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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hd.b, atfim undd poahy ol rErjuD- lha I d ex.hp froo thc Conlrlcrors' L'c.ne t w lo. rhc foltosing rmn (5<.7011.5 <br />Busrn*s d hol6sioo Cod.): Any cn, or Comrt which tcquir6 a psnil lo conetuct. ahs. imProrc. donolish or '.?u mt <br />slrudue rior ro irs isu&c.. 0l,o r.9uir6 lh€ applic r fo, such ponit lo 6L a sign.d sratmfll ltal he or sh. a li.mscd pcuet <br />to thc povilio.s ofd. Conracr.l! Lic€nsed Lis (Chaod 9, Commcncins with Sdion 7000 olDieision I ofln. Bus,n6s dd <br />Itof€sions Codc) or lhar hc or she is cx.nfl ficctom and rh. bdst aor Ihc aUcBed ctdflio. nyliolariooofs.clio.T0ll t by any <br />dpplica aor ap.fti strbjdbth. applicanltoscivilpenahyolnolno!.lhofiv.hundrcddollds($500) <br />l. s olvnd oflh€ !trorcny. or dy onplorB wnh waBB 6 rhct slc compos.lio.. will do fi. wort d tht slrud@ n nor <br />i qd.d or oncrca for el. {Se.?044, BNins d Prcfsio6 Codq Tnc Conlroclois Licds. liw (&)6 nol arpl, lo m o$r( ol <br />lhc popdy *'ho hril& or iDprore lh@[ dd rvlr do6 sch Mfi hnnscltor h€Gcllorlhrcushhis or hd oMflployG, <br />provid.d rhar such inrpmvcmaGnor im6rk or oiIaal for$16.lf. ho{6s.lhc bulldrs or inpmrcnml issEwnhino.e)@ <br />ofcodpldio( rhe Ownd auiHer will h.\c ih. htrd6 or !rcvins lhd h€ or she did ret buid o' imri.ov. rh. psFry lor tfi. putpoe ol <br />L s ownn ofrh€ lxopdy, dn .rcluivcly conl,&linr *ilh licos.d contactou to coNlrucl Uc rojdr (Sec 7044. BBinG <br />a Aohsion Code -rh. conlrlcrols Licms. Law do6 nor spply lo ownq olpropdtsno builds or nnprov$ lnd@d. <br />..d eho contrmts for sucn ploj.ds wirh a Codrero(3) licm.d poswt <br />'o <br />rhe Contr.rdrs Lictue kw) <br />t e Gxdfl unda S.dion-, B. & P.C. for lhis 160( <br />Drlq Oa...l <br />IaESCSS.SOUIEIIAIIA! <br />IECLABAUA! <br />, haeby lrm unds Fnahy olpelury on. ot thc lollorins ddldrlioN: <br />I hdve 0nd will ,mintoin a C61ificatc of Co6dl ro Scla l6urc for Norke6' comp.heton, as I'o\ id.d for b, S(tion 1700 oi lh. <br />Labor Code aor th. pdfommc. ot thc wo* for which thc pmil b su.d <br />Ihav€a willmainbin*o .rs .onpesarion iBur c..s r.qutcd by Sdlioo 1700 olrh. kb.r Codc. fot thcp6aoflm..of <br />OJ\ <br />My work.rs compmslion insurace cdid dd Fli., numbtr ae: <br /><.^/>2-olrqItLq <br />-l.dnify <br />thm i. dr pdloi,mnccoalhc rvork lor {hi.n lhis pd'nn is issu.d.I shallnolgnploy dy p6od id an, m flq <br />$ s ro bccom subjcr to rhc *ork6 co'npljMion lass of ( rlifomi. md asr Iha( r I snould b€.orne subjrl to lhe <br />wo.t6 compcNalion provisions ol S.dion 1700oarhe Labor Cod€.I sluu- lonhs1lh comply rilhlhos provisroN <br />lvARNtNc Failur€ lo a.u€ workcE (xnptrattun coldagc ii u.la*ful. nnd sh"llsubt6t 4 mployd ro aiminall'oEh6 d <br />civil fines uplo on€ huldrcd rhousd doll6 ($100.000), in addilion to rhc co$ oaco,npeBarion. danascs 6 pnNid.d for . <br />S(rion 1076 orrhe Labor Cod., <br />(,",",ttJre [l%inrdd md.nomcy s lc <br />DECIA8AI]()B <br />I hercby smmu.d.r p@hyofp{juryrhrl I m lic.f,s.d utrd6 p(ovGion oachaptd 9 (.otunocins wilh Sdlion ?000) ofDivision l <br />of lh. Busins d Proisiod Codc. and ,ny liceG. is in full forcc md e,Id. <br />K'*"o ).a\-'r -tLl <br />t\g <br />colllalcuaNr[lDlNclcENcl <br />I hqeby amm und6 F,ahyoapqju.yrhat rhd. isa co6rdction kdins asdcy aor rh.p6aom cc ollhcsork for \vhich lhis Frnil is <br />isu.d(Ss. 1097, Civ. C.) <br />AITU(ANTDECI,AIAIIO! <br />lhedyatrmu.ds pcnahyoapdjuryo.c of th. fouowifls dcldalioft: <br />Dcmolition Pmirs-Asb6ros Norincaiion F.ddal R.rlulat ions (Tilb 40. Pan6) <br />-Requi'ed <br />I elldol Noriicarion <br />I cenify rhar th. Ldsa l resr l.t ions rcaddins 6b.stos lerorald. nor applic.bl€ lo this pDjel <br />I..ni8rnal I have r6d lhis dpplicrlion and sr.lelhd rhc sb.ve iniomalion is con.l IaSiielocomplysnhallCnyandCounr, <br />ordin.ncB d Srar. La$ s relalioB to buildins .onsrrudiorl evl hdcby aul horte rcprMrarivd o f rhis Ciry and Counly ro dro upo. rh. <br />atDvc mmrioncd prcpory tu iflsp<.lion pu,!os6. <br />,.,.tllre IB <br />Set Backs <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Fram ing <br />lnsulation/Energy <br />Drpvall <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 z/Yv/l6 <b<L <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Forms/Steel/Holdowns <br />, fl,,1.''rA,l.!6, _ <br />tl <br />--------r------ <br />----+---