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SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII,DER Dr]!-CAILT'I'ION
<br />I hcrchy ifllnn utrdcr pcmlry,)t l].rjury rhar I o ckmpr rrom rhc contu.!trs Licctsc lr* lor rh. rolk)win8 rcrhn (Sc.70.115
<br />Uu\inc$ lnd Prolc$io! CGl.): Any Cny or Courry qhkh rcquirc\ u Pcnir k, connfl.r. ,hcr. i [ovc- dcnrnnh or toIan lny
<br />drucrurc. prirr{, ir\ isudn.c. rkorcqnncs rlrlPfli.rnl in ruchrcflnir ro ll!. n \i8.cd st.tc.rcnr rhor hcor \hc ir lftnscJ pu uur
<br />h rnc ttultn,n\ of tlrc Conrrcktr \ Li.cn\cd bw (Chrflcr 9. C.nnncncing *irh S.crioi ?Ur of Divisiofl :l ol rh. BusinNs rid
<br />Pn,ic$i{nNC{xlc)orrhdhcorshciscxcqnlhcrclionr0.dlhcbrri\forrhcrll+cdurcrlrion Anylidiliotrofsc.rb 70ll5byrn,
<br />.p!lrntrrtor rNrnrir subjcdsrhc alplicanrbacivil!.fuhrofiornircrhttrfivchundrcddoll3r(S5(XJ)
<br />-1,
<br />!\ o,ncr or rhc l]ro|lriy. or nycmrloyccs withwoscsas lhctnn dnnNns.rion. willdo ltr work 8d rhc (tr18 n nol
<br />inr.ndc{ or olLrcd for $lc (S( ?0,14. Busincss and Pmfcs\i.n\ Crxlc: licConr.clois Liccn{ tlw dds mt,pdy lo an osncr or
<br />lhcpmFny who hu ilds or inpn)vcs rlfRrn. aM Nho dcs su.h mrk himsell or heisclt or rhmugh hn or hcr o*r cmPlorcc!
<br />providcd rh.r such nnpercrrnrs m frn inrc .d q oicr.d for slc ll howcrcr. rhc boik,in3 or irlm$nEnr h n,ld wirhir onc )trr
<br />ofconrrlcri,n. rh.Ow.cr Auit]d *illhorcltrburdcnolpmvins rhirhcor\lt did nn hli or ir{mt! rhe P'opcdy lor rhc ptrrB'sof
<br />l. Ndwncrofthctmncny. omeiclusilclyconta.ri'rgqirh licttr\cd.ortrrcloFn,Nh(tud rh. Piojccl (Ss 701,4. Bu\inc\\
<br />ud Pn'fc\\ion Codc 'l hr Coit..kr's Licctrsc Lls des nor plyrortrosn.r.fri.p.ar*hoiuild\orimprov.srhcrco..
<br />rnd qho contrNrs rbr such pmiccls wiih a c(,nr&b(3) liccn\.d puHu0nr k,lh. ContNtn\ l-i.cnsc l-aw).
<br />-l
<br />! crcnrpl undcrSccrio
<br />1^tt-l
<br />I h.rchyrrlttrrun{l.r p.uxy.rNrluyotrc.llhc li)lh*irglccla.irtr\:
<br />lhrlc.d will nninr!ir rCcnificarcorCons.nr t, Sclf lrtsurc f,tr workc lrrPrtr\dn'i. i\ lxrvidcdlorl'ySccrion.lT0Oofrlt
<br />Lntxtr CoJc, Lr rhc pcilonMncc oirhc wort for *hichrhr pcnnir i\ isu.d
<br />Ihrkr sillnirinrri q orkcrr .onEnsrt ion iNurrncc. rs rcqtr nd by S(r ion 17lX) oi rh. l lbot CoJc, inr rhr p.rlormrNu ol
<br />rhc *olk lor shi.hrht pctrnili( i$uci My workcr' co,npcnlrrion in\urrn.o du ud lolicy nunrh.r !rc:
<br />-l
<br />ccnily rhd in rhc Frlonnsncc olrh. Roik fot whkh rhrs lrnnir i( isslcl. I \hrll nor cmpk,y nny tlcmn in any mrnncr
<br />k) as ro hc.om subjccr b rhc wor[cr' conDcn\lrio! l.$ ot Cllifornir, ,itl !+rcc rhd if I stn'uld hcQm suhj.d lo rhc
<br />worksr .onrr.ns0rion lmvnions of Ssr ion l?0r ol rhc ttrhrr Cdlc. I \h,ll. lon h$ilh (mpll Nirh rlx,$ pmvkio.\.
<br />$,\kNlNc l.riL,tr. n, \'.tr'. trokrri
<br />dnrrss (rdj.0OOr.
<br />MLr4Ky\res
<br />g. tr Lnrr*1l|. dd sh ll \ubl..r l cmnk'yc' n,.ri'niful Nndrics itrd
<br />rion. dr ugrs ns p()vid.d lor rhclitrr\ u! ro onc huftlr.d rhoulrfld
<br />)n 1076olrltr lihr G c- irr.rcn
<br />9-/1 t31
<br />I hcrcb, {ltm undcr rEnahyolperjrrr rharI nli.cnr&lu.dcrpovniotrofCh,prcr9(.ofr.tncirewirhSccli{,i7rl(n)orDivi\h:l
<br />of rh. Bu\inrssmd Pofcssions Codc. und my lt.n\. i\ tullf{trc mdcflsr.
<br />(I)NSIAUCIION"LENDINC.LAENJJI
<br />I hcNby lmirn under Fmlryorpcriry rhii rhm ic r.on\lrudion h irs a$ncy n, rhc lrnoflrDNc or rhe *orl tu thi.h rhn Fanil h
<br />hsucd(Sc. :1097.Ci! C ).
<br />APPI ICANT NTCI,ARAT(TN
<br />I M,, irid !od( p.nrlryoipcrjury onc of thc follooin8 dal&lion{
<br />Dcmolirion Pcirnirs'AslEsros Norificarknr Fcd.nl Rcguhriotrs (Tnt 41, P!n6)
<br />-Rcqun.n
<br />krrcr oI Nolifrdi,n
<br />l.cnia! rhd rh.fcdcrllrcBuhlioN Nsnling u\lf,io\ rcnD$lrrc nor ilplic{hlc o rhh r+d
<br />l.cniltrhrr Iluvcrcrl rhnrppL'catnr lxli rc rhdrrhc firc iIli,nniri,n,I aBrN ro omply wirh all Cir, rnd C.trNy
<br />ordiMncc\ rnd Surc L!v\ rcl rinst)ilc! ollhis Ciry and Counryi(, ctrrcr xlntrrlE
<br />xl[v. rtrrn rd prc,rny li)r ins
<br />ApDlicrnl or ,igcrl Si8niluf
<br />'o-<-
<br />e ttg
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation t.-
<br />Roof Sheathinq q /hh{.&11 )
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/ aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif
<br />-2
<br />--
<br />FINAL 7-z(-rA la1zO'7;
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />Forms/Steel/Holdowns
<br /><t t ,t*'l r ./,zl
<br />tJ d., rNam _
<br />a.r
<br />F
<br />tt
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