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BUILDING- INSPECTOR RECORD SITE.WORK DATE rD/srG.COMMENTS OWNER BUILDER DELC IATION I hdetry .itm u.de p..alry ol p<jury rhar I m dcmpr frem rhc conr,.roE' Liceffe Lar adr rh. followin8 r.en (Se 701L! r B6i"6s and ProtKiotr Cod.) Any City or Cou.ty $hi.h rcqutB a pq,nir ro soslrud, alts, i provc. donol6h nr r€rEt MJ ' sttudue pnor ro ns isudcc. also r.qun6lhc appli.dr ro' such lqnri ro nh a signa, srahdi rhar h. or sh. is licossl puutro.r lo rh. lrovistrns ollhe Contractof! Licen*d Latr (Chaptd 9. Commencins *nh Sarion 7000 or Diririon I ofrh. Busi.6s dd Pof*ions Cod.) or that h. or !h. is cr.npt iEc6om dd rhc b6sa for rh. all.t.d.r6riion Anyliolarionofsccliotr 70ll 5 b, ey. applic r aor a pmil subjds lh. applicanl ro a civil p€mlr, ol not morc rle nv. bun&.n dollEs ($50$). l, 6 o$nd oarh.l'oFny. or my.'nplolc *irh wa!6 s rhcn eb.otr1p.Bdion, Nilldo fic Nork md lhc slnlclre is ml inloded or of.r.d for el. 156.?044, Busins ed Proasioc Cod. 11c ( oniEcroi s Licse liw do6 nol apply to e o\rd or lhc poFny s'h. build! or inF6r6 UEol! ,nl *,ho d.6 su.h sork hitu.lt or hNlf or rhmu3i his ar hd o\ n cmploy!6. pro\ idcd rnat suct Lnprcverna e€ ml inlod.d or oitft! lor sal.. Ii hos6 6. lhc buildins or inp.ovml is $ld rvilhin one l@ of.ompldion, lhc (}!.c Euild€ will har $e bdd6 ofEolins thal he or she did or build or i,npmr. lhe pold) lor th. purFe ol L aosndofnr pmpd,, m cr.l8iv.l, co.ra.ring $nh li.@.d kdoa Io consrud lh€ pmjd (Sc 7044, BBrn6 and PDtcsion Code: Th€ co(radors t.icen* L.w do6 nor applylo o ovn( of prop.ny s ho builds or iiprovG rhesn. md $ho contads foi such proj..t wnh a Co.t6.1o4.) licosd ps@r & $cConlrlclois Lic.6. ri*) _l m.rempr u.do S-rion .a &Pa lorrhisrc6on !04[E8l:C0.!48[NtA1lqN IECIAEAIIO! I hRby.mnn undd p.n.lryof p6ju.yoneoft h. followinB ddlrarioB: I hav. md rvill maintain a Cdiar.or€ olconqt ro SdfiBu€ ad sorkgs conrpensalio., s p.ovidcd foi by S6ton l7(r0 orlhc tjho. Cod., lor rh. pofomdcc oafi. worl aor shich fic lonir i! isu.d lhaveandrvillmnifllain*ork.rs'.ompe'Mlioninsuran.e.sr.luir€dbrSeclionlT00ofthelnborCodc,tor$.pdfomdccol i,. \"'t lor (hi.h rhisRnn( is *.JAi. Vr sn'lsr !{nNhir.i.nin\ui'r.c!Jrierdlpjic)rJ"h!1dr\t t t- \ c.,,., (-t4-F T-.-) Y\d A-q {ze q _l.diayrhal in rhe Ffonnm..of rhc work ioi rvhich lhis pdnil is i5su.d, ! shall nor dnploya.t rmon in any mmnq s 6lo be.olnc subjd lo lh€ worlm' comp.Nition laNs of ( alifomi& dssRthal ifl nDuB b€cooc subjel rolh. work6 comFnsalion provisioB ofSalion lT00 otlhc Lrb.r Code l slell.lonhwith complyNith lhos prc!6ion. WARNING: Failur. ro sdu. workas compmerion .overaEc is mlosaxl, d shall subjd u 6nplo)s ro qimioal FElti6 ud ciril fine up ro one hondi.d rhousmd in addnion ro the cost of comp.nsation. dmscs 6 prorid.d lor rh. sdri.n 1076.f r18liln (.d. inrad I hGby ,,lim uodcr pqulry o I rErju,r rhdt t m licNl undq provtion or Chaprd 9 (.om6d.inr *irh sdiDn 70c[) oa Dn ision 1 of lh€ Busins d PDlsios Cod€, ad ny licdsc is in luu for.€ a clt{r. C-=r \)!, ,",. \\+=/\q **"yL I hmby afiinn tr dLr tdahy o I pcjry rhal th6e h a .om'rudion aqc ( n! rhc!dli,rnriN.fflhc\.'l lir \rhidr rh,s Nnrii s tsu.d (se 3097, civ. c.). Lend.f! Nde _ I crtilylld tlE lcdcal rer u lar ioB csedin8 ab€tos !.nr!al &c not ippli.able ro this proJd. oid'naN6 and Srarel.\ss rc hs.by aurh. e rqr*.laliv6 oallft ( ny dd Coun'y ro above nEnlioned tropeny for i ,\ppli.sflr or ,\gc r si8nNr A\r'*-.J^tt Set Backs Forms/Steel/Holdowns Erection Pads Subf loor/VenVl nsu lation Roof Sheathing ll 0 t)( 1 't**lYfl 'lr.' -Shear Wall Framing L nsulation/Energy D tl Ext./lnt. Lath Brown Coat Ivlasonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report FINAL I -2ou Y tuN,td Certificate of Occu pancy Notes Remarks Etc UFER Ground SLAB Floor Flood Zone Certif. ,"*JJ</te L.nJer! Add,6 _ AITIII:ANLDTC'-AEAIIO! I @ !finn u.do poahy of pcjry on. of $. followin! d*hr io.s D.holirion Pcmirs-Asb€sros Norification F.d6al Rcsulat ioos (lnG 40. Pan6) -R.qut.d l.116 of Norilicaion () t---+---