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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE tD/stG.OWNf, R BUII,DDR DEL(:ARATION <br />I h*.b amd unda p.mly of pdlury rnal I m.rmpr &on rh. Conlllclo^ Lic.trs. Law for lh. fouo*mg rc&n lse ?o.tr'J <br />Bushs ed Profsion Code)r Any Cily or Cou y qhich r€qut6 a p6nir o cocrtoct, al'd. improv.. {knolist or rep6n oy <br />srnrcNE rrior lo irs issuace. als '.qui,6 rhe lrpli.er for such F mil ro ,1.. siSncd stoldnor that nc or sn€ ts lcaed p@uer <br />lo rhe previsions of ths Contrcrofs Lic.nrd l,av (Chapl6 9. Co6nci.in! sirh sdtion 7000 of Oivision 3 ollhc Bcincs m'd <br />Ptuf.sio.s Cod.) or rhar hl or sh. i! .icopr thd.aror dd rh. hdi. aor th. all.g.d .Enp{ion Any violahonofs6lio.?031t by 64, <br />appli.d tor a pamt subjr8rhe appli.a.r ro.cililp.ralrrofnor more th fivc hundred doUa( (5500) <br />-1. <br />s owd olth. prorely, or 6y cmplorG {irh wag6 s rhct sL onrpdE lion. sill do tlE rvort dd $. $rudu. b nor <br />inroddl or or.(d for sal. (36 7044, amins md PrDadioB Cod.: Thc Co.radoii Licdc Law do6 nor apply io d omd o I <br />lh. rrlpsly rvho hil& or itrr,Iov6 dEor {d who {to6 sch srt him.lf o. h@lf or thrclgh his or hd oq €nployc6. <br />proeidcl rhar such inprolmts &. mt idod.d or ollatd 16r sL lf, how6q, rh. hildins o! impovqMl is eld wilhin on. <br />'6ofco,nplclio.. thc ol,"d Buildd will ha!. fio hr&n ollfoving rhd h. or shc did mt toild or improv. lh€ ptopory aor lh. plrpo* or <br />I. 6 owncr ofnr ,ftipdly. m crcnsncrconlractiDs Nilh licosd conmdoGto coNtncr rhe lroid (Se. 7044, B6ins <br />and ftrrBion Coder Th. conr.iclols Licms. Lav do6 n6r.pply ro d ownn olpropdy Nho builds or improvd thss( <br />rnd slo conlEcrs lo! sch proje.ls Nirh a Conrmcro(s) licd*d pusMr ro rhc Contlcrois Li.ds. ksl. <br />l anexempl und6Srrion-- 4. & P.C aor $is r.ason. <br />]u9BEE85l:A!!f!:!l4I!A! <br />!EC!48AU9! <br />I hdcby amnn unds p.trallyolrEjuryoncol$c follo{ins dclrrrn N <br />lh.ve dsillnEintainaCenific.teotCorHrroSelUnsureforworltenconrp..s.tidtr,dprovid.dforbySectionlT00ollh. <br />bhor cod., for fi. p6aomm.c ofth. Mrk lor vhich rh. p6Dil is isu.d <br />I hav€and silloraintain uorkera conrp.nsalion iNuBnc.. d r siune{ by Selion 1700 otrlE Lsbor Code. for lhc psfomdcc ol <br />lhe Nork for which this pmil is issued Myworkea composldn riurdcc.min dd polic, numbcr eel <br />l.dif, thar hrh.ldlornEnc.oflhesorl aor \rhich this p6mil is isucd I shall..t dploy ant p.rson in any nlamer <br />s 6 ro b€comc subjer ro rhc tror!6! co:np@sdion la{s ofcrifomia. dd a8E lh6l ia l should b..onE subjdr lo rh. <br />*(rh6s conpdsarion pmvisions ois.crion lT00 of rh. libnr CGL, l shlll. tonn* h omdy wilh thos. pmvtions. <br />WARNING: Faihft ro KU€ work6 comporsriotr covms. 6 unlastul. dd 3hall subjd mploF to silniul p€rdll6 and <br />civil fines up lo onc hu.d.d lhocdd doll6 (5100.0001. in addnidn b rn. co, of coDp€Ntio., danas6 6 provid.d tu rh. <br />S6lion 1076 ofrhc llbor Cod€, inrd6r dd rxom.y s lG <br />llcENllp-cotrrnAcrga <br />DECL6AAIION <br />I h@by arm unda p€nalry or pdju, lhat I m li..oeJ rnd6 povision ofch.pl€ 9 (rcndddns s nh sdi.. ?000) ol Division l <br />ol lhc Buin* dd Protsiod Cod.. and m, lic.@ b in fxll forcc t d.fid. <br />coxuauglalrrlDtrcAllElc.I <br />I htrbysllm undcr p€nnltyoIp€rjurythar lhs€ isa connrucltun ldding asd., aor lh. pdfom c€oithcwort lor $hich rhlr Fnil i <br />i$!.d (Sc l097,Cit c ). <br />A[[I,ICAAI.D!C!AAAI,&N <br />I hdlby orlnr und6 Fflalty of pgjury onc of rhc follovins dslear io6 <br />D.molnion Pmn$Asb6tos Nolificaliotr Feddal R€lulalio0s ('l nL 40, Pan6) <br />R.qtrt.d Ldler of Nolificaion <br />_l c€n ity $er the [c{r.l rcsulaliods rcrddin8 dbaros rcmo\ .l aie nol opplicablc lo this prejecr <br />I .dify th.t I hovc r€ad this applicalion dd sial€ lhat lhc ab()le inlomar io. i! corcd I alc ro conrply wnh all City ud Count) <br />ordinancG md Srat. t Ns rclarinr ro buildins codrucrioc dd h.reby .uthoie eF6..1ativ6 oarfih Cily snd Counly to 016 !ti. lh. <br />,bo!. n..rion.d ptut.rly aor tupection <br />appli.ant or^8.trt sisnsrure !! <br />4 9;nrav ^,", <br />//r/ly <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />COMMENTS <br />UFER Ground <br />Shear Wall <br />LenJn s JJ6\ <br />----t--- <br />= <br />=