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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCANA'TION <br />I hcby amm undd p.nalty or p.rjury $ar I m cxdnpt fto'n th€ ConhcloB Lic.nse Li* for lhc lolhwing r@n {Sd.?ol l 5 <br />B6in6s ed Plolesion Cod.)r Ary Cny or Counry shich r€quird n pcnnn to connrud. all6. inprove d.molish ot r€Pair .,:rv <br />$ructuq l,ior ro ns isumc., also rcqutB thc applic l for su.h p.f,nn to file . sisn€d slal@d rhd h. or she G licosd pu6udl <br />lo rh. provisions ol lhe Conlractoir Lic.n*d tjw (Chap16 9. Cond.n.i68 {ilh saiion 7000 of Division ] ofrh. susin.s dd <br />PolsioN Codr) or thd hc or shc is cxc'npr rh6.lion dd rh. bsis lor rh. all€sed ex@prion An, violdior ols.nion 70115 byanv <br />apDli.anr fo. a pson subjcs rh. ,pplicer ro a civil p€nany of not n&rc rhd n!. hun&ed doUm (t500) <br />-1. <br />a osrd of$c p{opc1y, or my cmploy6 renh w,8* s thcit elc conpstsaion. *ill do ln. (o* $d lhe slrx1m G mr <br />n 6d.d or ofided lor sl. (5(.?044, B6i.ss snd PI oasiors Cod€ 'lhe Cdniractol s LiceN liw do* nol tpplv lo an osr6 or <br />rhc l'opdy $ho hril& o. i.rFoc ths@tr an<l who dc such so.l hitns€lf o! h.Bl f or rhrough fii5 or hd 6!n .mplov.6. <br />povidcd rhar sucb imptuland s se nol hlodcd or o,red lor eL. I[ howo6. rh. buiklin8 ot nnprovoE.l 6 $k] sthin one t@ <br />oacompl€rioG rht Od.r Brildd wil h!rc lh. budd ofproli.s lha h. or sh. did mr blild or imlrov. the Ftpdty tot lh€ purlne of <br />-l,6ownq <br />ofrhc pmpdy. m *cl6iv.lyconlrrclins snh li..Nai conlracloN lo codtuci th. prcid (Sd. 70'l'1. Bu(inR <br />dd Pnf.ssbn Cod.r Th€ Cont.cbr's Li..ne Law doB not apply to d ownd olproPeny who buildr or impro!6 !h(@n. <br />nDd who co rads fo, su.nprojds wnh a Conlsclo(s) licssed pu6wt lolh. Conlrrcrors I-ic@e ljw) <br />ldncrclnpl undtr sNrion .tl &l'( iorriistaotr <br />raa[EBs]lollfrdtAr19! <br />DSCLAaA-IO! <br />I hdeby amnn und$ pcnaht ol pnlury onc ot the lollorins d(l&a(io6: <br />-lhawandsillnrinr.inaCcnilicareofConsdlloSclllnsui.aorNork.Bconrp.nsarion,sProvid€dlorbySdrioolT00oflnLabor Code for rhc pdlommft ofthe Nrk for which the psftil is is!u.d. <br />-l <br />ha!. a.d will mainlaifl work.rr' co'np.carnrn i6uranc.. s r€qun.a by s*tiod 1700 ollh€ Labor Cod.. lor th. pslorocc ol <br />r \hth rhs p<fftr N stu.n Vl qorle't (onrpmsron <br />'Nu' <br />&(. \ dE ard polict numb' r. <br />.4 la l,- F-uru a <br />-l <br />ceniryrhar i. rhc pcrfoi,nancc ollfic vork aorwh{hlhslemn is i$u.d.l shallnol dnplay.nypmon in aov 'ndner$ s ro baomc subjer io rhc wo B .ohpaerio. laws of CalitomiB. dd d86Ihal if I should bccomc subjdt to tnc <br />sorl6 conrpcnsorionpovisionsorserion lT00oarhe LrborCod€. l slrall. aonh*lr!yilh <br />dploF lo aininal pouhi<. dd <br />io.. dmagB 6 p!o!id.d aot lh. <br />WARNINC: f-ailu.c lo suc sorlm .omFffation m <br />civil fincs up lo one hundr.! rhors.nd dollds ($100.000 <br />1076 ofrhe l.alnr Codc. im.rsi d a <br />DECIAAAUq! <br />I h6.by affim n.ds p.n lry ofpsjury rhal I m liccnel undd prcvisio. ofChapls9(commmcinB rith Section 700Ol ..l)ivii'n I <br />ot the Busin* dd Pofdions Cod.. dd my li.cnsc is in rlll aor.! drd ctId. <br />t**."r*, h L <br />st <br />".,",L:-Ti)r//..z-<) <br />I h@by aIIm und6 pdahy o f psjury rhd rhd. is a codrudion lodins astry for Ue pafomncc of thc *ork for which this p.rfln t <br />issucd (Sc 3097. Ci!. C.). <br />Atrl,lcAtrLlllclaE Irax <br />I hqltr.jlmundd pdaliyoapsjury on.ollh. lollowi,s ddlo iom: <br />Dcnolition Psnits-Asb6los Norincarion reddal Rcxulali.as (lille 40, Pel6) <br />Requircd 1.11fl of Nolilication <br />-l <br />ccrlily rhar thc ledcral resuldions csardrng 4b$los rcmolal arc nol applicabl. to rl s Proj€ct <br />lcdiD thal I hn\€ 'cad rhis +di.a(io ion is conc1. , asrd lo romtly*irh all Cityand ( ount, <br />ordimncs and Slal€ L,a\s aurho.t !eF*r ar ir6 oalhis Cily ed counly lo dro uFo. $. <br />ibovc rdrioncd prelEnt lor <br />Aptrli$nr or,{tr.l Signxltrr€ <br />e eS <br />Set Backs <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Eneroy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />FINAL It].lht fi v[\40v1 T1-TSfil/N <br />Certificate of Occupancy I <br />Notes, Remarks, Etc. <br />Forms/Steel/Holdowns <br />T-Bar <br />Flood Zone Certif. <br />zp - *,./r4-)otg