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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNT]R BUILDI'R DELCAIIATION <br />I hdeby .mnD undd toalty of pdjury rhat I an .&npr frrh rhe (onkrctors Lic.ns. Lds aor rh. followin! r@n {5(.7011.5 <br />lausitrBs and Prot6sion Con.) Any City or Coubry which rdtun6 a pnnir ro consrrud. ah6, nrproe.. ds.olish or qEtr dy <br />r.1@. Ihdr to ns nsuecc. also rquirB rh€ applicol lor soch pennir ro frlc a sisncd sraroot rh, h. or sh. h li.6.d p6udr <br />to lhe provisioG ol the Conrr.cloas l-Eeis.d Law (Ch.p'd 9. ( om,ncncins wilh Sation 7Oo0 of Division I ollhc Busins dd <br />Por.str B Code) or lhal h€ ors& 6 crenpr lhschom md rh€ basis lor rhe allelcd crmprion Any violalion oasdio.70.1Ls b,..t <br />applicant ior.pcnnn subj{8rh. applicanr to a.ivilpcnahyolnor mor€ rhe liv. hu.&ed dollas ($500). <br />M.-.*,-"r*.0--r.ormyrnplo)6q h tr a!6 s rhctr sr€ composnoo. srll do rh€ \ort d\l th. lrnduc is nol <br />-,f8a"t -"n "t rn.*r.r(- roir. a*i;o. *,1Ptor;io* cod.: rh.c;nrlciois Li..G bw d.6 nor applyro oosqor <br />the ltrop€ny trl() hoil& or inproveIhseE e who dos such trll{ hnro€lf or t6.llor thmush his or hd oM cmployc, <br />provid.d rh.t su.h mEovdndad.tul i,noxLd onq€d lorslc.l[ horv6s.lh€ h,ildilB or i'nprevonot is sld Nilhin on. )@ <br />oaconpLrio,l' lh. Or$s Build6 sill havc lhc t!.ds olDrcvinB lhd hc or d'e did nol trild o! imprev€ thc pNpsly lor the p!ryDE of <br />-I. <br />6 osns olrhc pmpdly. d exclusively c.nlractin! wirh licms.d conrradoE ro .onnrucr th. lmld (sd 7044. Ddins <br />d ftlllsioncodc: Thc Co n.lor's Liccns. Law do6 60r applyto an o{nd oi proFny \rho buildso! inrprov6lhrsn. <br />and sho co ads for such Foj.ds rnr a Conr6do(, licos.d puGu rlorh.con aclofs Li.m* ti*) <br />I in,rlcnu lnder Sslui-. B. & l'( i,rihisrcarnr <br />,,,," - l(. zc:-1cQ o*,"., X- w,LqftM. 5r\ <br />t!oalEarl!!!Erl-Ir-u0.r!!!rz!34!!a! <br />I hcdbyrllt trndcr pcnalryol p.rlury .nc ol rhc loll vLns d(l rrors <br />_l hav..nd *ill,nai.rai,. Cdin.ar.ofCo6nr ro Scla l6ure lu qolkgl .onrpdreliotr, d Fovid.d aor by Scction 3700 ofth. <br />L.bor Code. ror lh. pclomsce o f the wort fo. \ hich lhe paril 6 isu€d. <br />I hav. and will maimain solt.ii' conp.Nalion iEurance, 6 rcquned b, Set ion 1700 oilh. L,bor Codc. for lhc pgfomdcc ol <br />Ih. {orl for vhich $is p.f,nil t ised My qorkeR c.q)@iio, i6!re.. cdi6 md polic, f,unrbd dc: <br />.mier <br />Policy N!mb.r:_Erpird:il/?l{/.or,tr rt,r <br />'n <br />rt. p..ro..an(. otrhc rorl tnr trh'ch lhis pomil is issued- I shallnor €mploy any Ptcon in dy nannd/ clsr.beon. brdr h rh. rorl6 $'npss <br />'on <br />la*s olcrlifomia, &d agre lh.r il I should b{omc subjat ro Ih€ <br />workdl compcnMlion provisioB oaseiion I700 or lhc bbor cod., I shall. tonhNilh co plys'ilhthosprovisions <br />WARNING: Failurc ro s(uc rvorkm' oomF6alion cornse n unhwrll ed shau strbjdl mployd ro sininAl r(Ehirs ed <br />civil line up to o.. hud&d rhous&d doll6 (S100,00{)). in addnion lo rh€ .osr olcohpecrrion. d0m8s 6 p,orid.d Io, thc <br />Sd1'or .1076.1 I'c I dhnr Cod.. n'fld J dtui.l t ls. <br />o,,.. - 111-c,2cre D( ,vrLrrAr!^- 1ny trXlrffi <br />ITICI.AEAIION <br />I h€rctry amrn u.dcr peElty o I pgjury that I on lics*d undd provision olchapls I (cotund.ins *irh Sdlnn 7000) ofDivision l <br />of rh. ausins ,td Prolsio.s Co.le. ad nrylicmc is in lull lorccmdeilEr <br />LicdscNumbq: <br />CO.NIIAUCruNI,IBITIGIGI'ICI <br />I hercby ,flim u.dd loElry o t perjury that rh6. is ! connruclion hding lsdcy aor $. pdfoflMc. of rbc work for which lfiis p6mil G <br />issu.d(Ss. 1097. Civ. C.). <br />AIITTANLDICTABAIIA! <br />I h6$y afinn trnd€r p€nalty olp.rjury one ofrhc follo\uins d(lualions <br />Dcmlilion Psnrirs-Asbrsros Nolifi calion lj.d6al RcruLtions (Tnh 40. Pan6) <br />-Reqrircd <br />Lclle ol Nolifi calnnl <br />6&sk's ron lal arc n.r appli.abl€ to rhl! projd. <br />thar th. rbove i.ao mtion is corar. I ssre to cooply u ilh .ll Ci'y and Counr, <br />$ ofrh$CirInDd(inn ) t, cnrn uBr rh. <br />ah^r\e Drnlioned p'ntcny f.r ins!(li.n <br />Applic{trr 0r.1gcnl SiEnrfire:",,,"1i'Zo k''L <br />x_arv\ aE+4 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />foof Sheathing <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 />H andicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL ?{>/l t //a{oYf-?z-) <br />Certificate of Occu pancy <br />Notes, Remarks, Etc <br />-+ <br />Subfloor/VenVl nsulation <br />I