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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DET,CARATION <br />I hr.by dflirm uidq pdahy of Fjury rh.r I an .ropr 6on rh. ( onlraclos Lic.ns. b\r lor lhc lollorvins r€en (S( 70l l 5 <br />susinss and Proadsion Cod€)r Any Cily or Count, shich r€qui6 a p6mit io connru(. ahr. improv.. &inolish rr rnEr ey <br />srrucrue- prior ro its isu cc. als. rcqun6 thc alplicor fu such p.nnir ro nl. a sisneJ s'a'md rhar h. or s\c G lictu.d pu6urun <br />ro rhe previsions of rh€ Conrr&roas l-iccned l,oLv (Chapl( 9. Coumcncinr rvnh sdrn n 7000 of Dilision I oflh€ Bsin6 ed <br />Ptuf6ri..s Cod.)6r rh h. or sh. ir .r.mfl rhd.fr.'n dd rh. bs! for fi. all.led .rmF,l ion Anyviolalionofscron70:ll5 bydy <br />applicantlorap6nilsubjdslh.6pplic&tloacivilF.nallyof.otmorelhanlirchutr&ddolles(ttoo) <br />-1. <br />6 o*ner ofth€ FoFny. or my emplo)B wirh sag6 6lh.tr el..onrpdMrion, $ill do rlr sorl dd rh. slnxlwe 6 not <br />iniddrl or oit6.d for el. (sd 7044. aosi.N Md Prof6sio6 Cod.: Tn. ConlBcloii l,icos.llN do6 nor .I)plr ro d o*nd ol <br />ihc prcpdy $h. build! or inpro\6 rhd6tr rd whd do6 strch $orl h'ns.llor hcMlf or rimush his or hs os @plo).d <br />provid.d rhal sucfi inFoEdE a€ rcr inrddcd u ors.d for elc Il, ho\,6 d. rh. buildina or i,npro\ .1mr is sld wirhin on. l@ <br />ofconrpldio.. rhc (\ nd Buildd will hovc lh. bud.n ofpaolina thal h. or shc did nol build or impfl)v. dt pmtdy for th. purpos. ol <br />l. 6 owntr o frh. prcps1y. m clclusivcly conrrs.lrns silh lic.Grd .omrrdo6 t' .oistud rhr Projdt ( S4 ?044. B6mN <br />md Pofsirn Cod. Th.Conlriclor! Licm* La* do6 noi rpplyto mowndofprop.nywho buil&orinpro(s rh6o,. <br />a.d vho conrracls for sch p.oj.ft with a ConrEclo(s) licots d puE@l ro th. ( ontrclois Li.G. Law). <br />I on €xcnrpi unds Sd ion . B. & P.C. ror lht rctr$i <br />.uq8[E85tCOUr!IlA!A! <br />DICLAAAIIA! <br />I h.r.bt aSirnr und6 Fn.hyofprjury.n.ofthc lollo\ing drld ioB <br />-lhav.ddwillmainrain0cenificar.ofcoNorroSclf-lsu!.lor$orkeBcon,Fnsarnrn,a!ro!id.dlorbystriodlT00olrh.llboi Co&, for rhc pGLmdc. ol rh. soi! aor shrh rh. pdnt is isu.n <br />I ha\cand trillm.intair *ork€rr conDcNalion iNtrranc.. s rcquted bySclnn l700ollhc Lahor ('od.. aor ih. pstommce o f <br />rh. sork lor {hi.hrhir ptf,nir is isnred. M, <br />ru;-r"'" <br />io. insulancc cadr and Frli.ynu'nbd r.ir *1\q\IEW Ir i1 <br />_lccdifyrhdr inthcpdlormanceofrh.*ork for * hich rhis Fmir is issu.d.I sh.ll nor oployanyp<son in uyn nd <br />$ alob.con subjftt to lh. *ork6' comp.salion laws ot Caliiomia. sd asr.c lhal if I should h..dnc aubjd' ro rh. <br />{ort6 .onrpm.tion pmvbio.s ofSatiof, 1700 oflhc t bor(ode.InEll. forlhlnhc.n,ply <br />WARNINC ljailurc to surc \orke6 compenslion colera!€ s unlaqful. srd shall s tn ro sinrinal pdahis and <br />cnil fines up lo onc hundr.d rhouud do ($li)r) <br />*\1] <br />llECLAEAIlO! <br />I hoeby smrm und6 D..ahyoipsiury that I m lcms.d und( provirion ofchaptq 9 (.onmdcin8 wirh S.clion ?000) ofDivision 3 <br />oa rlE Busin6s Md PrcfsioN Codc, snd my licdc is in full torcc drl eiI(l <br />L--)r <iLs c{ <br />t\ <br />TAIiIAIJqIIONI,MIICTIGI;ICI <br />I hcrcby amrn undq porflhy orp.rjury that lh6. ir a coBrrudnrn hdins as6.y for th. pdaonn.ncc oflhc\vorl lor *hich lhn p.n.'r is <br />issurd(s( l(})7. (iv c.) <br />AITI,I(3NLI}:(IABAIIO! <br />lMyallm under pdalry orpsjury on€ oilh. rolbs in! d*larari.ns: <br />l)emolltion Pdmils-Ash6losNotificarion Fcddal R.aulal'ons(T le.l0, Pd6) <br />-R.quircd <br />L.il6 of Norilicarion <br />-l <br />c6rit dml rh. f€dqsl ,.suLtioN Egadiru sb6tos rmorzl rc nor applicabl. ro this proj.ct. <br />I cdlii lhar I havc rad rhis appli..lio6 and sbl. rhar rh. abov. inlomalion is cor6l. I lrre Io comply u h aU Cty ed Coumy <br />.rdinrnr6 n d Srarr La*s 'rhhi!L{ildin& .o8rtudion. and hd.b!aurhoru. rcp 6urtariv6 o f this Cily md Counry <br />;1 l1 <br />abo\c nrntioncd prop.ny lor <br />Appli.rnt or ,\Eetrl Signal <br />{ <br />;:.], <br />Set Backs <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wali <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 Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL I lxlxt 74 / qztlA <br />Certificate of Occupancy I <br />Notes, Remarks, Etc <br />---\1) <br />Forms/Steel/Holdowns