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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hereby afftrr und6 potlly olp..jury thal I m cxen &6n rhe Conlracr.^ Licensc b$ for lhc lollowins rNn (Ss.?()l! 5
<br />Busi.6s and Proa*sion Cod.): Any Cily or Cou y {ni.h .€qut6 a pqhil Io cors:lflct. all6. iDprov., d.molish or rqan ev
<br />{tudo( pnor ro ns isu ce, dl$ rcqutd the applicml lor such pcnnn b nlc t sisn€d slaldor that h. or she n licmed ptrmol
<br />ro rhe ptuvBio6 oflhc Co lacroas Lic.Ned Lr* (ChaflE 9. Comdc.cins {nh Serion ?000 oaDililiob I ofrh. Busin.ss ed
<br />Ptu lesb.s Codcl or r hat he or she is .rc rB th6.6o m and ihc basis for lh. all+ed ermpl ion Any violarion oisrlrn 70115 b, a.v
<br />applic,,l aorap€mn subjerslh. applic.tl ro acivilpcnahyolnot nor.rhm five hu.drdl dollars ($500)
<br />-1.
<br />e omd olthc prcp.ny. orny.nplor$ wnh sas6 s lhcir $lc.om!.6alion. viU do lh strk md thc slrud@ is nur
<br />inrad.d or.fi6.d aor s.lc 156.7044. Busin* ad Pn'fsions Codc lhc Codr.dois Licdsc liw d.6 nor 0pplvlo lrtdof
<br />rh.pmp.ny sho boil& or in|rovefi6on. exl sho dc su.hw hnMll or hdclaor rhroush hi. or hd o*n .mplovG,
<br />p'ovided rh{ srh nnproffils e ml i eid ororcd for sL ll hosss.lh. buildins or intlrcvml is sld wihin nnc rcu
<br />oacompl.lioG lh€ OMd Blikkr wil h.\€ thc hlrdd olprovins $,l h. or shc did mt hr,ld or i,nProve lhe propdv aot th. Px,Po$ of
<br />-1.
<br />6 o$ro ofnr. pnpeny. m d.lusilel, conlra.lin-! wirh lic4.n coitrlo6lo mslrud rh. Pmjet (S4 704-r, B qinR(
<br />ud hD,bst'o Cod.: Th.Cooracloai LiceB. Law dod nol tlplyro oovorofprop.nvwho buil.ls or inprord lnsaq
<br />a.d sho co Bdsfor such pnj<l! wnh a Conlmcro(, lics.d puB@r ro lh.Conrr.ctoas Licd. tnv).
<br />lnm.\.!nnr un.L.\rr'o. - A. & P.C Io' lha r@n
<br />WORKFRS' ('O]\IPENSAl'ION
<br />DECIAE{I]II!
<br />I hsebyamrn u.der poralr, olp6jur-! on€ oflll. nn[Nir8 d(ldalions:
<br />I harc dd will maiolain a Ccnificalc oaco.* ro S.ll-lNur€ lor workeu conrpnstrioh d trsvidcn for bv sdrion 17m ' rih'
<br />Labor Codq ror thc pdlonnec€ olthc rvotl lor vhich rlE tdmn B isucd
<br />t harcand*ill mairlainwork.ra co,np.EalnJn iNnranc.,6 r.lun€dbysdionl?0Oolthct-aboi('oJc.forlhcpdfonhm..of
<br />r h€ *!rk lor which rhis p€mit is i$ucd My wor&ers coftpeN.l ion i6urM.. cdnd ud p.licy nu,nbd sc
<br />Poli.y Nurnbd:-Expir.s
<br />-l
<br />ccn,iy rhar in lh. Frfomuc. of Oc wort tor which this pstil is i3su.d l shall nor dplov &v pmn in dv mM.d
<br />e G lo bcom. subj€r ro lh. worlm' mnpc6alion latrt or Califomia. .nd asE thal il I snouB bc€omc subjd ro th€
<br />solk6 comp€nRrion rrc$ioN of S.clio. ]T()O ollh€ I lbor ('ode I sl[ll. lonhwid codrPlv w n lhor lrovilioN
<br />WARNTNC: Failurc ro src \wrtm co'npcMlio. covsosc is unla$iul md shall subjcd e mplord to 6inin l FEki6 md
<br />civil ,incs u, xr one hun&ed thoutud dolls l$loo,ooo), in addnion ro lhc.os olcomp..slio.. dmoa.s 6lt6id'n
<br />'or
<br />rh€
<br />Sslion 1076oarhc kbor Code inlrdt abd alioruy s fc
<br />t\
<br />DECI,AEAIIAN
<br />I hmby affirm u.dr lHaly of p€.ju,y lhar t M lic€ff.d undr pmvision ol Ch.fla 9 (conlmen in! wilh Sdion 7000) 'r Diviqi'n 1
<br />ol thc Busins and Pof6sioN Code. od my lic.@ is in tull aorc€ ad elrd
<br />-j Lo t
<br />D,,e r, (r(tr con,r'nor K (rL- NG .(--,"1,^-1')
<br />CONSTRUCTION T FNI)ING ACENCY
<br />I lEeby arm undq p.nrrry of Fjury rhar $se is a connNdi.n lfldins asocy aor lh. Pslomucc oalh. qork fot thich rhi. lemt is
<br />,su.d(sq.1097. Civ C ).
<br />APPI ICANT h'CI ARATION
<br />I hddr, alrm undd porty olFjory o.. oflhc followins d(lddiom:
<br />DoDolirion P@ils-A.6etos Nolification F.daal R.guktio.s ( l'illc 40. Pan6)
<br />-Requircd
<br />t [dof Noiifictlion
<br />I .6riay rhar rh€ fcddal rcrd,ltioN resudins 6b6tos rmolrl s. nol .pPlicab,c lo lhi5 prcjct.
<br />z<Lcdrry lhd I ha\ . '@d
<br />rhs spplkalion ard sld. rh, th. atov. infom.lio. i5 coEdt I t$* to comPlv wilh all Cilv ed Co! v
<br />'ordim\cB md Slare Iitr 3 clar ins ro burld'nB codrud'o( ed hd.5y aulhoi& ..F.glaliv6 o tlhB Cirv Md Countv lo dld qon tn.
<br />abovc menrioned p.ops1, li,r iNtdiion
<br />^pplici,
<br />o.Asetrr sisnlire, K $vL.,,
<br />l'rn i,uM,erprirr): falvd"- 6o'>Ly,nu
<br />*," rlrrlU
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsu lation I
<br />Roof Sheathing ////r/til ..y+fu,l
<br />Shear Wall ,/,-.L
<br />Framinq
<br />lnsulation/Enerqy
<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 />Enqineer Final Report
<br />tl
<br />FINAL ilteilLry K b.4^M\'72)
<br />Certificate of Occu n
<br />Notes, Remarks, Etc
<br />Flood Zone Certif .
<br />L.r'ler ( AddrGs
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