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BIJIL <br />COMMEN u[) aflt,n trftlcr prnahy ol pe'rLiry rhar <br />()1!NDN BUILDER DELCAI{A'NON <br />I m c\cmpr frem Ihc Conrr,cro6- I-ic.hse hv lor rhc lollownr8 rNn (sec 70ll 5 <br />Busi.cs md ProfNion cod.): Any cily or cou y whi.h r.qut6 0 p6nil ro constn(. ah6- improve dnolish or rqMt en, <br />srrudwc. priorlo ns isuance. slso .equt6 lhc applicanl lor such lEflil ro 61. . siln.n sraron.nr rhar h. or shc is licm.d p!E!.r, \ <br />lo rh. pio\isions ofih. Conrracrois Lic.ns.d La$ (Chapr6 o. ('ommdcins vnh s.clion 7000 oaDilirion I ofthc UNincss and . <br />PF lcssions Co&) or thar hcorsh. is.rcmfl rhd.Eom dd th. batt aorrhc all+.d e(mprion. An,_ viol.lionofsdion 70ll 5 hyany <br />appli.antlorapmitsubjeIsrncflpplicanlto.civilpmahyofnoimor€lim6\chundre!dollds($500) <br />l. d osMoarhc parp.nt. or my.'nplore6 {iri rvas6 6 rh.ir $lc comp.nsarion. *illdo thc \ork and thc nruduc s mr <br />intmilal or o,rd.d for sl. (Se 7(N4, BBind a.d Prolsions (-ode: Tte Contr.dois Licm* lis dos nor aptlyto moMd ol <br />!h. pmpgly rvho bnilds or imlmvGlhron. and *ho do6 sucfi w.d hiosclr.r h.elrorrhrouEh hE.rher o*n.mrLoy€6. <br />prolid.d ih.t such imrrovenE ns 6€ nol intfldsl or ord€d aor ele. IL hotr3s. rhc huildins or mrtrdv.IMr r $rd \rirhin .ne \@ <br />of.ompldion. th. o$rd B{itld will n0vc lh. hi'dd oaproving tha nc or shc did nol build or impmrc drc a@pdiy lor rtu purpos ol <br />l. .s ownd of th. t"opsly. m .x clusn€ ly conr racl ins with licc6.d contradoB ro consrrud rh. Fj.cr (sa 701,1. Bbin6s <br />md Dshrion Cod. 'l he Conracu s Li.cm. l-aw do.s oor aDply ro e osr.r of prop€ny qho builds or imp.ov6 lhdan, <br />.nd \lr ontrocls aor sucfi proj€ds Nilh s Conimclo(, lt6cd puEudl to rht Conracrors Li.de t:s) <br />I an .r.,npl und6 Se.lion <br />uoB[Eal(arlEEts4llo! <br />II&CTAEAIIOT <br />I h6€by aflirn und- p6ahy orFjuryoncorlhc rollosiry d<ldalioG: <br />I havc tuduru npnrai. a cenificgre oIco6dl lo selr l6urc ror wo ds'.o,npdsarion. as Fovidedforirysdio!.1700ofrhe <br />I rhor Code. fo, lhl p€raomancc of the worl ror *hich Ihc pmil ; issued <br />I he!. and will mii6r.i. $o,t6 conp.Narion iNnr.nc., s r.qrircd by Sdion 1700 of lh. kbor Cod.. lor rh. Faome.. of <br />rn work aor which rhi! p.mir is isued. My rvortd compdMion iNuruc€ qder ad policy nunbr d.: <br />I cdilyihar in rlB p.rfom.nce o f the work for *hich thh pn,rn is issuen.l shau not enploy any p€.son in aiy m,nnd <br />so a to b.comc subj€cr ro lh€ worl€J compmsalion laN ofcalifomia. and arN lhar ii I should h.con. subjel to lh. <br />*orkc' compsalion ployisions .lseion 3 700 of thc lib.r Codo I shaU, ronhwirh comply wilh rhor prolisions <br />WARNINC: Failurc ro sd. $0r[6' compdsrion .ovms. is unl.$tul. rnd shal subjd an 6nploy€. ro mdinal pddxi6 aid <br />compeNli.n. da@Acs ar Pov .d nY rh..ivil lii6 up t. on. htr.dral ihousnnd doll.6 ($lL$,00o), in .ddiion lo lh. c <br />inrftai and dr.m.r's ld <br />DECIIAAI]IA <br />I hftS, arm undd p6ahy of Fjury rhd I m licmsal uda pro\isio. of(laprs I (commacins rvilh Sslrn 7ul0).lDnhion l <br />ol lhc ausin6s ind P(a6io.s Codc. ad ny licns. is in full for.. dd .It(t. <br />l,icc6.Chss: :A <br />""'"' To/t. <br />8'2./ <br />calllascuaNrElDucic[lcl <br />I hGby rrrm unde paahy of p.rjlry that lhs. is ! connruclion lddins asocy lor lh. pdfomdc. of rh. {ort for snich lhis ponit is <br />isr.d {Se 1097, Civ c ) <br />I .nd. ! Nm. <br />4rtucaNfoEclA&ll&! <br />I h6!ry amnn undd pmalty olpqjury onc oflhe lollNvinr dclanlions <br />Dmolnion Pmns'Ashcros Norincarion F.d.r.l R.aul.rions (r ilb 40. Pd6) <br />R.quncd Ldrd of Norilc6lio. <br />l.un'Iyrl ll,c fedsalrcgrliri,'nsr.!dJnr! Nh(skxrenx\ilrrc m(.pfli.iblc b rhh D'(ilLrr <br />I.d'iry thd I ha( rod rhis arpli.a(ion adsrarcrld the abv. info <br />oidi.an B and srr'.lrws r.bring ro buildinB con5tu.rion. md <br />,tr!c ,nenh.ned t()pcd.- ror <br />'\pDliLrnr or <br />^gcnr <br />Stnrr <br />SITE-WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL '1/7t ft Sftgq <br />Certificate of Occu pancy <br />Notes, Remarks, Etc <br />2t+t <br />"",-r** "r.,^rfDCA ,& <br />b conply\irh allCirtaid c.unry':_'.'2ZZ;"'- <br />T-Bar