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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DIiLCA'I TION <br />I hd.l, 0mrm und.r lEnahy ot p.rjury rhd I m ci€,npt 6orn thc conrador l-ic.nsc ljs for thc aollo*i.8 rru! (S.c 70:l l 5 <br />Businss and ProfsFn Codc): Any Ciry or Counly Nhich r.quns a p.nnil lo constoct. ahd. nnprovq ddnolbh 'r EIqn ) <br />srrudure rior lo ils issrecc, slso rcqur6 rh€ appli.d for such pfltrir Io ail. a si*ned statmot Ill.l hc or sh. is licmsql Ddtrmr <br />ro lhe pmvisions ot rhe Conracbrs t-icenscd LiLv (Chapld 9. Coiun.ncins silh Sdrion 7000 of Dilision I oflh. Rusinds d <br />hol€sio.s C.dc) or rhar h€ or sh. ii €x@fl rh@6oh md rh. bsis lo! lhe alLs.d cxmprion. Any violarion ol S..lion 701 I 5 b, a.v <br />applic.fl aor ! pennil subjdsrhe apPlicmrroacivilpenaltyolnolnDr.lhmfiv.hu!&.ddollds($s00) <br />l. s o* os of rh. ptolErly. ot my cmph)B wnh sag6 s rh.i. $lc codp.nsalion. * ill & lhe \otk dd fi. s1ruc1u. is nor <br />inrdddl or oltced for elc lS€.?04,1, BNi.6 ed ProfsioN Code Th. Conlrack, s Lictu. Law do6 nol arplv ro d osn.r ol <br />rlE pmpqly *ho builds or impmvcrhG€G dd vho do6 $ch \6rI himscllot h@lf or dtough his o, ho os..mplor€6. <br />provid.d rhar such improrerc.ls5. mt idoltdtotofi*cd lor elc.l( fiosBq. rh. hildinr or imprerocm b $ld ehh on.'@ <br />orconplaioq the ow.d auildq will harc rhc hrdd orFovinr rhd h. or sh€ did ml b{ild or iryrov. lnc poFry ror the pulp.e ol <br />-1. <br />6 oM( 6arhe t"op61y. o e(l6iv.ly coniracling wilh lic€ns.d co ntra.ro 6 lo coBtrud ih. pojed (S{. 70'1'1. I}usi'Rs <br />Md ftoftsion Cod€:'rh. ( onrra.lois Lic€nsc l,aw do6 nor applyro 6 o\ens olpropdy who builds ot ioprov6 ihden, <br />and who.oniEclsfo.su.hFojds*irh,Contacro(s)licNdpuctrmrroth€ConiEcrofsLic6.tjw) <br />,,r", I \\L$lra* <br />DI]('LARA'I'ION <br />I hseb'am'runderp. ah,olpdjrr,on.orrhcnnlo*insd&lmrnrns: <br />I have ad will sai.rai, r c.nificat. ol CoMnr lo Self-lGur. for Nork.B .6nrPdretion. 6 Forided aor 6v Sction 3700 of rh. <br />lnbor cod.. lor lhc p6fomdc. o f lh. wort for vhich lhc pddi a i!su.n. <br />I hav. an,j will mainr.in work.r, .odFretlio. iBurecc s rcquned hy Sdr ion 1100 oflhe Libor cod., for lhc pdfomoc. oa <br />rn€ sorl lor which rhi, ptrnil is isu€d. My workss comp.cation i6utd.. cnid ard policv .uobd @l <br />Policy Numbd:-ExPts <br />-l <br />c.nify rhar in rh€ pntoroance oa$c worl lor which lhis Fnil is 6sued. I shall not €'nploy a., pc.son in anv mddd <br />e 6 ro beonE subJ<r ro rlt wort6' compqsarion lass or Califomia. ed agc lhar if I should bccomc subj*l ro lhe <br />sol{m compmerion poeisioB of Scclion lT0O ofth. Labor (.ode l stsll. ronhwnh conPlv wilh lhos proisio6 <br />*ARNINC lraillrc to *.u. mrkd conpmatio. cordagc ir unla\ful. d sfisll .n dnployq ro Lnrinal Pmlti6 ed <br />civil lin6 up lo onc hun&.d rhouend doll6 {ll dma8es as providcd for rhc <br />sfrir 1r)16 0lrlrc lrhtr 'od., ireren md t ney's <br />,b )4 <br />vhiotr.f(hapre 9(corn'ncD.ii3\ilhSrcri(,n7000)oil)i\s$nI h.dby afl-'nn unds p.n.lty olpdjrit $al I &n licosd undcr <br />ol rhe Rusind md Profsi.ns Code. and frr llccns G i. irlllolce ddcr&. <br />Lic@c Clss:-LicG. Nombn <br />CONSTRU(-TION I TNDING AGANCY <br />I h.rcby amm unds FElry o fFjuty thal lhsc is 3 coNlru.lion Lnding asocy to. rhe psfomanc€ ollhc Mrt tor whkh lhi. Fmn b <br />isucd (sd :1097. civ c.) <br />L.ndd ! Nrd( <br />- <br />I {J.r r <br />^,jJi<\ <br />- <br />ATfj,TCANL'TECLAEAIIIJ! <br />I h@6r'afEn und6 p€naXy of prjury ore ol lh€ follo{ i.s dsl&,tionsl <br />D.molirion Pmirs-Asb€los Nolificdion Feddnl Regulalions {'lnL 40. Pd16) <br />_Rotur.rt lrG ol Notificalion <br />I cd ify rnal rh. lcdqal r.sularioN r.Bsdins 6besl{s dnDral r. nor applicabl. ro rhis prorcd <br />rhd I h,!. @d rhis a$lic.lion nl st.r. thal rhc obov€ ioaomariof, is corcd. I alre ro complv*nhallCnvand Counl) <br />ordinalc6 dd srarc Laws rclatinr kr buildine .oNtrudion.rcpr6otaliv6 oflhis Cilyand Cou.tr ro dts upon lh€ <br />"to\c Dqlion.d prcpedy lor <br />Appli. t0rAs.trl shnalu <br />r-4rE# <br />,.,"'ttf,lf *g <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />ln s u lation/Energy <br />Drywall \\(,\(1 <br />Ext./lnt. Lath <br />Brown Coat <br />lr4aso n ry <br />Pool Fence <br />T-Bar <br />Handicap Req.\\o\(9 <br />^^n40qDeputv Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL ,14\\,,,,Utl1,il <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />--- T