€nsed t?$ (Chapr6 !. Conmocin8 $ith S.crio, 7000 ol Division I oflh. Businds ed <br />l,rofssionsCode)orthar hcorsh.is e{dnpt rh6elrorn dd lh. bsis lor rhe,lles€d.xcmplio! Anyviolalio.olsRrionT0ll5 byany <br />applicatrr for a pmit subjdrsthc appli.a.r ro acirilp.nalryofnor mor€rhai fiv€ hundred dollas ($500) <br />l, 6 orvn€r olthc Drop6ry. or ny cnployG rviln *as6 s rhen enc compNlion. \ ill do Ih. vork and thc iruclrc is ml <br />inrod€d oro,Iercd fo,.al. (Sc.?04,1. Bui,s sd ftolNions Code: The Conlricr.r's l-i.dse lrw d.a nol.pplylo osrq ot <br />rh. Fopd, slD hrild, or ihpo!6thoon. d who do6 such M.k hinN€llor hNlf or rhmugh nis or ncr ou c'nrloy.6. <br />providcd (har such imp.ovoneds e. nor intdd.n .r otfd. aDr sk Il, ho\'6 6. rh. buildinr o, imtrovmt G $ld tr nhid on. )ar <br />ofcompl.lion, rhc OM( Buil:kt *'ill havc rhc hdo orFori.B rha he or she did f,ol build or implv€ llE Flpsly ror rh. pnrpoe of <br />!. s o$n6 of rhe pmpcly. o.xclusivelyconlmclins *'ilh lic€ro.d cofuadots ro conntud rh. !mj.d IS*. 7044. Ba'nB <br />aod hofsin Cod.: ThcConlaclols l-icdsc Law do6 not applyio M ovtr6 ofp.openy who builds dr inpro!6 $.ron. <br />md $ho coilmts aorsuch Ftrj€€lswirh s Conlmclo(s) Iic€nscd p6udt rorhc Conlractols Li.ms t{w) <br />I mcx.mfl undd Sstion .R &PC iorlhir r6on <br />OEncrl <br />ldaa[E8llloMrrltalla! <br />IIECI,AAAIIg! <br />I hdeby amm und6 p6dly of psjury one ofln€ follosinr deleatioG: <br />-l <br />havc ed sill mainrain a Cdificarc oacoNnt ro Sclf-lnsur€ lor workd! con1pcns.rlon, s lx.viddl for by Sdio! 3 700 o llhe <br />Labor codq l& rhc p6f.mmc. of $. wor[ aor \hich rh. p6nil is isu.d. <br />k hav€ and will mainlain *ori(.rs co6p.sario. iBura.cc s roluned by SElion 1700 o I Ihe t-abor cod., aor rh. pofomee of <br />wort for which lhis p€mir is issuql M, workm conpdlarion i ur c. cmi6 d policy lunbd &c:.3t^t.-6r-4 <br />40 t q{rS(r 1'lrl'l") <br />I colilyrhar in Ihc psloDMnce of the wo for rvhich rhis psnn is issuen.l sholl nor cmployanyp.6on in dy frdnd <br />s 6 to baoftc subjdr lo lh. *orlcc comp€hsnrn hws oicalifomia. and flsrc ln2l ,i I should be.ome subjal lo lh. <br />wo!k6 coDpcnsdio. povisioftoasstnrn lr00 olrhc tibor ('ode ! shall. fonhwilh.onplyvnh rhoe povilions. <br />\IARNIN(; Failur. to su. sort6' compeNarion .ovms. is unb*'lul. &d sbnll strbjd m cnplols lo oieinal ,eahi6 md <br />.ivil nn* up ro on hun&cd thous d dollas ($100.000) <br />Sdion 1076 oflhcLaborCodc, intaesl andarlorney's 16. <br />iotr. da,nascs 6 ttuvidcd for rhc <br />l!!!I41!!!t0l <br />'2 c-q q Lc14--tl <br />^"4LoL& ."",-",".X%ie{B B6F ivLL <br />caxs.lBuqlloN.ll;llll$c EN(I <br />I hs€by amm und6 pcnally olpdjury lh.l thd. i5 o corotru.tion lmdins ascncy for lhc pdtrms.e of rhe work for rvhich lhn pdnrn E <br />isued (S( 1097, Civ. C.) <br />AITIICANLDECLTBAIIAN <br />I lE tt arm uhds p6rhy olpsjury on. oflhc followinr d(l@tions <br />Denrolilion Peniirs Asb.sros Norincalion F.d€ralAcpulations('lnlc40, Pan6) <br />Requtcd l-clrq ol Noi6crlion <br />cdiry lhat lhc f€ddal resu lal ions r€s6drn! dbctos ronovat ec nor.pllicablelo this pmjet <br />rharIh.v€radthisappli.dionandrarcrharrtuatv.infomalioniscor6l.IasretocomplysilhoUCityandaounry <br />dnl Slrrc l-a\s'dntnab buildnrs thorize r.pr6alariv6 oatht Cily Md County to dld upon th. <br />,.," - tl.gLlj <br />Drnlnn'cd p.Nny kn rnst)c!tron <br />\Iplicnnl 0r ,\,rctrl Six irxfu <br />L+fo! <br />II <br />Subfloor/VenUl nsulation <br />/.//,",", . tl'of 'l? <br />I hcEby amm lndd poalty o I pdjury lhal t d licc(ed u.dd p(vision .l chaFd 9 loflmmcins { irh Sdlion 7000) oa Div ision I <br />of rhe ausins dd PtulcsioN Cod., dd ny licos Ls in lull ror.c dd .lldr <br />Lender's <br />^ddB