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BUILDING. INSPECTOR RECORD SITE-WORK DATE tD/stG.COMMENTS OWNER BUILDER DELCARATION I I hq.by amrm unda pcn.lly ol prjury thol I m .r.6p Fom th. Conlra.loB Lic.nse b* tor rh. followiis f@i (s< 7or I d Busin6s a! Prolsion Codc): Any Cny or Counry rvhich r.qut6 a psmi ro oNltuct. alr6. inlprole dsnolish or Ep6n Myl sttuctue, pnor ro irs isuM.e also E{un6 thc applicanr for such Frnil ro 6lc a sisned surd..r rhar h. or sh. i lic.ro.d edm L to thc prc siore ol lh. Coorracroar Licens.d tiw {Cnaprd 9. Comm€ncins wirh Sdion ?000 ol Diririon .l of th. Bulin6s md Proa.sionsCodc)ortharh.orsheiscxenp(lhocnomddrh.b6istorrh.all+.rldcnrplion.AnlviolalionofsdioaT0llSbyany applicanl lor a pmrit subj<ts Ihc applicanl lo a civil pemlly of not morc lhu 6vt hun&.d dolles ($500). l. 6 osn.r olthe prop.ny. or my emplor€G wirh was6 6 rhet $lc conrposdion, rill do ihe $o ad ln. $Mue is mr inrmdeJ or olrd.d for sl. (sd.7044, B6i.6s m! Proa6sio6 cod.: Thc Contacror s t.iceN rls dD6 not irply to m ownd ol rhc F.pdy who builds or i,qro!6 rhc6n, and $ ho dos such slt hiosclf or h6slf or inmush his or hs o$n cmploy.6. prcvidcd rhtrt suct imprcv@oc emt inrodcd or oltdql for elc.ll now66. thc buildin8 or nnFovmnl i! $ldwithinonc )a olcorplclion, thc olxns Builds sill hav. lhe htrdq ofprorins thd h. or shc did nol trild or improrc thc pmlEly ror rhc purB)* or L a ownq ofrh. prop6ty. m .rclusilcly confa.riq silh licmed coflkaclou Io onslruct lh€ projccl (Sec 7044. B66s dd AnhirnCodc:'l h€ cd.racror! Licens€ I av do6 nol apply t. d o*oo olpropdy who brilds or i,npN!61hd6.. aid who conuacrs for such roj.ss Nirh a Coir6cro(s) li.dsen puBudr lo Ih. Conl8clois Lice6. Ijw). -l dncrmpt uodcr Sdrion-. R. & P.C. lorrhis r6on tlaB{u&rr0uutsarta!Dgc! aatlg! I hcLcby amrn unnLr poBlty of p.rjur, oneolrhc aollo$ in! decldarioNl -llElcffdwillmainrainaCcniar.alcolconHrtoSelf-lnsur€rortrorkcrs'coilpens,lion,atmvidcdlorhySeliotrl?00o4'hcLabor Code lor llr prlodnmc€ o arlE \vo* aor wlich $. pcnit i, issued. S€rion 1700 ofrhe Labor Codc, for th. pEfomtrcc ol cMio md polic, nuhb6 sc: ot I ceni&rnat in rh. psformanc.olrhc work for $hich rhis pcnnil is isstred. I shallnol emDloyany p6soo i. ey den( s 6 to b.tom€ subjd to thc *od6 conrpqsatio. laws of Calilomia. and as@ lhdt if I should bdom. subjrl ro lhc worlsd comp€Ntion provisioE of S..lion ST00 o lrhe l{bor (bdc. l shall. fonhwirh cotoplv *nh rho* pro\ ishN \IARNING: Failur. ro {ru. Nork6 corpdsrn,n cov@E. i3 unla$aul, Md shall subid a. onploytr 10 qiminal poalti6 und civil fl.es up b on. hondNd rhousdd dolld ($100,000). in addnioo h rhe cost ol comp.Nalion. danEses 6 trovideri tu lhc sRlim 1076 olth. Lahoi codc, intdan dd onorncy s LB \pflimnl' IICINSED-(QNIAACIAB DECJ.AAAIP I hmby amirn ondo parallt oap.rlury th.t I m licenEn md6 prolistu. of( h.prs I (commering rvnh Setion 7000) otDivision 1 ol rh. ausi'r6s ind Pof6s is codc. tud ny li(.'s. ii i" lull li!'ac ard .ll\r G47q looa I hftby affim undq pdalty of Fju.y rha rh6c t a on$rucrion ldding asocy lor Oc p6loJl@c. of lbe {o* for which lhis pcnnil is issr€d{S(. 109?, Civ. C.) AIIL(ANfDECLAAAUO! I hs.lrafmunder poahy olpcrilryone of thc follo*iru dalaratnrns: DctrDliion Pd,nns-Asb6ros Notifi.aliofl lrcdcml Re8uhn,ns (1 il. 40. Pan6) -R.quncd Lcllcr olNolification I .otily lhal rh. aqloal r.uularions EStrdins ah.itos rdn.val a c nor applic.blc to lhis pojet I c6riar rld I have r.ad rhis 0pplication od abolc infonnati.n is cotrd I alre lo co'npl, wilh dll (' o inan.6mdshre Lassrchrint to bui ilNc nr.rrn,rd tr,trn' ntr .\t,Ili.i r !' ^sur Sign"rtrrr Forms/Steel/Holdowns Erection Pads UFER Ground Subf loor/VenVl nsulation Roof Sheathino {5.-a )brhN Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat lt4asonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif I FINAL rl 7 l@qa VD./ Certificate of Occupancy T ur Notes, Remarks, Etc Set Backs SLAB FIoor t **I I