Laserfiche WebLink
BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AU!LDI'R DDLCARATION <br />I hcEby atlinn unds naahy ol rojury rhar I ar er.mq noft tbe ConliacloB Licds€ lrw lor lh€ follo{ing r.M. (Sd 701 I 5 <br />B!.incss dd Proasion Cod.): Any Cit, or County rhich reqund a Fnil lo oEltud. ahs. improve d<nolish or Epan .ny <br />slncrurc. paor to irs i$um€c, .lso rcqui6 lhc apph.anr ior su.h Fmil lo nl. a siened stardncol lhal h. or sh. is licdcd psua{ <br />ro rhc ltrolisio* ofth. Conlmcrors Lic.nrd t w (Chsplq 9, Coho.nc'ns *i'h Sdrion ?Lroo oaDivision I ofth.lrusi,s ad <br />Pmfsions Codc) or rhal h€ or shc n cxflpr llE€Eofi ed fic basis aor rhe all.aed croplion Any violdio. of Selioi 7O:r I 5 by a.i <br />applicat for a p6iit sub.jcls lh. applicdl ro a.iviltcmhyoinot morcrhe fiv. hundr.d dollds ($500) <br />L 6 owns ollhc Fopqly. or my€mployG wnh was66lhc( $1. co'Dt nsation. silldo th€wort d th. slruclrc is nol <br />inhd€d orornen for s.l. (sd 70d4. B6in63 d Pmf6ions Code Th.Connaclol s LiccBc tlw do6nor tpplyb MoMdof <br />rhc poFry wth trild! or inprold rh6a dd wh. do6 tuch mrl( himslf or hcelao. rhrolsh hk or hd oM.nPlor.6, <br />prcvd.d $ar such inp.ovadB m rol inlsd€d orofig.d trek.lf, t$w.c, fi. hildtr'8 or inpmvml is $ld wilhio onc ra <br />ofcompldion. th. Osnd Buildq will h.v. tlE hdo of Flvi.g ih& h. or sh. did ml hrild or inprcv. $. prDpoly ao. ln. p,?o* oa <br />--1, aroM*ofrh. prcpdy, andclusivclycontrdinB silh lic€Nd conlracloslo co6rrud lh. proj.!1ise. 7044. BBind <br />ed h!fts$ Codcr Tht Confacloa3 Lic.Bc tn* do6 not applyro M o$ns ofplopsly who builds or ifpiov6lhd@., <br />lid (ho .o.lads for sxch Frj..ls * n 0 Co! Eclods) licffid p6@l ro rh. Conlr.cbls Li.m Llw) <br />I d€rcinpr undd Sdion- ..t &PC.rorrhbr6on <br />tloB(E8S:cAtUlNtArIO! <br />DACI.4EAIION <br />I h6.by rm.m und.r Fnahy of pajury on. oflh. iollowiis d*l dioa: <br />I tule ad will msinlain o Cdilical. of(ongr ro S.lf"lnsur. aor worlcs compaEa( ion, 6 prcvided for by Sxlion l?00 ollhc <br />Lrbor Cod., tor rhe Ffof,naf,.c oflhc wolk tor wlicn rh€ pdnil it suol <br />( hn'. and *illmoinrai. *o.kqs cohp.nsarion insnanc.. s rcqut d bySclion 17OO oflhc L,bor Codc, for thc pafotrdc. of <br />comp.nsatiotr insuRncc cafi€r &d Dolicy nlnbd @: <br />P"."' t"-1,, 7 { U}t e4 4/ B 6 z 2,4/2" <br />I cdlifylhar hrhcp.rfolmanc.ollh.$ork tor rfiicfi rhis pcmn B usucd,l shallno( mploy any pdsn in anyrmn6 <br />so 6 ro b€mmc sbj6l ro lhc uo*d' coftpoelio, h*s of Califomia. md ogE lh.l if I should b.com. subj(r ro rh. <br />\ork4'comp@rioopovisioNofscdionlT00olU.ldo.Cod€.lskll.fonhq,lll]omply\ilhlhoepovirions <br />) <br />WARIINGT ljaluc ro su. sor*6 conpssation covqasc is unlawlul, ed sh.ll3ubjd e dnployE to qiminal pdRlii6 d <br />c'vil li.csuproon hundred thoced doll6 (1100.C00), in addilio. ro lhc cost of compcNorion. danag.s 6 provid.d torlh. <br />I hdcby afiinn unds pmahy or p.rjury lld I u.ds !,mlision of ChaBd 9 (co,nmoci.s virh Scdio. 7000) ol Dili.ioh l <br />ol ihe tsusin6s 0nd Pof*sions Code. d my licmE is 6 tull Lr.. dd .f..t <br />7 <br />I hcrcby afliiin utrds I'xnahlol !rruryrhil rhdc kndins ascncy for the ,sfomdcc olrh. worl for shich this Fnnil i! <br />issu.d(s(. 3097, civ. c.). <br />AITLICANIPEQAEAIIOIi <br />I hdrl'y amm u.dd poahy olpojury onc oithe rollovins ddd.rio.s <br />Dcmolnion Pmia-Asbcbs Norifi carion r€dsal Rerulanons (Till. 40, Pan6) <br />_-. Rcquied tdr6 ofNodfiolion <br />I crril1 th.r thc a€doal r€sularioN Esediog abdos rmovrl m no{ dgplic.blc Io lhis pbj6t. <br />II .cti& $al I h.!. @d tnis .pplicalion &d slarc lh.l lhc .bovc inrortr.lion 6 .oE..i. I aSre lo orpry w h arl clly tud counly <br />odi@n 6 ed Stai. t ws El,liig ro buildinS condruclio( ed hdctly au!!o.iz. rcpr6a1aric oflnis Cny dd Cou.ty lo dl6 upon d!. <br />itm\c mcnlion.d pnrpcny for i.spd1@n <br />Applicrnt or AEctrl SiBndlure <br />' zZ/e./rh- L-,.)LI <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathinq <br />Framinq <br />Insulation/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 />Enqineer Final Report <br />Flood Zone Certif. <br />FINAL Azsl-u I}rM la '*ve| <br />Certificate of Occupancy t\ <br />Notes, Remarks, Etc. <br />Shear Wall <br />ssrio. 3076 olrhc L.bor Cod., inlsGl ed alton y s tB <br />=::::> <br />""", 9/sb <br />l<) <br />t'".,2/s/z^