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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMilENTS <br />I a'n.r.n.r unda sRton .lt. & PC fo' lh8 rdn;..1!- s- ur "*-v-.42f l.nrc-t)ot)" <br />woRl(ERs' coMPihsAl loN <br />s <br />DECIAEAIP! <br />I h6eby amm u.d6 poall, oapEjury on€ ollhe rolbwins d<lmrioN: <br />-l <br />hav. i will mainrai. . Cdifical. oacoNol ro Self-lnsurc lor *otk.tr coniptutriofl. B pmvid.d fot bv S*tion 1700 o athc <br />kh., Coda lor thc psfomoc. ollhc wod for wnich rh. psfln G isu.d. <br />-l havc dd sill m6imsin wod(.rs .odp€Balion Guanc.. s r.quir.d by S.clion l70o ollh. Lat r Cod., for lh. p6fomue of <br />fie work aor wni.h lnis pcmil is isu.d. My worl.rs compssarion iNr&c. clrid dJ polky numbd &cl <br />-l <br />c.nify thar ir th. psforfucc otlhc w.rt for which lhis permit 6 qsu.d. I shaU not mDloy !n, pdso. in onv hdnd <br />e 6lo b.cooc slbjdl b ih. M 6'clmpc,salion laus oacalifomia. md asE rhar ial should b<.om. subjel to rh. <br />\rcrl4' coipgMlio. pevilioB ofsrrion ]TOO of lhc l.abor Code ! $all. lonhwith .omPly with thos pmvisioB <br />WARNINC: Failur. io su€ wo*6' composdion .oe.mB. is unLslul. &d shall subj(t o dplorr lo siftinal FEti6 dd <br />civil 6n.s !p ro on. huDdr.d lhousdd dolls ($IOO.O0I)). in addnion $ rh. cosl of compmalion daMSG 6 Providcd lor$c <br />S$xon 10?6 olthcLabo,Codc. i.l66l ddttrorncyi ls <br />€(o,t- 3- 2a a--,,L|"t,\.lal9as <br />UCI'NIED.CONISACIAA <br />ECIJAAIIO! <br />I hereby affm u.d6 p.nally o f pdjury $ar I m licds.d undd Fovision of Chaprd 9 (onmocins s nh sdlion 7CO0) of r,ilisio. ] <br />of thc BGine dd Pmfsions Codc. dd hy lictu. is i. lnll fotcc md €ftel <br />l,imc Numbs <br />calirBJJqllaNuxDllcicENcr <br />I hmby alliirn trndq penalry of r.itr.y ihat ihsc is a codruclio. loding aBmcy aor lh€ lqfonnMc. of lhc \rc* lor sti.h rhL Fmit is <br />isued (se 1097.Civ. C ). <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Subf loor/VenUl nsulation <br />Roof Sheathinq <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 />Deputy Final Report <br />Engineer Final Report <br />/) <br />FINAL /h//O 4 h-1, )c/ <br />Notes, Remarks, Etc. <br />J <br />Set Backs <br />SLAB Floor <br />Flood Zone Certif . <br />- <br />owNnR BU|LDERDf,LCAR TIoN <br />I hseh! amm lodr pa,lly oa psjury rhal I d .&mpr ftom tn Co.ra.brc' Licens. Ltw aor lh€ followi.s r.e. (5(.703 1 .5 <br />Dusins a.d Profsion cod.) Any Ciry or Coudy shi.h t.qui6 a Fon ro @drud. ak6 ioprolc ddnolish or rcDat dv <br />.rtudN, pnor ro ns isuucq aLo r.quirc thc opPlicel for such Frmil to 6L a sisned slalddl lhar h. or shc is licd.d p@ant <br />lo rh. prolisioE oflh. Conl,acrbas Lic.ns.d tlw {Chapl6 9. Comma.ing wnh SEtion 7000 olDinisio.I ollhe B6inB ed <br />P,ofsios Codc) or lhal hc or sh. b .xmo rhqelion dd lh. b6!is aor the allcs.d qdplion. Any violation ol S.dion 701 I 5 bv €nv <br />rppli.d foi. p€f, slbjcls lne lppli.ml to a .ivil pcnahy of nol hotc rhm five hundr€d doud ($100) <br />-1, <br />6 owhd oflh. prop€rry. or sy @ploy6 $iih wa86 s fi.n sk compcdi.lion, sill do lhc sorl ad the erudrc k nor <br />inl6& or oficrcd ior slc (Sd.7gl4, Bosins &d PrcfBioN Cod.: Thc Conrrlcloa3 l-i.d. La$ do6 ool apdv ro m otrnd ol <br />rhc popdy vho tnilG or tnr.o!61h66n. snd wtr {b6 sch slt hins.lf or hmlfor thmugh his ot hr om rnplor.6, <br />prolidcd thal such i,nprovo6ns ft nor inddcd or oil6.d for s€1. ll how6q. lhe buildio3 or impmv.1Ml is sld wirhu onc va <br />ofamgldio.. lh. O*td Britld will h,vc lhc budn orFovinr lh, he or shc did nol build or imprc!. lh. pmldtv tur th. pxtPc. oa <br />l. 6 ornd oflh. Fopelr. m .rclusircly conlracli.s wnh [ccN.d conlrrclo6 lo <odtuct (h. proj€cl (Sd 7M4, BGi6 <br />and Proisirn Codc Th. Conlr&roa3 Lic.@. Law dod nol otply lo d o*nd oaPrcp.ny who buil& or imProlB lhqon. <br />ed who co.rEcrs lor such FojeB wnh a Conlracto(, lic*.d p!B@ lolh. Co.lrtctols Lica* t w). <br />AIETANLDECIAAAIII}! <br />I rE by a]fhn ondr Fftlly of pdjury one of th. followins d(l6alio6: <br />Donol'rioo PamiteAsb€los Nolifi carion F.daal RcSularions (1 ill. 40. Pan6) <br />-Rcquir.d <br />kr( of Notifirzlion <br />I cdiry rh.l rhc acdsal ..gularions €gdditS Gb6tos rfloval dc n.r .pplicabl€ lo thls pojdr <br />lltY"*r, **.*o*ir applicarion dd sbr. rhd de !bov. i..onnarion is corr..r I 686 to compry {nh <br />'rr <br />cirv and couniv <br />ordinec6 dd Stalc h$ r.lrrnB ro buildins .oi5ltuclioq afllheby surhor?e rcprdard n 6 o I rhs Crlv ud codnit ro mtr upon lh.'i*:::,1:T-i.W <br />^* - t r's'z& <br />pemr,en'n.,pr,n,r Lru4ia e. Itrla Iq,)Ser