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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS OWNER BUILT}ER DELC RA'I'ION <br />I hmby amm und6 pqalty of pcdury that I m exmfl fmo lh. Conirrio6 Lic.ne ljw lor lh€ folknvinr reen (S( 70l l 5 <br />Busrn6s and Prol6sio! Code)r Any Ciry or Cou.ry whi(h rcqun6 a Fnnit ro coNtucl. ahs. improt ddnolth or lgnt .ny <br />srru.lurc. prjor to ils issudcc, al$ r.rlun6 Oc applicd fdi .uch p.mh to arl€ a sisn.d stalocnt lhal he or sh. is licas.d Pursuml <br />ro rhc provieions ofthe Conracroai Lic.trs.d li* (Chaptq 9. Com'n.n<ins wnh Sdio. 701x1olDivision I oflhc Busi.6 dd <br />PrcLsions aode) or lhar h. or sh. ! cx.nq $6.6om md rh. ba3G for thc allcs.d cxopl ion. Any vi6l ionolsdion?01I5bya.y <br />opplicanl aor a p€nnil subjeclsth. applicanltoacivilpcnahyofnotmor€rhtufiv.hu&.ddollds($500). <br />l. s oond of rh. Fop.ny, or ny €mployc viln wag6 6 thct solc compeGdtion. trill do th. q o* dd th. srnflu€ b tu! <br />i. qd.d or olTs.d lor sl. (Sd.704t. Busin6s ed Prol*ioas Codq The Conlraclols Licns. L.w doe not apply lo d o$d ol <br />Ih. proFdy *ho boil& or inprovB {hdon. and sho do6 such w* hinsclf or fiGll or rhrcush hii or ha osn .mploy€, <br />prcvid€d lh.l such inpreld(li e nol inlodld o. ofr.rEd lor slc. l{ ho*'6s. lhc buildi.S oi i,tp.or'ml is $ld wnhin on. }@ <br />ofcompldiotr $. ONnd Build6 sill haw tlE hrdd ofprovins lht lE or $c dn nol hrild or imFor. rh. FtF y aot lh. !{.poF of <br />-1. <br />6 o$r olrhc prepqry. d eiclBiv.ly .ont di.S sirh licsql coitadou ro coEtrucl lhc rojrl (Sd 70,14. Bdin6 <br />and }tofebncod€: The Corlrrclais Liccnsc Law do6 not applylo oMsotproPdrt$ho boildsot improv6nEeon, <br />and who conl.ads tor sucn proj.rs{nha contado(q lh.ffol pu6u,rt ro th€ Conlrd.tr's Lic@ t s) <br />-l <br />d cxdpt und6 S*rio.-. B. & P.C for this reetr <br />D.t. o,n{: <br />l!aaEl8gla!!E!!l41la! <br />DECI,AAATA! <br />I h.eby aliim undo p.n,nyofp€luryon olllE followin8 delearioN <br />-l <br />h,vc a.d {ill daimain a cqniflcalc oaconst ro SdfiBurc aor vorkers @nrpd.,rnrn, a Fnoviddl lot by Sdlion l?00 o f lhc <br />hbor Codo fo. lnc pqforl@cc of rh. worh for {hich th. pnnir t i$u.d. <br />_lh.vcand*illm.inl.inworke^comp€nsarioninsurancc.srequredbySerionlT00ofrh.ta6or(od..lorlhcp6fomdc.of <br />rh. vork for whi.h lhis pmh is issucd. My workss ompdsation insuruce camo a.d $nicy dunb6 trcl <br />Pol(y Nuilb.r:-Ertir.s <br />-l <br />c€niryrhar in rhc p.rfomancc oflh. *ork aor *hich rhis p-frir is issucd.lsnallnol oDloy any ps$n <br />'n <br />an, mmd <br />so d ro b.com. subjor to th. workd comFnsation laws ot ('alitomia dd asE $al if I should h.ton subrd to thc <br />"0116 compcnsarion prcrisioBofSc€lion l?00oflh. tibor Cod€.I stEll ronhsnh conPly *ilhrhorPmvisions <br />\VARNINC: Failure lo Fue {orkd' co6pccatio. covftsc ir u.lasful. dd shall subjst an Enph}-d io dnintl pdrhi6 d <br />civil fins up lo one hundEd rhoutud doll6 {$100.000), in addnion to lhe cosl oaconrp.Mxo.. dana!6 a proid€d lor th€ <br />se"oF :ru'6 nrrhc I dba' cod.. nrnN sd rnunr.J s f* <br />u.CIxs[LcaxrlAclaB <br />D&CI.ABAfIO! <br />I h@by eftro undo p@lry of Fjury fid I m licassl undr FDvision olchrpl6 9 (comna.ing $nh Sdtion 7000) olDilnio.l <br />of tn€ Ausin6s od Prolssions Codc. dd ny licds is in flll forc. ed .lTEr <br />CAIEItrIJCIIQIi.LENDINC.&GTXII <br />! hd.b! afiirm undd p.n.lry olpcou.y thal lhdc is a coNtruclion lcndins ,sdcy aor rh. !6fonn cc olltc rort for {hi.h rhis dmir is <br />isucd (Se 1097. Civ C) <br />AIII,ICAILDICIAAAIII}N <br />I hm6, aIIm und6 p6.lty of pdjlry one oilh. lollovins d(lral ioft: <br />D.n&lirio. PdnilsAsb.sros Norificarior Fcdsal Rqu,orioffi (Tnk d0, Pan6) <br />R.ltun.d Ldrcr.l Norilj.aridr <br />I .dil, rhd rlE aelflal resulalioN rclardins asbcsktr rcmoval de nor altlic,blc Io I his !reid <br />-l <br />c.n iry !ha1 I h.r. @d rhis appli.arion md sr . rh.r lnc .bovc infomalion t codd I asie ro .onply wilh all Cily and Co6(! <br />ordin!.c6 dd Srarc La*s Elalins lo brildins consl clion. dd hocby aulnorn! r{rtsrdi!6 of rlisCily d Counly ro drc lI.n lh. <br />aborc n6rioncd prepdy loi insp.dion pripos <br />Appric$l or Aqml Sirutur.: <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />In s ulation/Ene rg y <br />Drpvall <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 />FINAL tz-tc-l )r.W10) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Lic.N. Class:-t,icdsc Nudhd: <br />- <br />Erection Pads <br />Flood Zone Certif.