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SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation l\ <br />Roof Sheathing vwx)ruL4 WP.T <br />Shear Wall u \-/ <br />Framing <br />ln s u lation/Energ y <br />D rylva ll <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />FINAL v.\/41d <br />Certificate of Occu pancy <br />No tes, Remarks, Etq. n A, <br />OWNER AUII,DI'R DELCARATION <br />I hreb, afiinn und€. p..ahy ol FjuD, rhd I m .r.mfl from rhe Conlr0ctor' Licensc bs aor th. follo{ing r.en (54.7011 5 <br />Rusin6s d Profsion Cod.): Atry Cny or County whi.h raiunB r pdnir ro onsrrucl. .116. irprove ddnolish or rcPan mt <br />struclue pnor to ns isumcc also Equir6lh. lpplica lor such Fnnil lo file a si8.cd statan. nl.l h€ or shc is licftcd plmudl <br />ro rhe provisioB olrhc Conlriclo.s Licn*d kv lchaprq 9. Connocins uirh Scrion 7000 oaDivisio, 1 ofth. Buin6s dd <br />f.oadsios Cod.)o!thal hcorsh. is.r.nrpt ihq.6om ed $. b65b aor thr allcS.d ermprion AnyviolarionofscdionT0ll tbyany <br />rppli.a.t aor a p6mit subjerslhc apphca lo!civilp@hyof nor oor€rhe nrch!n&.!dollds($5001 <br />-1. <br />d o\rr ollhc prop.nn o, <br />'ny <br />€mplo)6 rilh * as6 6 th.t sle compensnion. \ill do th. No* dd th. sltoclm is 6r <br />inrdidl 6r or-ei n, srlc (Se 7044, BusinB &d Ptua*io$ Cod.r Th. Conlrrdol s Licne I* do6 nor arply <br />'o <br />m otr'n6 ol <br />rhe pn'Isty $ho builds or improv6lhs6l! aql who do6such erk lritu.lf or hcr*lforrh,luEh his or hd own cmDloy€6. <br />provided lhd such improEHls u. mI i, ad.d or ordld for sL. ll hoq 6'n. rh. buildin3 o! imFor.1ml is sts sitnin on. y@ <br />ofcodpbnrn. thc Ow.q Buildd vill har $€ hrdo ofprovins thar hc o, shc did nor build or inptu\c tic popdy for fi. purpos. ol <br />-1. <br />so$ndoflh€ prcpqrx m cxclusivcly contnctins wirh lico*d cortracrocro onslrucr rhe prcj*r (56.7044, BE n6 <br />ad Pi.f6i.n Cod. Th. Conl.rclols Licm. Lrw do6 nor rpply ro m os.6 of Fopdy sho buil{Le or inprovG th6a.. <br />aod who conhcls for such plojccls with s Contmclo(, li€os€d plEwi to rhc Conlr.croas l.icmc liw). <br />lan cxcfpi u ds S..t <br />Ihcrctyaff n undd pmaltyofpdjuryone olrh. follosin! <br />-l <br />tavc &d will haiolain r Ccni,ical€otconhr lo Scl Nurc aor *orl.r!' comp.nsrr ion, a Fovid.n for hySalion l?00 oflhc <br />Labor Code lor lnc psfolMc ollh. wo& for {hicb lh. Fmit is isued. <br />_I hav. od will oainlain wor*.rs' .om!.ca!io. insuiance. 6 re{undl by sarion 1700 of th. La6or Cod.. for lfic pofomdcc of <br />Ih. *o ror *hich fii! Fmn is isr.d My wckdr conpasion iBum. ffi6 drd Flicy nrmb6 &e: <br />I c.nirylhat in lh€ p€rformanc.ollfic wolt aor which lhis ponit is issusd. l shallnol flployeyp6o. i6 any mmo <br />$ ao t .om. subjd <br />'o <br />rh. wo*6 .ompcn ,rion la$. ofcrlifomia ed dsE thd ifl should beomc subjd lo lh. <br />wort6 comp.Gation poli.ioB of S.crior lT00 of rhc Lnb{r Codc I !h!ll. aonhwilh comply wnfi tho* provisions <br />WARNINC: liailure er wure *olkql comDeel co!6aa. is unla\rtuI, d sh6rl subjd u 6phys ro dininal lEDlric ed <br />civil fiocs up to one hundrcd thousdd dolhs ($l i. addnion to the con or.oEF8alion, ddrud a pmvidcd for rhc <br />Sdti.n 30?6 oflhc l.alrrCode int65r a al <br />,r.iar/ rlf.iQ <br />I nmby.m n unds paalt, ol pcrjur) that I m licens.d unds otChaplq I (comoci.g {nh s{lbn 7000)otDivision I <br />of rhc uusinss d Proasio"s Cod., dd my licctrs. is in aull fore and .lT(t. <br />(OIIIBUCUONIENDIIC.AGEICT <br />I h6by arm lndd po8hy of Fjrry th.l ths. i3 , .oinru.rion lddine agfty for ln. palonnecc of lhc eolk for which lhis p6mil G <br />issu.d (S(. 309?, Civ C.). <br />artucANr.D[cl48al0! <br />IlErry.Jrmrndr poahy olpdjury on ofrhc follo,i.! dal&.riodi: <br />Ddolnion Pmns-Asb6ros Notilicalion F.dsal Resulations (TnE 40, Pan6) <br />_R.quired Llxd of Noincarion <br />I.dily r[d rh. a.ddal re8trlarioB egadinS sLsros r.nkn al tuc nor appli.abl€ ro rhG prc](l <br />-lc.nilyrharlhavcedrhisapplication&dsrar€rhalthcabo\€infomoriotriscor.dlasreroconplywnhallCilyandcou.iyordi.ancG and Staleljwsrelatiu to ildins conslrudion. d hqcbynurhorizc lersnlariv6 olnns Cir, dd Cou.ryro mr6 u|rnfi. <br />atorc nrm(ion.d flopdy lor <br />,\pplicrnl or /\A.nl stn,r <br />BUILDING- INSPECTOR RECORD <br />Flood Zone Certif. <br />I ?- <br />,,,"r \ld\ll5rf <br />? <br />F <br />lr