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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE tD/slb.'COMMENTS <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathing z/a-z/1q k 4-1 <br />Shear Wall <br />Framing <br />ln s u lation/Energ y <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 />F|NAL /l/d/t'/ F /--f/L /0 / <br />Certificate df Occupancy <br />Notes, Remarks, Etc <br />OWNEN BUTLDER DELCARATION <br />I h6.by amrm und6 p6ahy of Fj!ry rhd I dn.Enp frorn Ihc Conracrou' LicM$ hw lor lh€ lollorins rwn (Se 70315 <br />Busins md Prclesion Code)r Any Cily or Cou y whirh r.qun6 a pdnir ro coBrtucl. ahq. nnprolc, ddnolish or EPat My <br />sloctue prior ro ils irsuoc€. also ,cqun6 lh. appli.d foi such Fnnir to filc r s,sr.d stalmd lhal h. or sh. is licos.d puN@t <br />ro rhc pmvisioG of rhc cont!0ctoir Lic€flscd Low (chaprq 9, conmcncing sirh sdion 7000 ol Division I ollhc B6in65 dd <br />PioLsions CDd.) or th.r he or she is cxeDpr lhseliom sd rh€ tEss lo. rhc all.Ncd cxdrplion. Any violalon ofS4lioh 7011.5 b, s, <br />applica fo! s p€mil subjrt3 the aprli.drtorcivillcEhyoanoimor.thofivchundrcddollds($500) <br />LsoMBoflh.proFny.ormymploy6sirhvas6d$.n$k.onpwrioo,wiudolh€sortandthcaMucisnot <br />inrddcd or oncEd ror sal. (Sd 7044. Busins md ProasioB Code lnc coht,crdrs l-i.mc kw d.6 nol apPly to d o{d of <br />thc prepdy sho builds or il.pror6 rh@n. od *ho do6 such wori him.lf or h.6elto.lhroush his or her o{n anploy.6. <br />poridcn rh,t such inForEmrs e d hlo&d or o,lerd for $l€. lf. hos'6s, rhc hrildin8 or inFolmr is FU wnhin on. td <br />ofcomplelion. I h. o\xns Buiklq vill h,ve thc hnd@ of pmvins fid h. or s\c did rct buld or nnro( th. I,6pdy lor thc I,uiFls of <br />-1. <br />s ow.d ofrh€ p.op6ry. d .rc lurivcly .onracl in8 wnh ltos€d conlGcloBlo co({tud lhc pmjd (56 7044. BB'ns <br />and Pilasim cod. The Cont,acl6f! LiceB€ L.s do6 nol apply ro u ownd of prup.rty $ho bui lds or inprov.s lnron. <br />aod who .ontEcls lor such Fojds with. Co.taclo(s) li.ds.d pusuel lo th.conriclols Lic.N t w) <br />l nc\cn, unJcr Sc.r 8 & r!.C lollhs r.a$n <br />\t()RKEkS (Ol\tPUNS llON <br />OECIANAIIOI <br />I l,sehy afln'nundcr pcnahy olpsjurto..ollhe tollNlifl8 decl[.ttnE <br />-l <br />ha* dd will n.inrain a Cglificat€ of Co6dt to Self-lnsuEtorworkeG conrp.nsolio!,6 prclid€d for by sdrion 1700 olrh€ <br />Libor Code, ror th. pafomdc. o allr {ork lor wnich lhe pmnil is isu.d <br />I halc and Nill nainiain so&cr3 compeB nrn i6uran.., 4 nllted by Sd ion 1700 ollhc t-abor ('ode, fot th€ pstomdcc ol <br />th. work lorwhichrhispcm is is.d. My *orlers comD.@rb. isrre.e caEi6 ud Frlicy numbo d.:t ut+ /16 (a <br />- oot -o I -t n*' o <br />-l <br />cslily lhat in rhe pdloma..cofth. wort for which lhh ps,nil is issue( I shall.ol dploy a.y p€6on in any n&nd <br />e s b b€.om. subrcl to th. po** omposarion lr$ olcalilomia &d .8r lhol ia t drould b€.om. subj.t to th. <br />woll(61 comp€Ntionpmvisionsof Sdio.3700 oflh. Lahor Corlq I shall, aonhwith comply wilh lho* porisions <br />WARNINC: Faile lo s@ wo 6' compaMio, .ov€rage is rnlNtul. d shall subjd e dplorE lo oitoinal p6'allB ud <br />civil fincs up Io onc hundr.d rhoGdd dolld ($lo0,oo0). in addnion lo th€ cost ofcotop.@rion. d,m86 6 provid.d for lh. <br />Secrio.10?6 ollh€ llbor ('odc, i dan md anonEy <br />,/? Q t/1 <br />ugl!ff!)!(2Nr&]rro&DIII,IIAUA! <br />I h6.by artu6 undd p.n liy ofpqjory $at I m licerecd unds p.olisnrn oachaF. t (comnBcinA with S..l n7000)orDivisionl <br />ol lhc Busin6s &d Prol*ioos Codc, &d m, licde is in lull lorce and eilecl <br />C A z t.36 R <br />"-. tr-2?-- /L ,n*^..-, /-z ot lrn .ozcEe <br />q0.usBucllaN.LEBDlNc-dc[lcr <br />I hmby amrm undcr !.nalry of pdjury thar ths. i5 . constu.r ion I'nding agac, for lhc psfomd.e of thc sork for which lhis p.ftit a <br />isu.{ (s(. :J097. ci!. C ) <br />AETIICAIILDICI.A8AIIOX <br />I hs&,y a1lnn und6 p..alty of pajury orc of ln. aollos i.S dslearions <br />ocmolnio. Pdnils-Asb6los Nolification F.d6al R.sulat ioos (Tnt 40, Pd6) <br />R.rtuir.{ Ldl.r oaNotifi calion <br />-l <br />cdiry rhar lh. I.dnal rcgularioN re8ddinB Gb6los removal arc nol alplicabl. ro this pro.Jd. <br />l.dilyrhat I harc r€d rhis applicario" ad statelhar lh.alnv.,nr.nn0rion G.oEd I aateloconply <br />ed C oury to dl6 upon th.ordi.an.6 e.l srorc bws,€l6tin3 to b{r.prscnialiv6 o I lhis ciry <br />ah\r n,01(nrcd f 'ot)111y <br />Ior <br />,{pplic.ni or Agql Signrh're: <br /><f ^-/C t 0 <br />tr- z?^4 <br />I <br />Set Backs <br />UFER Ground <br />o"", /r^ ? Q- /?, <br />tl