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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS Ow-Buildq Delmtiotr <br />I lqcby rfm undq pcBhy of pq.iury thrt I m qmpt fom thc Coillmn' LiccN hw for th. followir[ rastr (t6.703 t.5 Bsitrd <br />ud Proftssion Codc): Any Ciry or Couty which rcquir6 r pqmit to oromcq rha, improw, dcrclirh or rcprt uy ttructe, ptior to itr <br />i$@cg rbo rcquir6 rhc rppliotn for luch p6Bit ro filc r rigncd JEtmt tlt bc or rhc ir licmd puEul to tho prcvilioE of tho <br />Corfirctor's LieEcd Irw (Cbsptq 9, Commng with Scctioo 7000 of Division 3 of thc Buhs rnd ProfarbB Codc) or tblt hc or <br />rhc is acmpt thaefiom rnd rhc besis for rhc sllcScd qemprion .Any viohtion of Scdioo 7031.5 by ey rppliut 6ot r pmit rubj61r thc <br />rpplionr to r civil pcElty of not mrc dus five hundred dollan (3500). <br />_I, a ow of thc prop{ty, or my employe wirh mga s $ci slc @Dpcrctbq willdo thc wor! ud thc drudrc it mt iilqded <br />mfrdcd for slc ( Sm.7044, Bwiae rod Profesiorc Codc: The ConrrGor't Li@r. law do6 trot rpply to m ow of thc propsty <br />who build! or improvG thooq ard who doa rwh work hirolf or helf or duough hi! or ha om cmploye, provided thrt such <br />improvcmcnB {c oot intended or offcrcd for sh. l4 howcvs, tbc building or improrcmcot is sH wihiD orc yd of oEplrtior! thc <br />Omq-Buildo will havc thc burdcn of proving thlt hc or rhc mt build or improvc for tlE purporc of sle). <br />_1, I ow of thc propory, m aclurivcly @ntnditrg with lierucd @amctor to orutruca thc projqx ( Sc. 7044, Bwind rd <br />Prof*ion Codc: Thc Codnctor'r Liee hw doc not rpply o u om6 of propqty who buil& or improvG tlson , ad wlto <br />@Dlrrcls for luch proj66 with r Conrrdor(s) limcd punut o thc Cortn4or's LicaM Lrw.). <br />_I m qcmpt unds Sdion <br />-B. <br />& P.C. for this r4o[ <br />Date; <br />WORKERS COMPENSATION DECINRATION <br />I hscby rfrirm undq pcmhy of pajury orc of thc followinS delsmtior: <br />_I hsvc rd will mintrin r Cstifi€tc of Corocnt o Sclf-Irowc for rcrkcs' @mp.Ntioq I providcd for by Scction 3?00 of thc <br />kbor Codg for thc performe of thc rcrt for which the pomir is issucd <br />Klx ald will uintsin worl6' ompcetioo irolrucc, u rcquircd by 3700 ofthc Codq for thc prfomne of thc <br />which this ir irucd. My worLo'irourane policy trcl <br />Policy \- o <br />(This ration nccd not bc pamir i: for Onc huodrcd 0O) or hs:) <br />I ertrry dBt in thc pcrformre of thc mrk for which this pmit i, isuc4 I rhdl mt optoy uy pamo in ey Ma s a to <br />bcome subj*t o rhc rcrkd ' @mpcution hm of Califomia, ud rgr@ thr if I lhould b€orc lubjad to thc rcrlo' <br />@mpcutioo provisioB of S€tion 3700 of thc hbor Codq I shtll, fonhwith omply wih thos ProvisioB. <br />WARNING: Frilure o suc work6' @mpcrrtioo ov{&gc it uLwful &d tldl rubjcr u mploF to qimiul Polhis ud sivil <br />fm6 up to orc bgdrcd rhoMd dolhn (tl OO,Ooo),in rddilioD to the @st of @mp.Btion, demga u providcd for thc Srrion 30?6 of <br />tlE Irbor Codc, intqat rnd tnomcy's fs. <br />LICENSED CONTRACTORS DECI.ARATION <br />I hscby rffm urdq peuhy of pcrjury tlnt I u limed uoda provision of Cbapa 9 (omocing with S*tion 7000) of Divirion 3 of <br />thc Buire and Profssior Codg urd my li@Bc i5 in full fore ed cFa <br />I Liercc <br />I o*.,Contractor: <br />CONSTRUCTION LEITTDING AGENCY <br />I hseby !fftrm uods perutry of pcjury that thsc is a oEtruclion lcrding rgercy for thc psrfomne of thc work for which thir psmit ir <br />Civ. C.). <br />tErd6't AddrB: <br />A}PLICANTS DECI&---TION <br />DcmolitioD Pamits-Asb6tot Notfietion Fcd@l Rcgulatio6 (Titlc 40, Psn 6) <br />_ Rcquircd Lrtta ofNorifiqtion <br />I ffirry thrt thc fcd@l rcgulatiou r@El {e not tppliqblc to <br />_ I cairy thst I hsvc above information is omply with ell City and Couty <br />ordiuncs and sBtc of thir City lrd Couty to otc upon t}c <br />Appliqnt or agut <br />Istrte tlBt <br />Pamine Emc (print): <br />and aulhoriE <br />\ <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enUlnsul. <br />Roof Sheathing t0-G-d-7 ;{n.'n <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <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 \\,4i -f)Nr.n <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />Brown Coat