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BUILDING- INSPECTOR RECORD
<br />SITE-WOHK DATE tD/stG.COMMENTS OWN["N BUILDER DELCARATI(}N
<br />I h.icby afl1rm undcr p.n,lty oi n rilry lhar I mcxcn{ romrhc CoftrdoN Liccns L3, lor rlt finhsins r.r$. (5(70115
<br />Ausinc$ art Prolcssnn Codc): Any Cny or County which rcqoncs { Fmir ro conndc'. alld. inpro!.. d.mlth or EF.n my
<br />srMtuE. I,ri, b ns nsuacc. also rcquircs th. dpplicant for slch lcmil lo filc a sisncd \l!r.mnr rh, lt or sh. ir li.cn$d pu^nmr
<br />t' thc ptuvisions of th. Contmbls Liccnsd trw (Chrlcr 9, G'rlmmi.3 wilh Scrion 7(x)0 .r Divirion ll orrh. BDsims dd
<br />Pmfcsrhns Gxle) or thrl h. or shc is cxcrrrr rtrrcfiom nd rh. b.sir ror rhc .lLg.d cxcmption. Any violllbn ofSsrion 7031.5 6y rny
<br />aptlicant for 6 Frmil subj(c ttE aptlicant lo o civil !,.mlty ol nol m)a lhu five hldred douas ($500).
<br />-1.
<br />as owrcr ollhc ImIEriy, or m, emplorcs wirh wulei as rhcir blc omFnsdridl. eill d. lh. eork dd ltE stru.lw is ml
<br />inrcndcd or oficrcn ior slc (Se.7044. Busims ond Profcsions Cdc TIE C,ntac'ols Lic.nr Lrw do.s mr ,ffly b d owmr or
<br />rhc nn,frny wh)t il& or inproEs rlx$n. turl who dcs suh mrk hiNellor hcrclf or rhmugh ht or her own.mploltcs,
<br />lroviddl rh ru.h imFoRmnl\ m mr inl.nd.d or olTcEn for $h. IL tsscEr, lhc tuildin8 or iqmwrnr t sou wtnh 6nc Fr
<br />olconqlhrbtr rhc Oetur Builld willtEw llE hed.n oftmving rh tE or shc dil ml build or Lrpmt drc pn,Fnr lor rlt pnqretrf
<br />_l,,sosmrofrhc pn,!cnt, amcxclusiv.lrcdnkr.rir! wirh lrcn{d .onr0.ton to .onsocr rlr FNrd (s.c 7olil, Bunmrs
<br />$n h,iR\ion Codc:'rhc Conkrrff\ Liccns Lau d,Es nor applyb an owncr .l proFdy *ho builds o. imrmvcs thcron,
<br />rtrd who conlrach for such Fojccrs qirh a C.nrrro(, lic.nsd Durunr lo rhc Corrracrols Lt.n* riw).
<br />I antcxemrl undcr Sern,n
<br />1:2L:14!4 "**
<br />ITECLA&IIIoN
<br />I lrEby ritn'n undcr FnrlrrolFljury oncolrlr rolbwins d*.'larari,,n\:
<br />. _r hlrc ald will roinrain c Ccn iltare dl Con*m ro S.lf l6ur. tor n-o*c6 conpcns.lt,n, rs providcd for bySccrion 1700ofrnc
<br />kbor Gnq Ior rtr pc orflmc of lh€ wod( fo! rhkh lhc pemil is isrued
<br />_l hiK Nnd *ill mima,n workc(' comp.nsalion iNur.Ec, d rcquiEd bySalion 17Ul of lhc Lakrr Code, for rhe Frf(l@t. of
<br />rhc sork lor whkh rhis pcnnir is nwcd My*Gkcrs onw.stion insuoncccarier ad fnlty nxmh.r &.
<br />_l.cnrryrhar h rhc tE rorntrmcorrh.w.r*rorvhichihis JErmi n Gslcd.l shnllnot crq,loyanyrE6.n in rn, tunn.r
<br />so r to b.mm subj..r lo ttE wdlcs comlrcnetion lars of Califomi!. Md agrcc rhar i, I sibuld lr.otu subj.d ro rlr
<br />wo crl conlEnslionlmvishnsofSedionl?00otrhcLahrrCode,I\h:ll,ronhwith.omplyqlhrhoEpmvisions
<br />WAnNING: Failu.c t' $curc w.rt.r( LrnlEosin'. svmgc is unl,wtul. ind shall subFt m qrplorr k' alninal Fallrts and
<br />civil lincs trn b on. hlndrd rnoutrd dollm ($lm.om), in addirion io rhc cos of coryrcnsliotr. drmscs as Eovidcd aor th€
<br />Sc\r,on t076olrtE tjbor C''dc, mr.rcn a ouorrcysfc...
<br />,",". ?.2u t aD noro-n,
<br />oEc!4BAIIg!
<br />I hcEby uann udcr pctuty oa perjnry rhd I d lie.s.d undo l,Dvthn oachaprd I (co,rmncing *ilh Sclion 70(x)) 6f Division l
<br />or ihc Dusinc$ atrd Profcsions Codc, {d my li€ene is in tull Io@ r'd .ffer
<br />CQNIiISI]SUONIEIDNGACEN.CI
<br />I hcr.by rfirmurtcr rEmlry oI,Erjury lhar rhcrc n a con(tucrion hndins sscmy ror rh. tdr..lM.c olrhc work for shthlht Frmil i!
<br />nsucd (Scc. :1097, Civ. C.)
<br />ATELICANTDECIJAAIg!
<br />I ho$y arirn undcr pcnlhy ot rqrlry one ofrh. folloeiis dtlrarions:
<br />Dcnmlilioh PcrnillAshcslos Notiicaliotr Fidcrrl RcBuhlnrns (Titlc 40. Pan6)
<br />Rcquird ldt.r ol Ndificrtion
<br />l.cnifyrhd rhc fcltuBl rcgulaliotrr 68$dirS rsbcslos rcnrva, arc nor arlltrblc b rhh P8*rr
<br />_l.cnittrhar I hrwrcdrhh ippli. mtrand{alcrh lhc ltorr informlion h mnecl I aE e io cDftOIy wnh all Ciry and C.unr,
<br />odln,kcs ond Statc tiss rchtins ro buildins construcrion. id h.rcby aurh.riz r.prcsbrariks ofthnCiiy.nd Colntylo ols uron rlE
<br />lboR nE iomd pmFny ror insFlA
<br />Apt i.xnr or A[cnl Sisnnluru
<br />e$u- $eie-7-22402D
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />I I I
<br />FINAL 9lbe.lk 1 DFq'2 ,,7
<br />Certilicate ol Occupancy I
<br />Notes, Remarks, Etc
<br />Rev.0B 07 2015
<br />Subf loor/VenVlnsulation
<br />Ext./lnt. Lath
<br />Flood Zone Certif .
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