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W � IHERE�YAFFIRMUNOERPENALTYOFVE0.1UMiMAT11WLICENSEDUNOEflCROV1510N50FCHAV�ER � , d i(COUMENCINaWfiN5ECT10N700o�OFOry15�ON]OCTMEBV51NE55ANDCROFE55�O.+I5CO0E.AN� Z � X MVLICENSEISINFULLFORCEANDEFFECT. ' m ' � �/�,D � UGENSE CUSS L�C.NO. �''�� ~ OATE CONTMCTOF tJ • �� J V _ O. W �� WORKERS'COMPENSATION DECLARATION S,.Ct a � IHER[BYAFFIRMUNDERPENALTYOFVERRIRYQYEOFTHEFOLIOWINGDECU1MTqN5�� J Z ' . , O �IHAVE�NDWILLMAINTAINACEHTIFICATEOFLONSENTTOSFLFaNSUPEFOHwOF7KERS' _ • COA/PENS�TION,ASPROVIDEDBVSECTION77DOOFTHEU80FCOOE,FORTHEPERFORMANCE U I �t OF h1E WORK FOR WHICH TMIS PEPMIT IS ISSUED. � � � w �INAVEMIDW:LLNnMAINWORNE0.5'LOAfPEN5AT10NPlSUfUWCE,ASREOtlIREDBYSEGTION ^ O Q _ 77000FiMElAF70NCO0E,fORTMEPENFORMANCEOFTHEWORKFORWMICNiH15VER/A1TI5 / ISSUED.MYWORKE�$COAIPENSAtIONINSURAN'y/�C�u/��RIERlWD�P1O�LICVNUMOERME: CONSTFiUCTION l/. � jCANRiEN.f_:.L_L��IJ)L�� r,�S/4 ,�!�1�'N�/�tt�`t� PLANREVIEW Z POLICYNUMOER�� ELECTRIC Q � � (fH55ECfCNNEmNOTBCCU.T1.EfEDOFi1EPEPo.R6fdiCNEHJ�C(1CD sp;aol 1E554 PLUMQING Z I CERTIFY iHA7 N h1E PERFORMANLE OFT7[WORK FOR WMIGN THIS PERMIT IS ISSUFA.1 MECHANICAL � SHALLNOTEMPLdYANYGEfi50NINANYMANNEfl50A5TOBELOMESU&IELi70TME ' � WOkKEHS'GOMPENSATIONUw50FGALIFORNIA.MlD�GREETHATIFISNOULDBELOME INSPECTIONFEE ' S 54alECTT07HEWORNERS'WMPENSATqNPRON510N50F5ECT1ON77000FTHElABOR COOE, M iORTHWITHCOMPLYMAiHiN EP DNS.• ISSUANCE �� " p DATE:� 9 APPLICANi,. � SMIP � J WRPNINGFAM1 ETOSEWREWORKERS'CAAIPENSA710NCOYEHAGEISUN ,WFUL.ANDSNALLBE ENERGVPlC � � SUBIECiANEMPLOYEflTOCRINW�IPENALTIESANDCMLFWESUPTOONEHUNDNCDTMOU5MID ENERGYPERMIT � �„ OOLLARS(fta0.000),WADDITONTOTHECOSTOFCOMPENS�fION.DAMAGE5A5iROVIDEDFORIN � I �J SECTqN7]oeOFTHEUBOHCODE,NTEREST,ANOATfORNEY5FEE5. 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' ' ' � � ' , tNSPECTION RECORD � � - � � � , � . � � �: • � � • c • ' � o � � � - SET BACK: ' � - \ ' FLOOR JOIST � _ - - � FTGSlFORMS/STEEL - FHA REQMTS � � • - - � ELECTRIC GROUND UNDER FLOOR DUCT � � - - • GROUND PLUMBING UNDER FLOOR COf�IDUl7 • • - ' SLAB GRADE - � - - ' FIREPLACE FOUNDATION _ � TEMP POWER - - -- -� FIREPLACE BOND BEAM ' � �- - - ` • WATER SERVICE' � - " ' � MID HT.BOND BEAM � ' • ' ROOF SH�ATHING � .2 � P- � 8 FT.BOND BEAM . . ' � FRADAINGNENTILIATI�N `�` FINAI.BOND BEAM - ROOF COVER - /`'.� PRE-GRADING ' � • ROUGH HEATING�- , " BENCHWG " ' � ROUGH ELECTRIC - - ROUGH GRADING ROUGH PLUMBING -' FINISH GRADING . • SHOWERlTUBTEST " " ' POOLELECTRIC EXT.LATH/SIDING ,�` POOI.FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. . DRYWALL NAILING � DEDICATIONS ' SEWER_ _ .. FINAL ENG. , � SEPTIC TANK LANDSCAPE/IRRIG. SEEP PITlL.L. - _.. --- ' - .. ON SITE IMPS. GAS AIR TEST �- FINAL ZONING � � � . FINAL CONST: - f� - FIRE DEPT.FINAL � �FINALHEATING- � - HEALTH DEPT.FINAL . - F1NAL ELECTRIC - - - � DEV.FEES PAID - . . FINAL PLUMBING ENERGY , ' . , ti � • e � • –• . . - ------.---- • •----- - . ... . - � . - ,J�i.,l', .`, , i COMMENTS -- - - - _.. _ . ; �: .i , - - - � . , . . . , � ,.�' `��1 `: � � � � - . � :. 1 'r' �n' ,c-- ' � 1 i'� - - `��..E�+�.�G j , . '_ , � . " — .uJ • _ .. . -i��_1! r. -,. , " , SEPTIC TAf�FK SIZE ' 1' `"_. : . _ . SEEP PIT/U SIZE - , . - • . , ., ,. . � _ . . _ , ' � �f o !�,�� _,y1. -o p O _ .$h .�12 , � .,' - C — li o, =�"1 . "°.� 1'r � ., , � - . -- � . 1 � � ,_ � � , • – lo Y �