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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG COMMENTS OWN ER BT]I LI'ER D ELCARATION <br />I hdcby amrnr unds pdalrv of pdjurr rhor I m ercmpl lio'h th. Co.tmclo6' Lic..se L^v for rh€ followin! r€ed (S( 70115 <br />Susin6s and ltoa6siod code): Any Cily or Courry *hi.h r.qtrt6 I Psnil lo consfld. ah6. impBlc, dnolish or rclEt , <br />$rucrurc. rior l. irs isumcc. slso r.quir6 lhc apdi.anl lor srch lEmil ro 6L a 3i8ncd slatd.ol lhal h. ar 3h. b licfrscd p6@r <br />ro rh€ plolisioN ofrhc Co.rracloir Lic.nscd Law (Chaplo 9. codnencins \rilh Selion ?000 ol Division I ofth. Iru(inds,ad <br />Pruf6sions Codc) or rhd nc or she is €xemp lnd€Eon .nd rhe b6is lor the allcsed €xdnprion. Anv riolarion of sdtun ?011.5 bv.nv <br />applicanr nr ar6nn subjac lh. appli.a lo a.irilpcnaltyolnor nDrcrhd file hundrcd dollrs ($500) <br />l. as oM€. oithc prcpcdt. o ny cmPloles wilh {asd &i rh.t ele conpqs.lion, $i11do thc sork dd lhc strudu. h nor <br />inr6.H 6r olld.d aor el. (Se 7014. Bulih* @d Proa6sions Cod. Thc conracror's Licos€ lrs dos nor applv to u ortc oa <br />lh€ ropdy wfio boilds or inrrele ih66( and who do6 ech $(rt hims.lf ar hd$ll or litolgh his oi hd om mpkrrt6. <br />provided rhat slch imrovd rs m mr iDrodcd o. offod ro. sl. lf, howd6. th. buildin3 or i,nprolorcnl b eld $ithitr onc va <br />;i.onpklioi. E Otrna ltuilds vit h,v. rhe bor&n of pnins rhd hc or sh. did ml build or imFov. 6c prtrpslv fo. th. ptrPos of <br />L s o$tra ofthc pmftny. m.r.lusivclyconlracrinr rvnh li..nsdl co.radou lo .onstud rh. pNi(l {Sc 7Or4. Bcins <br />ed PFtusio. Codc: Th. Conlacloas Licm. Law doe nor applylo e osnd oiproP€nv who builds or imptov6lhcren, <br />and who conkcrs for such projd{swilha Cod@lo(s) lic€sed pusudt lo the Cont,.toas Li..N t5w) <br />I tun e\c,npl under sedio.-. a & P c irtr rhis t6on <br />woRxERs' colrlPENs^l loN <br />!ECLA.8A!]O! <br />I h6eby amrfl unds pdalry of tgjury oncolthe fdto{ids d(lmlio6: <br />-l <br />h.ve md will Daiorain ! ccniarc.re of CoNdl lo Srlr-lBuic fo! Notktrt conlP.nsrion. s p,orid.d ror bv sdtio" :1700 orrh. <br />Lahor Code lor lhc pqfoodci oafi. tolt fo! $hich lhc p@n is isu€d <br />I hsv. and will o.inrlin work€rt compc.etion iButancc. s relut d by sdr ioo 1700 oflhc r.bor Cod. foi lhc Flofr@c. oa <br />lhc sork for Nhrh this pnnil is Gucd M, wotkdr co,trpdelion insurdcc 6ir rd policv nuftbd 4c: <br />- 6tc,t P, . ot-.r r-r.,-" lr ^.ce €"*j <br />-t <br />cdiay $ar in rh€ Flomd..of rh. sotk for $'hich rhis psnn ir i.sucd. I shlll.or mplov onv p.Nn in dv mmn6 <br />$ 6ro b6om. subjel ro lh.$orks codp€tu ion,a{s oacalifomia. dd astcrlEl ifl should b.(oncaubjd to thc <br />rvolkgJ smF@rionPrcvisios olSdio.3700 ollh. hbor Code I shdl, fonhwith€o$Plvvilh rho* povitions <br />WARNINCT t;ailurc lo suc qork6 <br />.nil fin6 up l0 onc hundr.d thousad <br />Sdion 1076olrh. bbor (bdc. inls51 <br />comp.Nrion covds. ! otrlarvtul, ed shall subjsl m <br />dous ($100,000). in .ddnio. to rh. .ost of <br />v <br />l).I:!I_!]].\!I]] <br />I hercby aflinn unds poally o t p€rjury lhal I on licms.d unda lnolision oachaprs 9 (comnE.cing $nh S€ction ?000) 'rl]iYhion I <br />ol rhe Busins and P@f$sions Cod..4d,ny licds. c in full torce ar! ciltl <br />g <br />,,,",. t(f z7 /lg ,",,,r".,"r X <br />I l,@by arm u.d.r penalry ot p..ju.y rt a I'ic is e -m-ii; bidins tsoc, ror th. psfo,1,6c. or rh. wlr for *,ich this p€nnn is <br />issu.d (S{. 1097. Ci!. C ) <br />L.nds': )Jd. <br />- <br />L.ndd t Add< <br />- <br />APPI ICAIITI)F(]I ARATION <br />I ho$ aLrn r.ds penahy of pdjury o,c ol th. follouifl-! dcl&lioB: <br />D.molirion Pmils-Asbdos Notificalion Fedaal R.gulario6 (1 illc.l0. Pan6) <br />-R.quir€d <br />Lirrd of Ndi6elion <br />I h,vc iead Ihis applicorion &d srat.rh8I <br />'h€ <br />aborc iniotuar ion is cotrdt. I asre to comply vith aU Cirr ed Coo y <br />rt rcpr6draxv6 ofthis Cnysd Counryro dlr upoa thcrarcljvsreLlins to buildins coNttudion. md <br />lpDlicn l or ,\gcnl Signslurcx l*e+ <br />*",'\llz7lt8 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputv Final Report <br />Engineer Final Report <br />t,-\ <br />FINAL lvt bt//tr 4W?l I <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />) <br />Flood Zone Certif. <br />I cdilyrlEt rlrc ledral reuul,rioB tcsedin8 Bb€sros ronoval arc not applicable lo lhis prui(t <br />TT