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SITE.WORK DATE ID/SIG.COMMENTS OWNt]II IIUII,DER DELCARATION I hr.by amm undd p.n0liy of perlL'ry rha I n.rdrr iom rhc Conlraclon- Li..n* ljw for tnâ‚¬ followin! ia$. (S( roll 5 Btrsin6s and F ofBstun (1'd.) Any city or Connly trhich Equtrd a lEmil lo conslrucl. axd. nnProtc ddnolish t! rcFn anv strudurâ‚¬. r,rr lo iis isuan c. also !<ut6lh. alplicdl lor su.h Fmrit lo filâ‚¬ a sisncd naranai lhar h.or shâ‚¬ n li.dsed ptru(ml lo rhc pmvisions oflhâ‚¬ Co.k.ctofs Liccns.d Lau (Chapr6 9. Cofrmm.in* wilh S.clion 7000 ol Division I ofthe Busin.ss tnd ProLssmns Cod.) .i lhar h.orshc iscrâ‚¬mpt lhocturm dd rhc basis ao.lh. allcs.rl .imprion AnvliolarionolserionT0:rl 5 bl anv dgplicanl aor a p.mil sub.,trls rhc aptli.a toacivilpcnallyoanolnor.rhMfivchundrcddoll&s(5500) I, a\ o$nd of rhc prcp.ny. or my mdolc wirh {aSB d rh.ir $lc compdsrion. *i11 do Lhc $ ort Md lht siMr. i\ mr inrsdcd or ofiGed lor sl. (sE 7044, BusinN and ProfdioN Codc: Th. Contacrois Licâ‚¬B ks do6 nor aPply to ar o\r{ ol rhc p'np6ry * lk) builds or impro\6 th@n. ud {k do6 su.h \tri( hinscll or h6el r or throtrBh his or hd om cmtlor_.6. prorid.d rhal sucn improvtuB e nor idddal $oft(cd lor slc lr. ho{da. rh. hrildins or i'n{rov.ffir s $ld sirhin on. I6 .f.ompldion. lh. own6 Buiu.r sll hak rh. hnd.n ofprovinS thd he or shc did nor build or irprorc lhc ribF y for fi. purr{r or l. d o$n(ofrhe rrol<ly, mcr.lusiv.lyconlraclirs N,th lictucd .oitados to connrucl rhc rmler {Sa. 7014- Bsina and Pn Es.nn C.d. Th. Co mroi s Liccns. t,arv do6 ..r aPp\ to .n ownq oflhp.ny who bu ilds ot imprcvd rhd.otr. rnd {ho conhcrs lor such rmjcca rvnh a contm.ro(s) licdscd punuanr ro rh. (tnlractois l,icas l-atr ) I m.impl rndr Sdion .B &PC forlhisr.6on Dir. ()*ner EABXEB!:(OMrEl'/tflO! DTCLAAAIIO! I hd.ty afirm trnd6 Fmahyofp6ju.y06.ofln tollowiB ddlaratiotrs I har. dd $ill m.inrain a C.nificar. olcoMr ro Sclf- lNu!. for rvorkd comFErio., d lto dcd lor 6, Selion 37i)0 of rh. hbo. con.. for lh. F6fome. ollh! *ork for whicfi th. Pdmn 6 isu.d I hrv.!.d$illnaidr.inaoikds compsts.lion i6urr.., s rcqritcd hyS.di.1700 ofrh. kb.r Cod.- foi lh. Faonroncc ol rhc work aor which this pmil i! isu.d My {0116 .ompaeion i.surmcc c&da .*1 rolicy .unb6 s.: Icdilyrharinrhepdformanceoflh.xrkfds'hi.hrhisp.irnirisissued.lshallnoronployanyp6$ninantn ns $ sb b..onr srbj(t tolhe\ork6 .onp.Balion l.ws olCalifomil ed arR rhd ifl should bccon. $bid torh. $orkdl .ompâ‚¬.erionprov6io$ofsernJn1700ofrh.tnbor(od..lstu'll-ronh$nhcomply$ hlhoBlmvisi.ns WARNINC: FailLrE lo sur. trorlds conposation co!s.!c ,s uhla$tul. and shill sub.,(t a. mpl.vc 1o o'niial Imhi6 and cnil fines trp ro on. hun&.d rhousond doll.6 ltl()O.Oo(]). in ldd ion ro rhe co$ or comp.nsarioh. dama36 ar Pdvid'd nY rh' Sslion 076ofrhc bt r (_odq inlcr6l and alloms)'s fL$ DlclAaalo! I h@by atnm utuid poaht ofpdiury rhar I Mr lica<d undd tmvGion ofchnpls 9 (comdd.inP \irh Salion 70m) 'rDnislon I oi rh. atrsin6s ond Pror6li.s ( od.. md nry lictrc is in tull torc. dd .rd ,.^rrr"r",.ru\<42-> colsraucIlolu.ElDlNi.ac.Er(f, , hftby amm und6 Fnax, of pdjury lh.l rhq. is a coNltucrion kndinB 6socy for lh. pdfomsnc. of lh. *ork for trhich $is p.f,nit i5 hsu.d (Se.109?, Civ. C.) AIILITAILDECI.A.B.&IIOI I hd!t', afim u ds p.nalty orrnjury on. ollh. aollosi.3 drl.ralions, D.froliion Pdmhs-Asbâ‚¬sros Nohri.,tio. F.d6al R.rularions I l illc,10. Pan6) R.quir.d lnia of Notifi calion I ccnily !h lh. fiddd r.-lularioB rcsrdins 6b6ros rdoMl tre nor applrcablc lo rhi! Pojd I.dily lh.r I hrvc red lhis apDhcrlion ad nai. rtot rhc abov. infomarnrn ir.oftd.l asre lo conply*nh.llCilvand Coun'v ordinan.e ed Sr.rc ,jqs ,.lalins ro building connndioh. aid h6cb) iurh,trEJ Fpr$rdtr6 orrh$ ctr, ed Counrvlo dld upon rh. ir-,. nan.n.rtbmnd! ro, '6 , /l ^;;;,;.;,;.:;"",..", l\\4.r"-l*-/ 4*--,,,, //-/-/? Pemire n. d. lprlnr ): Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUl nsulation Roof Sheathinq Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL t-7'tg .JJJt\?v\ Certificate of Occupancy Notes, Remarks, Etc BUILDING. INSPECTOR RECORD