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SITE-WORK DATE ID/SIG COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall ,,s <br />Framing h"9"t7 /4.V/tLA <br />lnsulation/Ene rgy Y/i <br />Qrywall 7-zl"t.?KYBI )uti <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />FINAL Ur.tb2"J).5r]2(@ <br />qertificate of Occupanc v <br />Notes, Remarks , Etc <br />BUILDING- INSPECTOR RECORD <br />OWNER AUILDER DELCAR{TION <br />I hseby arm !.ds la.lry ol r,6jury llul I m ermpr 6on th. Co.t.doE LiccE Law forlhc lolloNirs rNn (Sc.70!( 5 <br />Btrsins ud Prolesion Code): An, Cny or Cou y which r.qun6 a padr ro conslrud, dlld, inptuve, dsnolbh or rq6n ) <br />slnrlue prior ro its isu cc. also r.qun6 lhc appli.d aor such tEnn lo frI. r siencd $ardd rhd h. or sh. n licred puNM <br />io rh. provbions ofrhc conrracrofs I-icenseJ tr* (Cn.prq 9. Commencins virh Sdio. 7000 of Division I ofr& RusnE$ &d <br />PrefNions Cod.) or lhat h. or sh. is .idnpi rhd.fron ed rh. 6ai! lor 'l[ dl.!.d .rmprion Any viobtbn of Sdion 7011 5 br'..y <br />appli.anr lor apeftir subjdslhc applica roacililpcnaltyofnolmo.erh fivc hundrcd dollss (!5(lO) <br />l. !s owno ollh. prcld1y, or my cmFlorB wnh wa!6 as rn* ele c.mtetualio., Nill do rlE $ork &d th. nndm is mr ' <br />intod.d or oflqed for sl. ( Sc 70.14. Busins md Pmlsiore ( .i.: Ti. codtadors Li..N tiw d.6 nor rpply ro .n o$nd oT <br />lhc pm!.n), who build. or imp.ov6lh@n. ud who do6 such N\trlhi,nsellor tmclfor thronsh his orhd oNa.mploy6, <br />providcd rhar strch inprol.l1ds m nor inrmLd or ofid.d for el€ !I ho*6 6, rh€ hilding or inprovflol is $ld * irhin on. \qi <br />oaconpleiion. rhr Olhd Buildd Nill hav. rhc hnd6 of Fmvirg thrl hc or sh. did nol build or inproE lh€ Fropsty aor lh. purFrc of <br />l. 6 os ns of thc Fop.ny, dn .xclNiv.ly contrrdi.S \ith lic.N.d .o.rraclo^ ro cotrntud rh. pmjd (Sd. ?014, B6ins <br />md PrDf.ssion Cod.: Tn. Contactor'! l-icos. l.aw do6 not apply ro an own6 o iDrop€.ry who builds o. imrrov.s lhs6n. <br />and rvho contmcrs aor sucfi pmj.€ls wirh a ao mdo(, li.d.d Plluua.r ro rh. Conradols Lic@ trw). <br />I m.xempl undd Sclio. <br />Dilq Orn€r: -WORKEXS C(}MPENSATION <br />!EC!A8A]rO! <br />I hr€by ailim undd p€nahy o I psjury one ol the follovinr dRl&.lioB <br />I have ed s iU oarnlain a Cd i,icdtc of Co6qr ro S.ll-Insur. for \ 0116 compssrion. a Folided for by SErnin l?00 oi lhe <br />l-ahr Cod€. for th€ pstonnanccoflh€ so for Bhict rh. tmii is isu.d <br />I harcandrvillmaintain wort6 .omp€nsalioa iBuranc€. s r.quir.d by Secliof, 1700 oithe Labor Codc. forihe pqfonnanc. ol <br />lh. * ork aor which lhis D€rmn is (q.4 My Nork6 comDdsion insurmc. cffii6 ed D.licy numb6 s.: <br />ElPtdl <br />I .dilyrh{ in rh. pdadlfun..oalhc work aor *hicfi lhis Fmil is issu.d. I shallnol mrploy aly p€.$n i! aiy man.s <br />$ 6 to hccom. s'bjd lo 1fi. 10*6 co,rpdsation la(i o I Califomia, md agE rh.l il I snook beomc subj(t to th. <br />\0*6 comFnslion provisioG ofS.dio.1700oarh. tib.r C.dc,I slhll. fonhwnh.omply wnh Ih.c prolisioB <br />WARNING: Failu( lo kue *ork6' comp.Gation co\6.sc is unlaNtul. a.d shall subj<t mploy( lo siminrl rEralri6 and <br />ciril frB op r. o.. hundr.n rhousnd doll6 (!100.0C{). in addilion Io rhe cost ofcoDrEnsrion, daruad d provid.d ror th. <br />Sdiion 1076 of <br />'hcL.borcode. <br />inrdBtdddromcy,s 16. <br />I,ICENSED CONTRACTOR <br />DECIAAAIIOI <br />I hdcby amm und( r€nahy of pcrjury that I an liens€d !f,dd pmvision olch.pls 9 (comdcirB wnh Setio. ?000) ofDivisioo l <br />of lh. Acind md Pof*ions Cod.. dd my licm. i. in full fon. an1 .fimr <br />caNualJculN-L[NDtlc-Acllcr <br />I h@by amrd und6 p€.ally oi pdury lhal th6. is a onslnrclion k dins.s6cy for lhc pdfomanc. oflh. work lor *hi.h this psnrh G <br />issu.d (S*.109r, Civ. C.) <br />lado s Mmc: <br />AITTICINLDICIAAAIIQN <br />I hqdry aflinn unds Faalty ofgrjuq oneolthc follosin8 drlddions <br />DenDliiion Pemic- Asbdlos Nol incal ion Fcddal Rcglldions (Tnt40. Par6) <br />tetrned l-elier oiNolificaltun <br />I ccn,lythar rhc fcdsal ,.sularions reg din3 osbslos rdro\ al dc not applicnhle t. rhis projd. <br />l.6rilyrhar I havercadlhisappli.arionedsrar.rh6r rh€attrve ioromehoi is corc.1 IasrenJcodply*irhallCiryandCounry <br />odinancB md sr,rc L.{s rclring ro buildins .odntudion. ald hrchy adhor;. rcF*nr{iv6 o f rhL Cny dd Cou.ly ro ore upon $e <br />rbor. frorio.8j popcny for insp.dioo pupoc. <br />.\ft)li.i r 0r rrrtrr si[nrltrrr <br />\ <br />UFER Ground <br />Ext./lnt. Lath <br />Flood Zone Certif.