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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 loor/VenVlnsulation I-M1,Roof Sheathing // /tEhfl l
<br />Shear Wall t)
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\,4a so n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL tNisblv'u!tc{-,
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />OWNER BUILDEII DEI,CAR TION
<br />I hereb, amm !6dr a,.n6ll, ol prju.y that I dD cxempl liln thc Conrado6' Lic.ns. rjw f.r lh. iollo$ins t@6 (sd 70ll 5
<br />Busides and Prolsion Code): Any City or Couit, which r.lunc . F.rnir to cons:1ru.1. ahd. imprev., ddolish or c?6t ey
<br />structu€, riorlo ils isue&, abo rqon6 lh. appli.d lor such psnit to filc a s(ncd sralddt $ar ht or she is licsed p$uel
<br />ro rh€ provisions olrhe Con[acrois Lic.ns.d LAv ((haprd 9, Co,mdcirr silh S6lion 7000 olDrvhioh 1 ofrh. Buin6 d
<br />PFrdsions Code) or rhat h. oi sn is.x.mpt th€.fro,n md thc bsis tor the allcxed croption AnyviololionofSeslionT0.ll5brady
<br />.pplica fo, a psmit subjds lh. appli..nl ro a ciril pmlrl of nor mor.rhan 6r€ hundrcd dollrs ($500)
<br />-1.
<br />6 o$,ns oaihc proFny. or my cmployG vilt *?s6 6 Ihcir slc codp.rsation. $ill do th. Mrk dd th. sltocrm ie .ot
<br />inrddei or of€.ed lor slc (S* 7044. Busin6s &d trof*ions Codc: Th. Conlrscloas Licds l,aw do6 nol tpplylo.nomd ol
<br />rh. Fopgly s,ho buildsor inFov6thlotr r.d \rho do6su.h$! ninE.lf or hdll or rhtuugn his or hd o\r .mplot€6.
<br />pRrvidcd ihat such iml,ov@eds d. @t intdd.d or ollEdt aor s.]. I[ how6,6. rh. boildina or imlrov@dt is eld wirhn onc t@
<br />of.ompbion. rh. ol,nd 8uitl6 sill ha\. the hdo otrrcinB th, lE or sh. dA nor hild or imprcv€ th€ Fopdy lor lh. !{l!o* ol
<br />!.6 orvn6ofth.p.opcly. mcxclusiv€lyco radi.s *1h licmcd co.rados lo comtnd lhe lojd (Sd.70'11.ItuD*
<br />ed Poison Code: The Contn.lofs Lice.sc Law doB not apllylo d o\nd olproD.ny $ho builds or imprcv6 rh.r€on.
<br />otrd who onu.ds aor such prej€crs *nh a Conlack (t lio€tudi pu6oan! to rt€ cont cror s t-ic.B La*)
<br />_l an.:mpr undd Serio tl &P( for rhis rasof,
<br />]TAI(EAII:OMTEN,IAfIA!pEc!.aaa!q!
<br />I h@by amm undd poalry of pdju.y on€ onn€ followiry daldalions
<br />-lh.vcandNillmai.rainac.ilificar.oico,N6lroSclf-lNur€torNorl.r3conrp.nsolion,6pmvid.dforbySdlionl?00oarhcL!bo. Code. ro. rnc p6fomec. oarh. wort for which rhc p6nit ie isu.d
<br />I have andNill mai ain lork.ra cohl€nsalio! iBud..c. d r.quted bySeclion lT00oflheLaborcode, for lhc tElodece of
<br />fi. sorl for \rhich rhis p6nil is su€d My wolkdt compeBalion iBormc. cmis od policy numb.r e.*t.,.-& fu)
<br />L,.t u-.t / t/
<br />I ccnilyrhar i. rh. p.rfomocc ofth.woik lor shi.h rhis peflnit ir issrcd. I shall oot sntloy an, p.uon itr any muns
<br />$ 6 ro laomc slbjel to th. srrt6' compNlio, la*s oi Califomia, tud asrd rhd ia l should bcom. subj6l lo th.
<br />work6' .onpsalio. polisioB of Srlion I700 of thc LaU,! Codc I slEll, fod[wnfi compl, vilh thos provlrions
<br />WAiNINC l,ailur€ ro sue $orkd comp.Mrion .or.m*e is unlaslul. ed shall subjdi m cnpL)s t snni.al paDhi6 and
<br />c'vil fiies up lo onc hundrcd rlFostu dolltus ($100.000 addln,n to rhc .os olcomp.6ation. danascs d providcd for lh.
<br />Sdion 1076 tlrh. r:bor cod., inrdes dd
<br />I hmby .rm unda p..alty o I p€rjury lhar I e
<br />ol rhl B6in6 dd Proisions Code sd my
<br />1q -L- s'1L J
<br />/<t-t ,/ td co
<br />I hdeby .mrm ond€r p.nahy of pajury U'ar rhac i! 6
<br />is!.n (Sd 1097. civ. C.)
<br />rh. pqrorfrm.. ol'rtu rvork lor $l,rch lhis pomir is
<br />APPLICANT NECLARA'IION
<br />I @.rmr under p.nahy otpdju.y on€ of fi. aollo$i4 d(l,ElioNl
<br />Dcholirio. Pmils-Asbdlos Nolilication Feddal Rcgulations (Tirlc 40. Pan6)
<br />Requircd L.ttd otNoli6cation
<br />I cdilyrhd rhc f.dml re8rLtio6 r.ardina 6b6los rmoval {e nol applicableb lhis prcj€ct.
<br />-l
<br />cslify rhar I have rdd thB appli.dion ed $!t. thar th.abv. infomalio. is cotr.d. I asre lo.onPly wnh allCny a.d Co@ry
<br />ordiDanc6 ud Srate IiNs rclatins r
<br />,&trt horioncd prop.ny lor b ^. ,.14*
<br />,tt/t,)
<br />At.
<br />l)al.:
<br />Lcndd\ AddrB
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