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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DEL('A&A'IION <br />I hseb) amnn u dd pdalry of lsjnry thot I m ercmpl fmrD Ihe Conthclom Licens La$ aor l h. followins r.M" (S( 701 1 .5 <br />Busin6s and Proaeion Code): Any City or County which r.qun6 a ldnir ro constoct. alts, improvc &nolish or rcpair uy <br />n duc, Drior ro irs i$u cc. also ,.quiB rhc al)plicml for 3u.h Ennn ro filc a sis!.d srar@d rhar h. or st€ b licc6.d p6uad <br />ro lhe proviiioG ofrhe Controclois Lrccnsed L.s lchaplq 9. ConndcinE with Sdion 7000 or Division I ofth. Busins ud <br />PoLssions code) orlhat he or shc b cxerpl lhd.6od ed lhc bdii aor ttu all.Eed cxmplion Anyviolarionofsslion 70115 b, any <br />applicdl lor a Fmil subj*ls th€ applicdl ro a civil pcnahy o f nol mo.€ lhe fivc hu.dr.d dol16 ($500) <br />-I, <br />a oM6 of lh. FoFny, or my dnplolc wnh was6 s lhcir el. comPoslion. will do lh. $o < &d rh. nf,rle b rcl <br />i.rmdcd or oftered f.! sl. {Sc.7044. B$ins dd PmfNioB Code The Cont&rors Licn* bw do4 nol ap?ly lo e o$s of <br />th.ptupnty who t{ild! or improvBlh@n. d who doe s.h sorl hinsllor h6clao. rtrcush hi.6r hd o{tronploy6, <br />,nvid.d rhdl such i6For€mB e nor inlad€d or ofi6.d for ek. lf, hoBd, $. h]ilding or imFoKIc ts et wnhin onc )@ <br />ofcomplction. th. olms Duilds wjtl ha( thc hid6 of Forii{ lh, h. or slE did rct build or imrtov. ihc pDFry tur lh. F4oc of <br />-1. <br />*.Mdolrh< lropdrr, d.xclusiv.ly cod,.clins silfi lico$.d conra.r.u lo coNlrucl lh. p.oj..l(sc 7044 B6ins <br />.nd ftoGsion Code: Ticconkrcrols Lic@. b{ do6 not spplylo soun6 orprcpdy $ho builds or inprord lhd@( <br />rnd rho coffis aor such pmjcls with a Cootrdclo(, licotsd pmudr b thc Contscrors l-ic@ llw). <br />-l <br />dn .remg und6 S(tion-. B. & P C lot rhis rson <br />ruga[EstgrutliNsa]laNlECldIdUA! <br />I hseby aflrm urder pdalryoapdjur) oncoalh.follo\ein-q d(lralio6: <br />I iave ed will nainrain a Cdific.r. of ( o6dl lo Self-lNorc lo, rvorkot .onrp.m.lion, 6 P, ovidcn lor by S{tion 1700 of thc <br />Labor Codq aorthcp6fom c€otlhcwork lor which lh. pdnil is isu.d <br />lhav.aftlwilloa,nlainwod.rscomp.Nationinsu.ancc.s.equtdhysdioolT00ollheLsborCodc.foirhcpdionmnccol <br />lhc Nork aor {hich rhis r$nir mmpwnon i.lutrc.cnid md p.licy numbr dc <br />f..at + \ <br />/qaaoao70/Kl <br />I.di!thal in the pcrlornucc orlhr *orl rorwhi.h rhisp.ntrn is issuen. lshallnol onploytnypmn inanynons <br />$ 6 ro b.come subjer lo rhe$ork6 compsalion laws ofcalifomia. dd igr.. thol if| should b€cod. srhj.d ronE <br />so.l6.onp@dio.polisionsofScclionlT00ollh€L{borCodc,Islull.ionh\ithcomply*ithlhoselrolisioN <br />NARNINC ljailure lo su. *.rks conpmrioo .ordas€ is unla$nn. dd shrll sobjd m 6plo)q ro dininal p.Mhi6 md <br />.ivil fins up 10 one hu.di.d rhousd dollc {1100.000), in addilion r.lhc cos ol conrpcnsalion. dmascs a provid.d lor rlE <br />DICIAAAIION <br />I h€reby o,lirn uoder pf,alry o atdjury that I an liccn*d undL{ provision olc'h.pr6 9 (comnacins s'iln sdiio.7000) olDivtion ll <br />of ln€ Busins d I'rorsio6 Cod.. ad,ny lictre is in loll lorcc d c,I(r <br />7=avoF <br />^' t/za/ta +e <br />cQNraucuqxrllD.Ec-6c!!(I <br />I h6by afnnn undd p..ah, ol pclury rhal lh6c Ls a coNlrucrbn knding t8mcy fo! thc l)6lomdo. ol rhc wort tor *hich this pann is <br />issu€d 156 1047, Civ. C ) <br />A!&TCANLDICI.ASAIIO! <br />I lEd,y,innn unds tmalty olFrjury onc oflhc followins.t rldarions: <br />Ocmoh'on P.dirs Asbcros Nolilicalion Fed€ral Rqulalions (Inb 40. Pan6) <br />-R<Iuftd <br />Lrtldof Noificdion <br />-l <br />ccnily rhal lh€ Lllfal r€gtrlrtioN r.g6ditr8 6b6tos reno\ al ar€ nor ap,li.able lo lhis prcjst <br />-l <br />cdriiy rh6r I h!!.,cad this applicolion dslaterhallh.ahvci.iomhioniscor€cl.IasrElocomrlyqnha[CityardCounly <br />ordioanc6 &d srarc t ws rc,.rins to blildins coErruciiofl dd hdcb,.orhorizc repr64lativ6 oflhi. Cnynd Colnly to o16 upon Lhc <br />ahve in€nrrcned proped, ror idspccliur <br />Applicmr or aaenr Si8n.r (() <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Subf loor/VenUlnsulation <br />Roof Sheathing <br />Shear Wall <br />Fram inq altt//6 ?lN 4,m".Od,, <br />lnsulation/Enerqy <br />Drywall {'U11/lt :il*( <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar /?-/iq ;h*x <br />Handicap Req.\r\\(\do\rr r.J.[\N\ <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />FINAL p$.\(r) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />SLAB Floor <br />.\no\\. <br />l <br />-^rr2< <br />Lmd.ls Add6 <br />-4 <br />I