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SITE.WORK DATE lD/stG.COMMENTS OWNER BUILDER DEI-C RATION
<br />I hcrchy rlti.n undq Dcn.hy of pcrjury lh0l I .n cxcnrpr rrorn lhc ColltracloE Lien* kq for th.lolbeing rcohn (Sc..7o]l.s
<br />Dusinc$ md Proicsiotr Codc)r Any Cit, or Cou.ty which rcquncs a Firnil ro conslrucl. alrcr, nnprovc. dcrnolhh nr rcNn ,
<br />\rrucrurc. !.hrlo ns hsuana, alw rcquncslhc q,plic0nr ior $dh rcmilro n[ ! skmd stotcmnl lhd hcorshc ir li.en\cd pursuanr
<br />ro rhc rovnions of'rr co.kacrocs Li..nscd ttrw (Chafl.r 9. cl,dmncins uirh secrion 7fiD.r Diviiion I ollhc Bxsincss rtrd
<br />Pm,e$tuns Codc) or lhir h. or sha is cxcnu thcrclrom Md rhc ues ir rhc alkecd cxcnprion AnyviolarionolScdion?0ll.sbylny
<br />aprrlicinrnrapcrmirsubjcctslhcoppliclnlhrcivilttr.lr!olnolnDrcihrtrrivchundrcddoll.ii(3500).
<br />-1.
<br />0s own$ of lhc lmfcny. or nry rnrplolor wnh wag.\ a\ rh.t slc d)hpctrl...tr. w,ll do thc sork .nd rhc srmlurc h mt
<br />i.rc,ricd or oftcrcd aor slc 1Sa.7Ol4. Busim$ and Itofc$ions ('odc Thc Conlrerol s Liccnsc Las does .ol apply ro an o*ncr of
<br />ric pmprny atbt ilds.r i.{,or$ tlEEin,.nd who d*: soch work himsclf or htr$cla rr rhmlgh hk or h.r own cnrloyccs.
<br />trovidcd rlrr cu.h inFmhnf,nk e n, inrc lcd orontrud ln slc li k)wcrr. ilr l,oiHing or nnpdwtu h$hwirhhoncfr
<br />o f complction. lhc Owncr guilds will havc lh. burdc. ofrmvire rnd hc or shc 'iid ml h{ild or ir(,o!c lhc pmpcny ior lhc purF$ of
<br />_1. ,s nwmr of rhc pmrdy. in crclusivcly cunkding wirh licc.\.d conrr.roN k, .on(ru.r rh. pn,i..r (se 7(lll4, Busmc$
<br />ond &.r6si,n Code:'Ihe Conrrlcroas Liccnsc Llw d@s nor rpply ro in o{ncr.lplopcrly *h.l,uilds or iarprcrcs rhcrcon.
<br />lnd who conrmcN for such prclccts wirh r C.nl6cbnr) li..n\cd pusutrr h rhc Contmk/ s Licctrk tjw).
<br />-l
<br />! excmlr undcr Scctio
<br />Orne.:
<br />UABtrE&T:g'MTINSAIIO!
<br />I2ECLA&UION
<br />I hccby trifiirnundcr l)cnlll! oi!.{ury orc oilhc lbllosirt d(l,i,rio.s:
<br />-l
<br />hivc urt wil nuitrr r Ccniticarc ofconscnr ro sclrlNorc ror woikcrJ (,npcnslion.03 lrovidcd for by Sccrion 3700 oithc
<br />tjb.i Gxlc. ior rhc l.domumc .fth. solk {.r which rhc p€mii k irsral
<br />_l huvc lnd willmoi ain workcr'coDrpcrsotiotr insurrNc..s rcquncd hy Scction 3?(x)of lhc Llhor Codc. io, rhc Ilcrrorroncc oI
<br />l.cnify rlrrr nt rh. pdrtunu.cc dfrhc work liJr shi.h rhi\ lrcrnir is issucd.l slull nor cmnloy rny p6on nt rny ntonrcr
<br />$ !s lo hccrnm subjcct t{,lhc workc6'conrEnsdion hws ol Crlifornin. anJ l3G lnd if I stuukl bcconE suh,c( t, rh.
<br />*orlcri coorp.netion rrevisbns ol Ssriotr:lT0oofrhc L.txtr Cde. I shlll- n)nh*i'n conply wirh ihss F,vnio \
<br />WARNINC: t{ilurc ro surc $ortcN sn'prtrsrrio. (ovcnsc,s u.lnsrul. rnd sh.ll suhirr .n cmploy.r n,.ri'ninal Fmhic\ rnd!
<br />.!vil linc\ tr|] ro onc hundrcLl rhousrtrl dolLrl lSlL().UJt)l
<br />SL{ri{ .1076o1rlr l:hn('ixtr. i crrn x rrttrtrct \ lccr
<br />n)n. Jnnnlc\ \ fnridcd itr rhr
<br />{"',. 1'\'z-d
<br />LUU.I&lltor
<br />I h.rchy rffi,hxndcr pctulry of Frjury rhar I d lirn$n u.der !.6rishn ofCh,fl.r 9 (snnMming eirh scclion 7m0) ofDivhion 3
<br />.r rhc Businessand Profcssions Codc, lnd my liccnse t in tull rbre lnd cllicl
<br />$-*""r"g C
<br />7-telra\ rxrr
<br />cqlslxlstlu$ENDINcAli$cr
<br />I hcEby rffirm undd Fndlry orFriu.y'hd rhcrc k. conirucrhn Lnding rg.fty for rh. pdforroncc oflhc *olt for whichlhn Ilcrnrl n
<br />irsncd (s.c lm7, Civ C L
<br />afturlNfuictABArro!
<br />I lsrbyilmundcrFnrlly of pcrjury one olrhc followinA 1lr.^lamrions:
<br />I)cmolirion Pcirnns-Ash.sios Nolincalnm FcdcrolRcBul.tio s I Iillc 40. P.n6)
<br />-Requncd
<br />Lcrlc. oi N.lirrrtion
<br />I [nilrrh]r rhc f.,lcrJlrc8uLrn)n\ mgrling r\h.dos 'ctrr)rrl rrc n.rxlfli.rhlc k, rhn pnil..r
<br />-l
<br />ccnriylh lhNc rc.d rhit rtrtl r.rt,otr {nlndc rh.r rhr ft)vc r*.oflcd l,8lN r,.u.ply wirh !llCiryand Counry
<br />.trl r c.! rnd srd. Lr\s toldi'i! k, btr'ldi'ru j.I)rc\crhrivcsol rhiscil,a counryk] cnrcr uF)nrh.
<br />atrl\t nrnri,nrd polrn, fitr irsp.crion
<br />f ,u""n,,. n*"o,.,**,u*
<br />4emit.e nunE (pnni):Ar.lrc..^\ Qrt(:.'x-"'7-tL-ta
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall
<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 Reporl
<br />Engineer Final Report
<br />Flood Zone Cefiif .
<br />,1
<br />FINAL 7 7,"1\\9 i ua4[t)/
<br />Certif icate ol Occu
<br />Not S Remarks Etc.
<br />1 t w fr
<br />\
<br />BUILDING- INSPECTOR RECORD
<br />SLAB Floor
<br />wolk r'or which this Fflnir is hsu.n M y works ! conrFflsdiotr irsur!trcc cadcr lnd Brlicy numbcr nrc
<br />-7^ t- 9,
<br />1:
<br />I
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