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-BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNT'R BUII,DER DELCARATION
<br />I hr€by amrm u.dd penally ol pejury rhtr I d ex.mll Forn th. Conrraclo^' Lic..s. Lrs for rh. lollowinS !ron (56 7011,
<br />Busin6s ad P,otsion Cod.) Any City or Counly thich r.qut6 a pdsil ro cod c1. ah6. nnprovq donolBh or ror6n dy
<br />srtudu.. prior ro its isumcc. atso lequic lhc applicdl fo, such !.rnit 'o
<br />6lc t si8n.d st.lnd lnar h. or sl. b licm.d putliat
<br />ro rh. rrcvilioB ol$e Conlrnclois Lic€nscd brv (Chapt6 9. C.mm.ncins trnh sdrio. 7000 of Division I ofrhc BGin* ryd
<br />Prclessions Code) or thal h.orshcBcxc'npr rhs.&om and rh. b6sis for thc all.s€d cioflioo Anyviolaliohofsdio,T0ll5 by y
<br />alplica aor 6 pcnnir subjakrh. applic.mlo.civilp.nallyolnol morclhd fi!. huddre{ doll-s ($500).
<br />4Ol4 - o,*.nrrr,.p-n r).ornymplo)Gtr hsn!6dIhei'sLcompens€rion.silldorh.$o .(l rh. sro.lrc is mr
<br />i 6d.d orolI6.d aor slc (5€.7044. Busindsmd Prctsions Codq 'l hc conkscroi s Li.m* Law do6 aot applylo@oMddf'
<br />rhc propdy Nho boil& o. irl,ovs rhs6h, dd who dc n(h {ol{ hnnsclaor hdscllorlhreush his 6r ns .$n.,nploys,
<br />provided rhar slch imprevoMts e nol inlod o ofis.d lor et. lf, hoNod, rb. b(ildina or i,nprcvaml is sold wirhi. oh. )d
<br />ofconpLtiorl $. Omd Bdlnt will hirc tt bu&r of prouin! thd lE or shc dd mr build oi impror€ ihe !rcpsly tor thc plrFeof
<br />elcl.
<br />-1,
<br />asoM6oilhc propdy, edclusiv.ly.ontacrinB {irl licmed conrmclouto codrucl lh! lrored lsd. 7044. Bsins
<br />md t\!ftssion ( odc: Th. Coolractois Licosc Law do6 nol apply lo d ornd ofpropdly \rho builds or impro!6 rhosn,
<br />and who.onrmclsio.su.hprejcls$nh.Cod6do,{s)li.c.!.npufilutloth€Conhtct.asl-i.d*bs).
<br />tllX,""I t'
<br />!.tKuar!l!.a!
<br />I hc'cl)) rltun, un(lc' tctrx 1y fll)Lrjuy fic flrhc nnli$i'rr lc.l rru,s
<br />I havc ad sill hainrah a C.nificar. ofcoMt ro scr-lBur. aor \hrkss cotr'p.nsdrion, a Fovided for bySdion 3?00 oilhc
<br />Labor Codc. for ltc pc."fom cc ollh€ *otk aor stich rlE pdl is isu.d.
<br />-,
<br />hrv.andwillhdinrainrvolk.G comp€nsarion i6unnce. s requncd bySarion 1700orrh. Labor Codc. lor th€ pdlomdco of
<br />tlD \6rk aor whi.h rhb pmnn is isu€d. My *ork.^' comps&l io! insu,occ cnie dd F.licr nunrbd ec
<br />I'},,|(y Nuhlt :-Erf ir.s
<br />/AD cd'rr,hr m rh. pdf.nmn!. olrhe \oA lor s'hrch rhis p6mit is issu.d- I lhau nor ftploy any psson rn any Ednd
<br />-il6 ro b.(omc bj(r F rhc \ nrl6i (omprnrr'^n lrtrs olcalilomia. ed ogrE lhar ill sh.uld l!$ne subjet totbc
<br />trork(fcompdsationprovisionsofs.dionlT00olth.l-atuCod(lshall.lonhNithcomplywilhlho*prolisions.
<br />WARNING: Fnilur. ro ecure workql co.D€nslion covra8e is unlasltl. Md shall strbjd an e.ploys lo dminrl p6.hie anll
<br />cilil fincs up ro one hundrcd ltous d dollm ($100.00$). in addilion o rhe.o$ ofcomp.neliotr. damas6 a provid.d lor th.
<br />Code. int66r dd.rlorney's i6.
<br />1 t8 BnSt tqnP,-/ Do "tu(.l:ltlD_coNl&rrrca
<br />DECI,AAAIION
<br />I hcEby ailim u.dtr poaltyorpdjurythal I m lica!.d u.ds Fovition otChapls9lcommdcids sirh Sdion ?000) olDivisnrn l
<br />or rhe Busin* ed Pmtssio.s Code. md my licenE is in lull lorce dd elt&
<br />(!)!iIA!!IIQ!&ENDI!G.&GE!CT
<br />I hq€by amd und6 penall, oi pcjlr, rhd th6e is a coistturlioD k dins asncy lor rhc pdfomec. ot th€ \vo.k i)r Lrhicn thii p.nnn is
<br />is$ed lsa.30!7, Civ. C.)
<br />A.Etuc NLDIO.AaArIA!
<br />I @ alinn unds pdahy olpdjtrry on. of
<br />'he
<br />aolloNin8 deldalions
<br />D.molition Pmils-Asb6ros Notificrt io. Fcd6alRcsol io.s (Tnl. 40. P0n6)
<br />-Requircd
<br />lrtto of Nolifi @rion
<br />I rdrl' rha rhc leddal '+JLhoB rcx&d'nr ebctos 'dn\sld. nor dpplcdhl.lo rhs prcJqr
<br />[9i.-,t 'r,"' r r".*,*a,r's appl'car'on dd narerhr th. ab.v. inrom.tion is corecr.I arre ro comrlywirh all ciryandco! y
<br />ordinancB alrd Sratc L3rvs rckr ina ro build$s coctrucrion, od hdcbr .llhori2c rcDr6otariv6 ollni cily Md cou
<br />.bove mcnlioned prop€rr' for ispation DurIDs6.
<br />hppricmrr or,r*orsisnrrur " 12"
<br />Ir'"-".*-.t,r,,,,P4J€ gfie{xo",",1 t8
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />D rylva ll
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itilason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
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<br />FINAL z-f17 fZO'L /a;ca2(.27/
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />I
<br />Subf loor/VenUl nsulation
<br />Flood Zone Certif.
<br />x
<br />Il &PC fMrhisraotr.
<br />1
<br />II
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