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! SITE-WORK DATE ID/SIG.- , COMMENTS OWNER BUILDER DEI,CAR TION I h.r.by afiim unda rBralr, ol p6juy rhd I m ex.mpl 6on the Conltoclots' Lic.is. Ijw tor thc tollowirs r.en (sd 70ll.t B6in6s dd PrclBion codc): Any Ciry or Cou.ry *hich r.quiG a psnn lo codmct. alts. ir.p,ovc, d.nolish or ,.pst dv studuri lrior to ils issuuc., aLo i.q!t6 rh. .pplic&r fot such p6bn lo nl. t si8n.d slald.nl thd h. ot stE is li.ds.d pomd ro rlE provisio6 of th. Contacbr3 Li..ns.d llw (chaptd e, Corh.n.ing $nh selion 7000 oi Dirilion I otln. Busincs ed Prcfsions Codc) or rhar t. or sh. is €x.mpt 1fi6€from ed lhe bdis for lh. all.led crdgion Anvviolalionoltdrio. T0ll.s bvonv applica for a pnbn subjris lhr sppli.anlloacililpcnahyoanoimorclh&iv.hrn&eddollas($500) -1. d oMer oi rh. prop.ny. or dy .mplolN wnh *a86 s lh€t $lc comProrion. sill do lhe wor k ind tlE nruc1@ G not inhdcn or oil€r€d for ele (56.7044, Blsins and LYof6io6 Codc Thc ( o racnt l-i.sc tnw d.6 not aprlv lo e owns ol lhc r$!dy $ho b{ilde or ioprovB th66n, and who do6 such \ork h i'ns€lf or hdsclao! throush his or hd osn cmrlovccs. p.ovided rh.r su.h iolrovcnos 6€ nor i.rddcd or oftrsl for sl. ll hor'6s, lhe boildin8 or impro@ot is $ld wihr oE )@ ol co'npkion. lh€ O\\Ts Buildc qill hnvc rhc bordo oflrorins tha h. or shc did ml holld or iinProve lne pmpdv aDr lh. Ftp.s ol -1. so\l@oarhclropdy, dncxcluiv€lyco .a(ins *nh [cs.n os ro .onsrnd th€ rojd (Sd 7044. aains .nd PFlission Codc: Thecotrtrcror's Li.cnscL.*do6 nol atplyro a'o I p,op6ry who builds or nnprcv6 thdmn rhe Conlracroir t,ic@ bw).and who coMs lor such prcj.ds*nh a Codr8do(s) licscd puEumr I anerempt under S$r \ q!!! -B ].!a! I h€r.by amm und. pcnaLly _l hEvc dd will nainlaina ofpdjury onc olrt( Inlbs Ccdificale of Consdr to sclf-lBurc lor rvorkc'3 as pmvidcd ror by Sst on:1700 olllt l,bor Cod€. lor rhe psaol]mc. of lh. vort lor whi.h th. p6nit is isued. -l hav. and will mainlain vo'*d conpq&rion isue.e, 6 rcaut€d by Sdion ]?m oalhc Labor Codc, for lhc pqfomdc. of rh. w6rr for wnich tht Dnnit is iscd My workdt comroeion i6urdc. cnid Etd lolky runbq de Poli.y NuDbs -!xPncs: -l.rdily rhrt in rhe poiormarcc ollh€ wor[ lor {hich rhis pcnnil i issued,I shallnot enploy sny p€6on inanyman.cr $ B to bccome subjecl $ thc s 0116 compensal ion laws of Calirom'a, wortdJ composarionpmvliio6 ofS.clion 1700 oflh€ lsbor Code, t a8re that ill shonkl b..om sulrjsl lo thc WARNINC F ilur. to su! workcE co,npeMrion civil li.cs up lo one hundrcd lhousd dollm ($100,000). in Sdtio.1076 oftheLaborCode inl.r6r dd.llom.y 3 fG ,",.,\\-za -lt I h.r€by arm u.d6 p.nat' o t pdjury tld I m nccasd undd povision ol ihe Busin6s ud P'lfsiohsCod.. udmy licosc is in full lorc. ed c Con(ru.lo. colllallcul)&lElDllc.&cfN(r I holby altu,n undq p€nahy ol Fjur! rh.t rhd. is a oNrudion k dios asd.y lor rh. pElommc€ ofllE wo ror which rhi! psnil b issucd (se 1097, civ c.) ATTIICANLDICI,AAAIIA! I horby alfinn undq ptnally orpcrjury on. oflh.follosi.s delantions: Donolnion Pa.ic-Asb6los Norifioario. Fcdqal R.golalio.s ( In1.40. Pdl6) -Requned LelrqolNoli6carion _Iccniryrhar rh. aedml rcBtrlarions qddi 6b6ros moval &c nor appli.ablc ro rhn plojccl. I l.ai'ryrhal lhtr.cra,lrhE apnlEaron mJ(ndion is coret.I ase Io comply\irh rllciryand (-ounry I ,ftimrtr6 ed \Drc tiws Elarns ro burldrns ofrh's Ciry and ( ounlyro.nrs upo. th. !tx,\ e m.Tr ion.d pmpdy for irupdtion p il-2n-r8,rppli.rnl0' .\grtrr Sig tt'r.CoL; z - Set Backs ->Forms/Steel/Holdowns'e,tJ- Erection Pads UFER Ground SLAB Floor Subfloor/VenUl nsulation Roof Sheathinq -,1'1 Shear Wall r4toltg -I?M\ Framinq vl,bltq't!'U-"9 lnsulation/Enerqy nlbld'Ii K&e) Diywall tc.lt4t? 1r -r?tvr,.urrL 6t -)'Ext.)nt. Lath tit"hRfu.twJt'rr Btdwn Coat L (I u I \.-/ Ivlasonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif I FINAL 7/r//4 *fr-d^t Certificate of Occupancy 't-,L/ Notes, Remarks, Etc. -21.1f, oE \VtlL *o db, It u U 04-Itl rUl b (70 BUILDING- INSPECTOR RECORD b Y,/r'l- Pxllr: GMrE -", !\:2f :18