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BUILDING. INSPECTOR RECORD SITE-WORK DATE OWNER BUILDER DELCARATION .I h@by altun rnd6 p.n.n, oa pdlury rhal I m crcnfl 6on rh. Co B.16ilrtr. D*'for fi. aollowi.g r.Mn lsd Tdlll Bu.in6s dd Profsior Codc): Any Cily or Counl, qhich r.qui6 a Dcnrit to connrud, dt6, imFov€. dsnolish or ft,tsn dy stu.ru., Fior to irs Gsumcc also Equn6 rh. applicd aor such pnmi to fiI. . s8md {ahat rhd n. or sh. is licc6.d puBuanl ro rhc rovisions of th. Coffia.roas Lic.nscd L{rv (Chaprd 9. CommcncinE snh S(lion 7000 of Dilbion I oa'h. ausin*q and Pofe$ioB Codc) or rhar hc or shc i5 .rdpl rhdetion ad rh€ hssis for rhc all.gcd .r.mprion Any liolation oas..1hn 701 I 5 bt .ny applic. for r p.mii subj.ds lh. appli.a.t ro dcivilpcnnlrrof.or mr.lhd filc tundr.d dollds ($500) I, ai 0$6 olthe Forcny, or dy @pLyG s''lh was6 d lhcn $L onposaion, sill & lh. *ort &d ih. dnrtm i! to intad€d or olIred fo. sale (Se.?o44, BusinN md PmfeioN Coda Tn. Conlraclors Lic$c ljw do6 flol apply lo an o\rcr o I rh. Fopsly sho hilds or irymv6 rh@n. ed *to do6 wch u!* hims.ll or hNlror rhoulh hb or hd osr dnplor.6. provid.d th.l slch impmvcm8 @ mt inldd.d or olk for sl. Ir. ho*6,6. rh. toildinA or i,nprovmor is sld within ooc )@ ofconpldiotr fi. OsM Bui[k win harc d!. htrd6 ofproriie thd h. or sh. did d hrild or ihFur fic prlpdy ror th. purrre or L s oNM ofrhe propdy. m crclusilely cont.clin! wirh licaa.d .onrndou to sBtrud rh. pmjd lse 7044. Busins Md Prol6sion Cod.:'lhc ConrEclois Licds€ Law do6 nor applyro o owns ofpropcny who buildsor impro!6 rh.rmn, a.d who .ontmcls for such Eoj.crs wilh . Co.lr..io(s) li.ds.d pmu&r to th. Cont.clors Licdse Lnw) I m cranfl undo sdrio.8 &PC Lrnrisr.aon l)xr€ ()sner .!!.88Ets5]!!!IEtS lt(2!uE(Ira{Ig! I lEcL) allirnu ddp.tralryolpnj y.n.olr[ennL(\\i,r! J..lnrarn s I havc ond will mai.rain o C€rl ifical€ ofconmt lo selfJBur. aor Nortds compmation. s Drovid.d lor by S<r i.n 1700 o r rhc kbor Cona aor rh. pdfollmc. of rh. wo* for qhi.h rh. p6nn i! Gsu.d t.zl havc and will maialain work6' .onrensa b. ituurancc. d rcquir.d by Sdrion 1700 of rh. tib.r ftdc, for th. psfomr.ncc ol /t\c sorr lo.qhrch lhs rEmr' 's 'scd. M) w lci ompsdEn rDu,ucc cdo tnd p.h., numbdr. (..*. 1"r,...,".. (o*stu-y 6 [ t1't N.tt /P.tny N"",b*, wsA 5a\ t'l 71at {,,0n*, - a /or /,t I cdiayrhd in th. pdlormaocc ollhc wort aor which rhis p.mir is issu.d. I shallnol mploy any p6oo in any mdnd $ 6 ro b€com. subjd to rh. vo*m' comp6arion la*s of Califomia. dasErhar ifl should b<ome subjd 'oihe\rcrt6! conpsMtion prcvisioB of S..lion 1700 ol lhc I lbor Codc. I shall. lonh*'nh comply * ilh $o* polisions WARNINC: Foilurc ro s(Ec work6' conptuarion covdasc ir unlavful, md sh,ll subid .. mploydlo dminal F)alr6 tud civil li!6 up ro onc hun tGj rhousnd dolld (1100,1100). in additio. ro rh..d ofcomp.Nrion. dm.3cs .s provid.d lor lhe S(rion 1076 oflh. Labor Codq imd6l mi atom"y-! 16. K,"",( -tE- /,ra^ J.t/* !!t!!!!DlrrN!&!croauEc!A!]!t!o! I nftby amrm xnd6 poalty oa psjury rhal I m lic.ns€d und6 provision olChlpld 9{comdo.ing {irh S.dion 7000)ofDnision 1 of lh. Busins dd PmfsioB Cod., 0.d my licm. is i6 alll aor.e md.fret. (rr**"cr*" C +5 (".,.-b:z-81:l x*'-45 x-(olilalcro!_tErotlc_acErcl I hseby a,iim und6 rEmlry or pdjury rhat rhdc is a col(o.rioo lcndin-! ,gd.y aor rh. pdaoms.e of lh. *orl lor \tth lhis Fnil 6 issucd(s*. 1097. civ a ). AffIIQI.NIDECIABAU!,II I hdtJ, aitm undd p6alt! of psjury one of the iollorvinE ddltr.l io.s: Dc'no&ion Ptrirs Asberos Nolifi.a'ion F.ddal R.gularions (Tnk40. Pn6) Rcqtrir. l-rrrrolNo(iilrridl I cdiry lhal lh. f.d6al r.sulai io6 r.srdins sb<slos rmoval ir. nol alplicablc ro rhir pnjel I cd'ryrhat I !flvcr.adrhisappli.arionddsrarerhar rhcahovc rnrotuarion 6cord I a8r- ro comply wnh aU CU aod Counly oldinanc6 and Sratc ljvs Ehlins ro buildinE consrrucrion, dd h6€by aulhon4 rcp6dGliv6 of thB Ciry Md Counl) to st( upon the .b.v. marion.d pmFny aor iNp€dion puqrs6. zApplienl or As€nt sisnirure ' Pemite nrm. lprinl): )k^ U4.! Stan Tlo Ler o,r", a /atf ,7fi Set Backs Forms/Steel/Holdowns Erection Pads SLAB Floor Subfloor/VenUl nsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Dryvvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL Notes Remarks, Etc. ID/SIG.COMMENTS 75+ UFER Ground J/eJal b(tu) Certificate of Occupancy