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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER BTIILDER I'EI,('ARATION
<br />I hseby afllm udr p.nahy of Fjo.y lhal I m cxmpt &on rhc conlncroE Liccns. Law ror rh. rolbwi,iS !tuo (5(,7011.1
<br />Busin6s od Profsion Cod.): Any Cily oi Couly whi.h r.quns a Fmil lo co(qtud, alrd, inprove. ddolish or E!tu dv
<br />stu.ruc, rsr ro irs isuancc. als requii6lh. arpli.a.t aor such pdflil to fil€ a uu..d st.rancnl thal h€ or shc i5 licmkd pr ant
<br />Io rhe previsions olrhe Conlr.crois !-(enscd Lav (Chaprs 9. Co,hnmcins wilh S6lion 7000 of Divirio.I ollhe BusinBi dld
<br />Plof€sioi. Code) or lhd lE or she is c\enpl rho.fron trd rh. hiBis for th. allcsqt qmlrio. Aryviohtunofscdion7011tbvenv
<br />applicn lor a ptrnn subjds rhe appli.anr ro acivilpaahyolaol mo.€ rhd nvehrndtcddollds($5OO)
<br />I, 6 owna of rhc !,oFly. or my enploy6 wirh wa8s 4 rlrcir snc conrp€,satio.. ( ill do the vort dd lhc sltudu€ iq nor
<br />inrodai or on-.d ror el. ise.7u.l. ausif,Bs ud ProfsioE Codc 'I hc Conrtoclois Licctrs. l!* d.6 no! alplv to an ownr of
<br />nE poldy qho buil&or imFor6 rh6{n. dd sho do6 such M hims.lfor hd.lfor rhrooSh his or hs o*n.nplor.6.
<br />prolidcd ihar such imr.ovonds e nor inrdd€d or ofidcd lor sL l L hoN6 o. fi. hoildi,s or i,nprov{El 6 sold within onc }w
<br />.r.onDld6., th. Owna B!ib6 Mll ha!. lh. hrdd ol pbvins rhd h. ot sn. did mt hild or imroL $. propoly for thc purlb* of
<br />-l-
<br />6 oM6 olthe propdy. o .rclusircly conldclins wnh licds.d conlraclos lo @Blrucl rh. prrjst (S4 704',. BEK
<br />md t:lltsion Codc: Thc conr..toa s Li..m. Lrw do6 nor aDply lo d o*nd oaprcp.ny qho buil& or imProvB Ihdon.
<br />md who conlrads for such ploj.cls wilh a Conuado(t licd*d pu6mt to lhc co.lr.crois Lic.dc Lav).
<br />lrn c\ctr,ln un d S..rilr
<br />WOR' TRS'COMPENSATION
<br />DECIAXAIIOA
<br />I h6.by artrn undd Fmlly oi p{jury orc ofth. following d.clmlions:
<br />-I
<br />have ,nd will minlain a aolificar. ol CoBdl ro S.lf-lB'ft lor wotkeB coNpeMalion, 6 providcd for b, Sdion 1700 of$c
<br />Labor Codc, lor thc l!6iommc. of th. uort tor "tich lh. p@til b isocd
<br />I have and will mainl.in worl.rl co,npmarion iNur.nc.. s rcqutcd by sdtion I700 oi lhe ktn,r ('.dc. ior the psfommc. of
<br />thc worl for Nhich ihis p.mi is isu.d My qorkrs comp€.elion i6u' 3n.. .di6 ud policy nudbd d.
<br />PolicyNu,nbd: Erpircs
<br />I ccnilyrhal in lhc pdfommc. ofih. $ ork lor which llis pcmil is nsued.l shlllnol onployanvpmn in a.v nMno
<br />so 6 to b..om. sobid lo lh. w*6' co6pasatio. l.ws olcalifomia. dd dra. Onl if I should btcodc subj(l lo n'.
<br />wo!k6' @mp.Ntion prcviiioB o I secrion 17oo oarn€ kbor Code I sbll. aonhwnh comply rvilh lhos. tmvisioc
<br />WARNING: Fail(. o srr. worl6 coopcGalion o\cn!. is unlawful. ud shrll lubjd a onplolq lo fininal pemhiE sd
<br />civil fi.es trp to o6c hundrcd rnousdd doll6 ($lL)0,0tr0), in .dd io!. d,mas.s a proYid.d ior th.
<br />SErFn 1076.frhc Lahr Code. inr66t
<br />b,,., .t /t{/,1
<br />I hd.br atam und6 !€nahy olpejuy rhal I m licosd undr Fovision ofChapts9 (condoci.s Nhh Sdion 7000)oaDivision 1
<br />ol rhe auin6 dd PotdioN Code, d fty lice@ is i. axll fotce ad ett*l
<br />.s3 0 3l
<br />1r
<br />c.aNsrau(IlalL&NDllllcErcr
<br />I hseby amm undd p.rrlr,oapdJurylhat lhrc isa coi3ru.lio. lodinS asacy lorlh. psaom c.ollhc$ort lor lvhich rhis p6mil b
<br />issucd(S(. 1097, Civ. C.)
<br />ATTITCANLDICIAEAIIO!
<br />I hddry altrn und6 p€.ally of Frjury on. of lh. aollo*in8 dclmations:
<br />D.moliiion P€rm it s-Asbe$ or Noti iicat io n F.d6al Relulatioos (Tirl. 40, Pdl6)
<br />-R.{uncd
<br />l,cllr of Nodi.aion
<br />-l
<br />caril, rhar lh. tcdsal rcsulaliod Esddin! 6t-tos rdoval a. not appl,cable to $is prej€cl
<br />l.slifyihal I haLereadlhis srarerha[healDreinlonnalio.iscotr*1.Iarreroconrply\rilhallCnyo (-ounty
<br />oidimncB d Srarcliss(L{in8 ro 6lr ayRV Nttd%t ptMldrGoiihhc
<br />'
<br />d coury arq uD.n lrE(-- _,"/r//tl fab\c nro ioncd,rcpcny for
<br />.\lit,ti(Nnr or .^sor sknnru
<br />A*&/,**
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence & l.p\olq flr t1 ,{-ul {n )
<br />T-Bar I
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif(X- d,t f"-^,,[e )lt tflq ,U"240r,I
<br />FINAL L9 t1 ,l/4E@,)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
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