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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVl nsulation -.-) Rool Sheathing 84t+-tB ffi.nt -.:.> ?') ) Shear Wall Framinq lnsulation/Enerqy Drywall Ext.i lnt. Lath Brown Coat It/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif . FINAL h Vrrltl t:7nn7t /6> Certif icate of Occupancy Notes, Remarks, Etc. OWNER AUII-DI]R DELCAI(AT!ON I hc.cb, !il!n hder p.nalry of prrjury th,r I m crc'npl ltunr lh! Conlrncto6 l,iccn* Liw turhc r.llo*in8 rcastr (Scc'70115 Bu\inc$ lnd Prorc*hn Cod.): Aoy City or Couoly qhth rcqutcs 0 trnni k, c$ndtu.r. alr.r, imProvc. dcmolirh or rcpln any itudrr.. tiior to irs hsDancc. aho rcquircs llr lpi,liclnt lor {chIlcnlir ro lil.r rilicd sarcrrc rhd hcot shc is liccn\cd nu6En n, rhc pmvisions ol rh. Contrcror's Li..nsd ba (Chrprcr 9, Commcmins wilh Sccri.n 7fi)0 of Division 3 ollhc Busincs 30d Pnir.s\io.sCodc)ort,mltEorshciscxcmprlhcrctonondlicbasnfo.rndrll.g.drx.nrpriotr.ADyvi,lntionofS&ri,n70:ll5by,ny r!plic!.1 lor a pcrmil suhjat rhc appricanr ro acivilpenrhyotnor'mrcrhm rivc hundreddollarslSiU)) l. sl .wrcr or rh. prupcny. or my cmpbyccs with {isc! trs lhct rolc onr.nsarion. will do thc wolt ond ltr (nr@ n nor iNcnd.d o! o,rcrcd for arle (Scc ,044. l,usincs and Pmrcrsnn* C{xlu: Thr Conlrrcxtr s Liccnsc liw docs nor allly b rtr.wrcrol dL F)Irdy who builds .r irhrroB rhcNr- atu who de( su.h work himieli or hc elforthn,uBhhisorhctowncmployccs. pmvidcd rhar snch i' |novc'tuiis m fr, ir .fln\C or offcEJ (or $h ll Inw]q. rlr hoilding or i'ry'm*m r is sold {ilhin onc }Mr of cotrDLliotr. ltr o*rcr Buildcr *ill h,ve rh. t rdcn or pn,vi'rs rh,rh.otshc dd m' hoild or in{mr rh. pmFny tor tlI l[lnsor -l- aso*rcr of rhc pmFnr. ad.r.luiivcly.o k,.rirANir[ ] '.cnscd co nnrcron ro coosr dc r rh. j,qc.r (s.. 7tX-1. Bu.iri.\\ nnd Prtrrcssiotr Codc: Thc Conir.clor\ l.iccnsc t,n* d@s nor $nly k, an owicr ofnn,pcny who huild\ or impmvcs rh.rcon, and who .onrnchfttrsuchpmjcdsqirhtrContn.rons) liccnrcd puruu hrhcConka.roi s Licctrsc hwl. I an.xcmfl u.dd Setio l, & l'( lnrrhisranni IYABtrEIIIIAMPJNSAII9N IIECIAAAIION I hdr.h, rrfinn utulcr p.nalryorp..ju!yonc olrhc followinE dcclftarions -l h(vc el {ill minruin a Cedili.lrc ot con*nr ro sclf.ltrrurc for workcn conf.nsd ion- as F,vid.d f bySccrionll{xroflhc L.txtr Codc. for I hc I'crlormncc of rhc vo,k tor whth rhc Frdir k ir\ucd I havc aid qill mrinrrin workcrt conlt.mrrion insurlncc. rs rcquircd by S.dioi .]Tffl of rhc hhor Coic. tu rhc prr"'"',i.r "r rhc work for which lhis Frmil is hsucd M,workcn comtr.nsorion in soran.. .nricr a Plicyflumbcr uc -l .cnily thar in rhc pcrlnnuncc orrhc work ntr whi.h rhh p.flnit is ksrn- I shrll nor employ,ny r.6.n in rny.'uncr s N t, b.rom suhjrr tu rhc qo ssconrFnsdionlswsofculir'ornia-andasr..rhdirIshouldbccomsubjccrrortt work.6' ..mp.nsd ion pmvkions of Sation 3?00 oi thc Lnbor C{nlc. I shall, ron hwirh otrlPly wiih thos Pmvtiur ovcriEc t unhwru!. arld shlll \ubii an cmpbltr ro dininrl FMlti6 and ), in dirirr fu rhc co( ol compcn$riiJn, dr uScs as providcd lbr rhc DECIdSAIION und.r Forisian orChrrr.d 9rconrmkinS sirh Sccrion 7UD) orDiviriotr Ipnahy.r !.rjury th.t I un liccned of rh. Btrsinc( afld Prnt$ions A'd. d rv li.cnsc is ni foll f(rc and clltcr ' coNlISIreuoNIlNDrNria{iExrI of Frjury rh{ rhcrc is a .o.(d.rio. lcndinE a8cncy for rhc l.rfohnrmc ol rhc work for which rhis Frnir il i(sucd(Sc.. 3097.Civ (-) APPI ICANT T)FCLARATION I tErhyfllltmu cr lr.mlry orFrjDry onc qrrhc rolhwnr8 d..l0,nlions: DctrDlilion Pcrmih Asbcsros Norifi.arion Fcdcral Rcguhrn,is (Tirlc40. Pnn6) RL'qun d kner oi Nolifi calion -lccniiyrhlrrhclcdcBlregnhrn'.\ruatrdnr8Nbcaosrcxivrlrrcnorrpnli.ahlchrhistbi..r I ccniry'h.l I hNc rc lhirupliclrn,n md {Jrc rhd I i'rtunn 1i,nr N.oir(r I rSrLr h.of lnl:_ ordnhn csdnd Slrrc tjws rcl(ir8ro bui ( ltttlu Zry/ l V tt L