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BUILDING- INSPEGTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hs€by aflim undq pqally ol psjury lhal I m cxcnpr &on lhe ConradoE Lictuc Llw for $e aollo*ins @$n (Sd.70l l 5 <br />aulin6s ann Proa6sion Cod.): A.y Ciry or Counl, *hich r.quir6 . p6nir ro coGlru.r. ahd, inprove. ddnolish o! r.Fn my <br />shclu.. priorlo it! issumc.. elso r.qun6 th. applicd for su. h pcmi' ro fi Le . si8n€d $aroncg <br />'hd \rfr :h. is licmkd pucu l <br />bin provlsio6 ofthc Conradoi! Li..n..d tlw {ch3prd a, conm.n.inS wirh S.clion 70OO ol Div6ion I .frh. ttusin.s and <br />Prcfsions Codc) orln3t hcorsh. is.rdnpl rhd.fronand rh. basis for lhc allcscd cr ption. Any \ iol2tion ol S$lhn 70:l I 5 by any <br />applicd loraFrn subjrl. rh. amlicaorma.ivilpc!6ltyofoornorcrhdnvchundrcddolles(1500). <br />-1. <br />6 oMd otlhc proFny, or my cmplo'6 with saa6 s lh.n $le compsN.lior. $ill &r ltE wolk ed $. strucrE is nol <br />i,tGlld orofd.d forek(Sc.7044, Busine dd Eol6sio6Codq TrE Co.bador's Licc6c L!8 do6 not arply to oMdof <br />lhc propdy wno hikG or ihprovGllsor dd rvho do6 uch roi( hinsclf or he*lfor ttroush hir or h6 o*t mploy.6, <br />provi(H thar such inpmrma e mt inla{h orofii,Ed for sle If. hoBBc.lh. toildins or inprovffil is sld wirhin on. ,* <br />ofompt io[ $c O$nd Buildd will hav. tlE hr&. oiFD'ii* rhd h. or sh. dd @l t{ild or imFlr. fi. Fopal, for tlE plrros of <br />L a o\wd ofrh. pmpdy. m .rclusi!.l, contrdin! r irh li..n*ri conra.toE ro coGrrud th. prej..l (56 70,14. lnlend <br />dd P,of6sion Cod.: 'l hc Conlracloas t,ic.nsc t,as do6 nol applylo !n oNnd ofplopcny *ho builds or improld fia.on. <br />ed who .onthss for srh pruj.os wirh r Co Edorl3) li.@d pmumr lo th. Cont.ctois Licm. t $) <br />I u cxmpt u.dd Setiod ,B &P.C aorfiis r€aon <br />D.ter OnGi <br />loax[Ss'laMSElsAllo! <br />DECldf,ArlO! <br />I h.rcby amxn und6 pm6hyofpqjuryon. ofrh. followin! dcltuario,ts <br />I havc dwillmainiain0C.nificorcofcons..troSclfinstrr.aorsorkos compdsalion. s providcdfo!byS€clnn1?00ollhc <br />La6or Codc lor lh. pdfomancc ollh. sorl for shich lhc tsnil is irsucd. <br />I hav. a sillmainiainworl.6'comp.nsationiBumnc..ar.qun€dbyStrlion1700oflheLiborCodeforlhcpFlenndcc.l <br />lh. wort for Nnich lhis Fmil is issuol. My workdi .ohpmatiof, insurmcc c iq {d policy numb6 sc: <br />I .diry rnd in rn Faomanc. oarh. \ro aor shi.h rh6 pdnn is i,su.d. t shall not mplo, o, p6son in any muns <br />$ 6lo b€.ornc subj..l to thc worl6 composolior laws ofcolifomia. ed asre thal ifl should b<odc subjftl ro lh. <br />wort*'comp.NtionprcvisioGofSelionlT00oflhcLlborCodelshau.lonhsithcomplysnhlho$povBioB. <br />WARNINC: Failur. ro suc sorkd .onFErion c.v@gc i. ulasful. Md shall subjei dplols lo oimi.al p<EtiB ed <br />civil line up lo o.c hundrcn rhou$nd dollds olcompensalion. dnnrgd rs pr idcd a.r rh. <br />:::'i;1i;7i2. <br />DECIJf,AIlQtr <br />unda provision olChapl6 9 (conmdcins $ilh Sc.rion 7000)ofonision.lI h6cby amm nndd pdalty o f p.rjury lhsl I <br />of lt. Busin6s ud Pmacsio6 cod., rnd m! li.ds is in i!11 lor.. dd clld <br />",, ry'io// 6 _ <br />I h.rcby amnn under lcnaxyof pcrjuryrlla lddidg agscy aor rh. pafonnar. oithc{ork for \rhich lhis pqnrit i! <br />isuot (sc. 1097. Civ. C.) <br />APTITCAtrLDECLAAAIIOX <br />I hoqaftnundd p.nahy ofrdjury on oflhc lollosins d<l&ationsl <br />Doolilion P@ils-Asb€ios Notifi$t ion F.ddlReauLtio.s (Tnlc 40. Ptr16) <br />R.quir.d Lltq of Noi6cdion <br />I c61ii that lhc f€ddal rcsulatioB r.strdins sb€tos ranolal s€ not appli.able lo this prerel <br />abo* i.aomarion is conar I a8ra lo complyvirh.ll Cityond Counly <br />rnd hd.b, aurhoriz. rcFMr.rn 6 of this Ciry and Counry ro oltr urEn lh. <br />^,",t/s/zi <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />SubfloorNenVl nsulation <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Qqruty Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL b/t/tc{9t1f7 <br />Certificate of Occu pancy <br />Remarks <br />UFER Ground <br />Roof Sheathinq <br />Notes,Etc. <br />cdi-r- <br />Poli.y NMb6:_ <br />I <br />I