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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNOX BUII,DER DELCARATION <br />I her€by amnn u.dd p.nahy ol pgiury rhat I d dc'npl Fon thc (onrraclon L,cens. l3w for lhc lollosinS tcMn (SN 70315 <br />BNin6s aaj Prorsion cod.l Any Cily or Cotrnty whicn r.qut6 a rEEir lo .odtud. ahs. impiove do&lish or dral an, <br />slrucrur, pflorro ns isuanc., fllso Gquir6 lhc alplicul ro, such !.nnn ro nb a sisn.d statflst lhal h. or 3h. is licds.d Pursuad <br />b rh. E.lisnrE oa$. conlra.loas Lcnscd Lare (Chaplq 9. Con'n.ncins wnh Sdion 7000 oi DivisFn :l or the Busi..s md <br />PofNions Cod€) o! thal hc orshe is exflpl lhselioE dd lic bas6 for th. all.Sed cxcmplion Any violalio. ol sdion 70ll 5 by flny <br />alplicantlorap.mnsubjerslhc.pplicdlroacirilt.n.hyoanolmor.rhanfivehuodr..ldollds($500). <br />l. s ownE olthc pmp€.Iy, or ny €nploy6 Nilh s a!6 6 rhcir slc compcsario., N_ill do lhe wor! &d rhc iflciu! is nol <br />inroded .. ofidcd lor Flc (56.?04-4. Buins dd PrufBioB Code 'l he Contdois l-ics. L,w do6 not apply lo e oMd .f <br />rhc ptupdry {ho builds or inp'o\6 ilHon. di who do6 such rvori hnnscla or hds.li or lhmush his or ht om.nploye6. <br />providcd thar su.h i,nprolands d. nor inrmddl or ollscd foi ek. ll hov66. lh€ buildins or u.ptu\.mar B eld wnhin on. )@ <br />oaco,npkion, th. Owns AUki6 will havc thc htrdd ol pruvins rbt h. or sh. db not build ot nnFoi! lh. PolHy aor $. p(!F* ot <br />-I, <br />s oNnd ofrhe rmp6ty. m erclusiv.ly conlradins \vilh licdsd conlrackr6 to c.nnrud rhc p.oi.rl(56 70'14, Busins <br />and ltoision Cod€: 'rhc conlradois Lic.nsc Las do6 nor applyto o*r( ofrop.ny $ho builds or nrpovcs lh{en. <br />and Nho conrmcB for su.h prcjedsrvilh a Cona!c1o(s) licaBi puBU i ro rh. Cont,clor's Lico* IzN) <br />_l rn cx.nrfl u.d.r setio B & P C.lorllri r6on <br />TOAKD&IIAMIIMAIIqN <br />DDCITA8AIION <br />I neb, silm undd pqElry of pojury o.c of rhc fo llo{inr ddl,r,tioN: <br />-I <br />h.( &d vill mi ri. a C.rlificale of Coreol lo S.lf-16u. hr wotteG conrF.elion, 6 Itrovid.d for b, Sdion 3700 oflh. <br />Labor Cod€. for lh. dforocc ol rh. Mrt for which thc pmil b issucd <br />-l <br />hlve a.d wiu nainraid work€6 corp.Nalion isurac.. 6 r.quircd by selion 1700 oalh€ Labor Codc. fo. lh. psfomm. of <br />rhc \mk ftr*h'chdis pLnnn .B' omp€nd'o, 'nsdtu(.csid Md poli.ynurnb.rde/b^ fut\ <br />oo I q <br />-l <br />c.niry rhar in fi. lqfomoc. oalhc wort for which lhis Fflnil $ i,ssu.rl. t shall not mploy any p6on in d, BMd <br />$ s td b.oin subjdl ro th€ mlt6 conpqsalio. la$s ol Califomia. md asr thal if I should b..od. s"bj6t to ih€ <br />workd comr.Mlion Dmvisiore ofSelion lT00oarh. tibnr Cod..l shall. fonhwilh cotoply wilh lho* provisions <br />*AR'llNG: Failue ro wuc so 6' ompsEaliotr cov@sc i. unldwrul d shall subjNt @p,oF lo dnni.tl poahi.s and <br />.nil finLs up lo o.c hrndrcd rhousand dollars ($l <br />l'nE Lhrr(idr i.(66r an,t <br />It ab l( <br />I hs.by artrn u.d€r pcnahyofpdjuryOar I m li.dE d uodd pro! ision olchapl6I <br />.l ihc ausinas ald PmlNbB Codc. dd mylicose is in tull rorc. d clI-l <br />wnh S..lion 70001 olDivilion.l <br />30728qIf4<- <br />co.Nira!(u0l{IlNllllclcElcr <br />I hGby alltrr undd poralry of pdjury lhar lhd. i. a codtudion lGldinB asocy tor rh. pdfonMc. .atlE vort for Nhich rhB ldbii is <br />issucd (S.c 1097, Civ c.). <br />affuc NLD[cirISaua! <br />I hcEty rflim utrdq D€.alry of D€rjury o.e .a rhe lollo{ inr ddldarions <br />Demolirbn PsmiteAsb6tos Norifi calion Fcdqal R€sularions (l irlc 40, Pan6) <br />R.qun.d Ldr$ olNolifi carion <br />-l <br />cen ily rhal the Lnsd rcsularions c*edi.8 sbGlos rdnoval aE nol aDplicabl. o rnis psjd <br />-l <br />c6l iry rhar I havc rdd lhir lpplicarion rnd star€ thot lhc .bovc inlomalion $ .odd I aEe lo comply rvnh all Cny dd Couly <br />ordinanc€s and Srar.lrws relalins ro building conindion. d hdcby aulhorizc ..rr*dati!s of this Cit, d Counry to drd uB)n lhc <br />alr\c nrdrlionedr,roreny fo! <br />Applicanl or ,\gctrl Sigmlu It <br />P.",tt*"" "tt t"\.1 iaeU <br />q-zro/q <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing tLfr.t/lx 5\5116 <br />lnsulation/Enerqy <br />Drywall lb i/1,/t)t si\ xx <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar l/*//7 <Ls?# <br />Handicap Req )-\r\r\ <br />^.^-lrr11.Deputy Final Report <br />Engineer Final Report <br />FINAL ,2\-r\q /'-\I.hic) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Flood Zone Certif. <br />tr",", lI