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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loorA/enVl nsulation >\ <br />'('trRoof Sheathing I l.9Dt Jl4dtl <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I <br />FINAL a/'*- <br />Ce(ificate of Occupancy A <br />emarks Etc <br />I 'tq|]tw N'il ffitrznlt 1L,'fry <br />OWNER BUILDER DELC RATION <br />I hseur_ amm unds p.naly of lcrlury that I m cx€mpl lrcm lh. conkiclou l-rcelr Li$ for lhe follo{in8 rcM. (S( 701 1 5 <br />Bus'n6s ,nd Pof6sion Codc)r Any Cily or Counly rvhich rcqun6 . p€nnit lo conslrucl. ahd. nnprore dflolish or r4air.ny <br />shrdm, pnor ro ils isu ce. al$ tqui6 rh. applicml foi s".h p.nnn lo 61. a sisnaj $aianmt rhar he or shc ; lic.tr d puBx t <br />lo rhe FovrsrN ol rh. ContE.lois Liccns.d ljs (Chapl( 9. Cohflm.in! wilh Sation 70{0 of Division I ollhc Busins d <br />Pr oLsions Codc) or rh heorsh.iicx.mpt rh@6om ed lne bsis aor lhc alles.rt ei.,nflion Any\iolationolsc{io670115b!.n, <br />applicanr lor a rEdi su6jdB rhc .pplicml to a civil penally of nol mo( rhnn fiv. hundrcd dollss (5500 ) <br />-1. <br />s owner oatlE p op€ny. or my .toplolB * irh * as6 s llEn $ h conrp€nsrion. will i!) $. work ed lh€ slntr1@ G nol <br />i ertol or olldcd lor ele (Sc 7044. Blsins dd Pmf6ioN Code 'thc Conlhdols Lict6. L.* do6 nol arply ro e o\ tr6 ol <br />rh. p6pdy $,ho burld! or improv6ln.@n. ed s ho dc such Nrrt himsclf or heelf or lhnu8h his or hd o\rn .mploy.6 <br />provii.d lhal such iElrovdruhB re not i oded oI oflot{l for sl. I r. towdd. rhc boildins or i,nprorddr b eld sirhin .nc ) @ <br />of.ornpldio.. lh. Orvnd Bul&r will ha!. lh€ hndq oaprovin8 thd he or slE did .or build or inPioE the pmldy for fi€ puqnse ol <br />l. 6 owtrs ol rhc propdry. an .xclosiv.ly contractins s ith lictr.d co.liados lo coaslrucl th. P@jd (Sd ?041. B$ns <br />.,rl ltofGion cod.: ! lE Contacrda s Lic.ds. Law do6 nor ,pply lo e osnr o aflord y \ ho bxilds or imp.o!€ thson. <br />and who Lonraft lor su.h lfoisc rilh a Co Bclo(r lictuod pu6utnt lo lhc conta.rois Lic.N Latr) <br />-l <br />m.ronpr Edr s-tio <br />voaEE4s:cou8lIsarq! <br />DSC!4BAr.IO! <br />I h.rcby alfinn uids pcn.liyofp6ju.yon€ oflhc fou$vi,rs d.cladioB <br />-l <br />6a!. dd {ill mainrsin a Ccniarcalc ofcon$r ro sclf-lsurc aor vorke(' cdnpm$lion, s providcd for by Sdrion 1700 o alhc <br />Lnbor Cod.. for lh. pdfom ccotlh€\eor* lor lhich lhc tonn is isued <br />I hdle ond \'ill'n.inrai. *.lk.rr compeBarion iBurance. as r.qutedbystrionrT0ooflhcLaborCodc,iorrheFfomnnc.of <br />rhe \vo,k ior rvhich this pmil is i.sudi M, worl.n conr!.6ation insuanc..mis dd Policy numbq ae <br />I cenii rhar in rh€pdaormanc.oflhework torwhichlht psni it i5su.n.l shall oot m!,loy &r r6on in anvmuod <br />$ 6 h b..onE subi(r ro lhc wo,t6 .dnpaMlion 1.\w of califomis. ed asft rhd il ! should baonc subj-t b rhe <br />*o 6s conrpNrion povitnJ6 of s.niob 3700 of thc L{tor Code I shall. aonhwth comply wilh lho* prolilio6. <br />\I,{RNINC Failur. r. sure Mrksl <br />.ivil nncs ul) to one hundrcd lhosdd <br />Srri.n 1076 olrhe lrnr Cod.. intld <br />.ovsdse is unla$tu|. d shall subjcr M annloy€r lo sininar Fm[i6 and <br />addnion k, rhe cost of comEnslion. duras.s 6 providcd for lhc <br />i\ <br />I hqet_v ailnn undcr p6,llyolpclury llml aD licoEd 0ndc. p'dvisio.of cnaprq I (co'nnencins *nh sstion 7000) olDivision l <br />of rlE Btrsins d ltof*ios Codc. ed my licffi is itr tuU lorc. dd elTer <br />fi c ?cl Qsawtz <br />l7 <br />I h6cby atam undd p€nalr, ot pqjury ltal th6€ is a @.srudion !..din8 asdcy io, lh. Faommce ollt€ <br />isu.d (Sr.3097, Civ. C ) <br />Lend.' rName <br />- <br />AIIIIIANLDESJAAIIA! <br />I hoSy dfton uidd pcnalry of rgjury ofl€ of lhc fouo*i.s dcclear ions <br />D.DDlition Pamils-Asberos Nolificat io. F.d€ral Re,rubl ions 0 nE 40. Pd6) <br />-Rcqut.d <br />L€ri( ot Nolifi..l{n <br />io is cotrecl l asrelo co'nplr wirh allCilyand Counry <br />n,! r.FMrali!6 o I lnis City Md C.u.ly ro ors urF. lh€ <br />"F,U{.L\ <br />Lcdl <br />Lendd rAddN'- <br />I <br />tt