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BUILDING. INSPECTOR RECORD SITE-WORK DATE COMMENTS l. 6 otr nd o fth. Fop.ny. or my .nlploy6 $ilh q'a86 6 thct sol. comFnsslion, will do lhc wort and rhe smdue is mt intfldcd or oflcrcd fo. el. (56.7044, Busin€s od P,ofsions Codq Thc ( onlmclDrs Li.m. Lr* doB nol .pply b an o$ ns o l rh. tspdr who build! oi inpru€ $6e.. Md who dG such Mrl hinsellor h6elao. throu3h his or h€r osn €'nploycs, trovid€d rhal such inprov6ndr5 @ nor inrdrdsl o' orsed for s!l. lf, hosdd, rh. hrklin! or inlrov.ffir is $t snnin on. )@r olcomphn ( lh. ()$6 Buildg will haE thc ludfl of prcrins rh, hc or shc did nor hriLr or imFor. fi. Fopdy aor rh. plr'[s of l. e oMq ollhc Fqalr. m dctusnrly coniractinS wnh lh.tr d con'radoE 10 connrud Ihe FoJ(r (Sc. 7014. B$'n6 tud ft.fesionCod€:'l hc Conrracroi s l-ic.Ne !,aw do6 nol applyro a ownd olpropd, who buildr or improvBlhd@n. and who qr 6cls lor slch tsj.ds wnh a ( o mcio(s) lics.d puuuturl tolh. Conrracror's LicoE ltrv). -l dcr.opr uod6s*rion-, B & P.C for rhi3 r.Mn i{aaSESl..caMrlr$ror DEC!A8AI!Q! I hscby a[r,n undd poalty oI p6jlry onc oalhc follorviq ddd,rioN: I h.v. md will maintain . c.dific.lc of ( onsol lu s.la-lmrr. for \rcrksi compdsarion, 6 prelid.d lor by sdrion 1700 o f th. Labor Code. lor rhc pdlomd.e of rlE wor! lor whi.h dr pmir i, ilsu.n I have and wil! ftaim.in wo.t€ro' comp.nsalion iNurrnc., s r.qut d by Sal ion 1700 ot rh. t bor Cod.. for lh. pnaol:mcc oa th. wort for wnicn lnjs !.mn is isal My workers ompaelion insumnc. caris ed policy nufrbt d.: _l caria) lhar in rh. pdao@ftc oa$. worh for *hi.h $is ponir is i$u.d. I slEll nol mploy sny pc.son io an, n&nd e 6 ro b€.one subjal to th. q,ort6 smpssriofl lass ofcalifomiq dd drc tha il I rhould h-omc subj€l lo lh€ wodre' comFMtion provisioN ofs..rioo 3700 of thc Gbor Code t slull. fonh\ith comply wnh rho* pmvisioN. $,{RNlN(:r l:!,lre ro su'c $o.kds r. ,l,6erid, cov.r.gc 's trnhsn,l. and slfll hi(r 'n mDloE ro minal 63Ii6 ed -izr6'i. aL,e* - p.'la.a r", 'r,. t,-<Z y._ 'u:*.S-rion 1076ofrh. tat r Codq inrdd and ./,1 It(rrs!1!lllNr!!11]1)8 /l)r( I \R \ rx)\ I ha.b, amfl D u.der p€n.llr olpqju,-}undd rovision olChaprs9 (con6ocin! wnh sdion 7m0)oaDivision l or rh. Busina dd Ptulaions cod.. md ny li.dtsc is in aoll aor* dd .llcl B /76 -/tr I hdcby ariinn und6 penahyof psjury$ar hsued(Se.:r097.civ ( ) is acoNtruclioo lcndi,s asdcy for rh. tdfolrmc€ of rhc \o lo, Nhich this psmil is arttrcSxfD[ct aEauox I ho@.llrn ondd p6rlt, oapdjury on. oalh€ folb$nr8 delaalio.s: DcNohion Pe,nns-Asb6ros Norificalio. F.ddol Rqrlorions (l illc40. Pano) -Requt.'.1 l-drcr of Notifi c.lio! .!rLr 1o comply silh allcir!and cotr ry iv6 otrhis City and Countyro dre lIFn th. Set Backs Forms/Steel/Holdowns Ereclion Pads UFER Ground SLAB Floor SubfloorA/enUl nsulation Roof Sheathi ng Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. t"\ FINAL i z//r//f -Nq l Certificate of Occu pancy Notes, Remarks, Etc. ID/SIG. Shear Wall O\!NER BUILD'R DELCANATTON I hcr.b rmnn undd p.nalry oapojury ihal I an.r.nrpr liom rh. Conllictors Liceise Law aor Ih.lollowins r6onls<70llt Rusin6s ard ltolsion Codc) Any Cny or County shich rcqutB a p6nil lo oBltuc1, all<, inpore, d.molish or r.P.n tt, slrudue. pflor lo its issudc€- also rc{urd llE applic&t for such Enn ro 6lc a sisn.d nalmdr rhar h. or she is li.e.s.d pu6uan 1o rh. Folisio8 of thc Co.rro.tois Licenscd Law (ah.prd 9. coo,ncncinS Nirh Sstion 7000 of Divist n I olrhc a6in6s ed hofsions Code)orlhat heorshe is ex dDpr lhsearo m md rh€ h6sis lor rhc sllcr.d cxdnflion. Any liolarion ofSelion ?011.5 by on, applic! lor a p€mn subjds rhe applica roacivilpcnahyoInolmorethMfivchun&aldollm($t00) civil lin$ up kr one htrndrql rhousdrd ollds L.ndeis AdLlrs I