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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER Bt]ILDER DI]LC RATION <br />I hcreby amnn undd pa0hy oi pqlury that I d crrnfl lmn th. ConlEcto6 Liccnse t tr lor lh€ tullo$ in! tee. (Ss 70l l 5 <br />Busin6s dd Prolssion Codc): Any Cily oi Counly trh(h r.qur6 . pd,nr ro coNrud. ah6. impro'e. ddnolish or rcpat uy <br />(rucru€. pior ro i1s tsuancc, aLso r.quL6 thc applic..t lnr sulh p.mrir ro filc a sun..l nalmdr rhr h. or shc 6 ics.d p@dl <br />b rn pmlLioB of lh. Conlraclors l,rcnsed Law (Chapld 9. Conncncine wilh Sdion 7000 ol Drislo. I of rhc B6inN and <br />I'olsions Code) or thal hcorshc i!.r.npt rhdetro,n dld lh. b6sb fortheallcred cxcmplioo /\., liolarionofsdion?0115 byany <br />appli.a nr a p6nn subjetsrhc applicinlloacnilp.mltyofnolmocrhMliv.hu6.teddollds($500) <br />-1. <br />d oMd of $. pmFn, or my .mploy6 wilh s.-a6 s lhcir sl. ompo\.rio.. sill do lh. *or k tnd tlE slruci@. n nor <br />i dd.d or oild.d aor elc (Sc 7044, Buin* dd Prof*io6 Cod.: Th. Co.lrrclois Licds Law do6 nol apply lo ovnd of <br />the pop.ny who toilG or inFov6 $06., and who do6 su.h so,t hnnsclf or hNlror lhrcush his o. hn oM flploycB. <br />provid.d rh'l ruch inrrovdd3 m noi incnd.d u ordd lor eL. l[ howds, lh. hildrns or in rovoal t $ld within on. y@ <br />of conpl€lion. rh. Ow€r Blilda wil h.v. fic hnkn ol prolins lh, h. or stc did ml hild or imFow te FDpd, ,or lh. pulFs ol <br />l. s oMd oarh. Eol-siy. dn etcluively conaaclin,l wilh lico*d cont.dorsto codrucl lh. pdjd (sc. 70'14, BEin< <br />ad ltlf6sion Cod€:'l hc Conlraclor's Licms. Lawdo€nol applyro ovna o l a'opdy *ho 6uilds or improvcs lhcmn. <br />and sho ommcis fo. uch prcjdswnh a Codraclo(s) li.dEd puismr to rhe Conldclff's Licdse I2s) <br />I m cxmDr undcr Sdion .B & PC. forrhi! lsotr <br />D.r.r Oin.r: <br />1!ABtr&8lt-(A!!lENS4f!(]! <br />DECLARATIOiI <br />I hmby alltrm undd p.n.ltyorpdruryoncolrhe follo$inl: d.claralioB: <br />Ih.vc d *ill maimain a Calificatr ol Co6ol to S.lr l6urc Lr wolkcB' conD.niario,. 6 p,orid.d lor b, Sction 1700 of rh. <br />L2bor Codc for rhc pdfonn.ncc oflh. {ork lnr which lh. p@il n 6u.d <br />: I ha'. tud s 'll na'nra'n wurr (r conrp.Garion insur.nce. 6 rcquiEd by Ser ion I700 oafi. Libor Cod., ror rh. IE aoflrecc of <br />rh. Nork lor*hi.hrhis pmrn is issucd c.'nr€sdion icumn.. .aid ad rDlicy aumbtr dc <br />t .,, iJ <br />q <br />al cdify $ar ii th. p.rtomanc. ollhc worl lor vhi.h lhis pqf,ir is issu.d. I shallnol mplo, any p<son in any <br />'nannds 6 ro b..od. subjdt ro rh. wol{6' compcB.lion la*s of Califomiq ud age thd il I should bc.omc subjel lo lhc <br />sork6' .omrssarion pmlisions of Sdion 1700 of lhc Labor Codc, I $all aonhwith coDply s'ilh lho* po$ions <br />\IARNINC: Failurc lo Eu. wo m .onpds.rion .ovs.se is unlavtul. and shau subj(r m olloyd to siminal FEhis &d <br />ro onc hundrcd rhourdd dolls ($l0O.L$0). in .ddilion to the cd of conpesarion, ddnagcs s providcd for fic <br />::r/7ffi:-A;": <br />Dl:clr'aalto! <br />I h6cby attm und€r !e.6lr, olpdjury nd I dn lic€.so.l und6 prolision oi Chaptd 9 (connEncins wnh S€lion ?000) of Diiion l <br />ol thc Busins ud Pofsio6 Codc, dd my lic.tr. is in full forc. atd cff6l <br />qb 14 c to, c t4Q..^."^,,.*u <br />_...*.-g t*/1 <br />CONIIIBIJCIIONI.E DIIG.AGI;ICI <br />I hGby amm lndr p..ahy of !.rjry thal lho c is a coNlruclioo bnding aSncy for rh. psfomanc€ of lhc {ork for $hich lhis p<mil it <br />issued (S{ 1097. Civ C.). <br />aflllcalr.D[cLasarlox <br />I @ .flim undc. rE alty ol pdjury one oalh. aollovinB dal*ttions: <br />Oonolit ion Pcrmic-Asb.slos Norifi. ion Fcd@l R.rJ iotu (Tn1. ,10, Pan6) <br />-Rcquncd <br />ldrdoaNotifi calFn <br />l.cnilytld rhc ledera I resulal ions rclddiry 6b6ros renNlald. nor altlic.ble lo lhis prqd <br />-l <br />c€nitthat I havc rcsd lh6 ,pPlicar nrnddstiterh.r r.bovcinform.rionscoral complr \rirh allCilyand Couniy <br />ordinarc6 sd State li*s rehrinS ro bu ildinB conr ct <br />ib.\ c mmrnn.d rtroedr to, iNq, <br />^ppll.rmorAs.nrsisr.lur. ..1 <br />.e <br />.:::ii)ug- <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulatio n/E ne rgy <br />Drywall <br />Ext./lnt. Lath <br />lt4ason ry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL 7^tp.l t1 /L(.e,(.e{l ) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Brown Coat <br />LenJ 'r Add6s <br />0/n vt <br />----+--- <br />=