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SITE-WORK tD/srG COMMENTS OWNEN BUII,DER DELCARA-I-ION <br />I hdcby amirn udd pdalty of p.rjury rha' I tun .rc'nfl ftum <br />'hc <br />Conlr.clo6 t,icc.sc ljw for rlr follo*in8 r.&n (sLr 7011.5 <br />Busin6s and Prof6sion Code): Aoy Cily or Conrny which r.quts a p€rnil 16 conslrucr, alrs. impovq dmolish or rq.tr ry <br />srtucrue, prir ro ns isudc.. also r.qri6 rh. appli.dr aor such Fnni' ro fil€ a si8n.d sratmdl thar hc or sn. n licc$rl Pmnsr <br />ro !h. povtioB ofth. Conractd s Lic.ns.d L!* (Chaptr 9. Coo,n.n.ing wnh Serion 7000 of Division I ollhc Ausins dd <br />Prolc$ions Co.l.) or lhar hc or 3h. is .rdnpt rh6.arom dd rlE b.sis lor thc alles.d cxflplion Any violalion ofS.dion 7011.5 b, any <br />applicanlfo,.pcnnilsubjclsth.applicanltoacivilp6ahyoanormor.th fiye huoded doll&s ($500). <br />-I, <br />s owod ofrh. troFny, oi m, anplors wit wa86 4 $eir eL .onrp6srio.. wil do th€ *olt d the slruclu€ i nol <br />inrdrdol or olI6.d for el. (Se.7044. Busir6s dd Prolsions Code Thc Co.rEcIors Licosc Llw 1106 nor apply ro m ovnd of <br />thcprop.ny {ho builik or iqro!6 rh@.. rnd sho do6 such Mrt hiNlf or h6.lf or rhmu8h his o. hd oM .nployG, <br />provid€d tho! slch inprc\qMts e mr inrcdaj or otrald aor $L. lf, how6'6. l!. hlidiu or niprovml b eB wnhin o,. y@ <br />ofohpldiotr lh. o\,M Buildq will harc th. bu&n ofprovins rhd h. or shc dil ml tlild or impmvc thc plpgry lor rtE FnFs or <br />l, 6 own6 oa$c pmp6ty. m crclEively conrractins with licosqj coarralloB lo coBrtuc h. Foj..l {Sd. 7Or4. Burr6 <br />and lhftsioi Cod.: Th€ co.rrcror's Lic.ns. Law do6 oor apply ro a o*nd .lproFny who builds or improv6 rh€r@n, <br />md who coitracts for such p{oje.rsvilta Conrra.lo(, licds.d pu6wr ro thc conrador's Li.se b{) <br />-l <br />M .xempl undd S6lion- B. & P C for lhis !6on <br />D.l. o*n6: <br />]totraErs:lllluilldrla! <br />l|EclAAAIlA! <br />I hoeby Aflirn under pcnalryofpdjulyDn. olrhr follosi.s deldarions <br />I h.rc ed *ill m.imain , Cdilicd. oacooknl ro Selarmurc for uorleru' @nD.nration, 6 prorid.d fo. by s.rion l?Co o f thc <br />L!ho, Con., for lh. pdloFEcc ollh. worl aor {hi.h rh. ponir i! suel <br />_lh.(andwillmaimainwo.kescomp.ns.lioninsurance,srcqutedbySslionlT00ofrheliborCode.lorthcpnfontrmccol <br />rhe work foi snich rhG pdnt is isual. My workBr co,npd,rion insurmc€ cnicr ond policy nunbs e.: <br />-l <br />ccnilylhar in Ihc psfo@ncc oflh. *ork lor which lhis pshn is nsu.n.l shallnol qrplo, an' p6on in anymdnd <br />$ 6lo b..ome sobjer ro thc soi(6 comp.Bation la$ s o I Crlilomi.. d asla thal ifIshouldbccodcsubjdtroth. <br />trorlB' compcnsation polisioB of S.dion l?00 ol lhc tjbor Code, I slEll. tunhN(h comply wilh lho* a/olisio6 <br />wAtlNlNG: Failur€ to sure wortq, conposatnrn covqasc 6 unla$lul, and shall subjd m dnployer lo oiminal Fd6 &d <br />cril fin6 up b one hunded lheusand do!16 (5100.000). in addnion llJ rhc cos .t comp.nsalion. darnas.s 6 r,rovidcd lor lhc <br />S(tion 1076 olthe Lsbor Cod.. iird6l ed anoifty's r€6 <br />ADplimnri <br />IICENJiID.(:ONIBAEIOA <br />DIiCIAEAIION <br />I hd.ny ami,n und6 p€nah! olpsjury rhd I m lia6.d undd Fovision oactaDt6I (connocin[ wnh sdtud ]0o0) ofDivision l <br />oa rhe Busin6s dd ProfeioN cod., ed my li..M i! in tull for.e md eIIEi. <br />Lic.6e CIN: Li..6c Nu,nbe: <br />corirf,lJglQdr.r;lDllc-acllcr <br />I hcEby amrnr trnds peralry o I pcrjury thal rh6c is a coGrto.t{n lc.ding re.nc, for lh. prfommc. oilhc \orl aor \yni.h rhh Fnnn is <br />issued (Sd.1097, Civ. C.). <br />ATTII(ANT.AI:(:IAAAIIAN <br />lkryaflimrunder pqalty olnrjuyonc orth. follovins d(l alions: <br />D.molniod Pmns-Asbesos Norificarion l-€deral RcsulalioN (1 ille.l0. Pan6) <br />-Reqtrted <br />Lelter of Norincalion <br />I.orilr rhar rhe ledcralr.gtrlartrns rcBddi.U slsros onolal c nol opplicable ro rhis prejsr <br />I cdifr rhar I hav. rcdd rhis application dd sralcnd rhc.bovc inlonnation 6 coodl.I asre ro corpl, $ilh trllCil) and County <br />ordina..c and srar. ljws Elatins to bu ilditrs consrruction. dd hmby aurhonz€ rcrre$rai ir6 . athb Cn, d Couoly ro qrs uDon lh€ <br />abole norioocd popcny for iGpdion pripos <br />.\pfliu r or ,\gdt SiA rt,r. <br />P.rn hR nrmc tpnno: <br />Forms/Steel/Holdowns I ,1 ) <br />Erection Pads [0r t9 U r-[rr,toqc / <br />UFER Ground D\ <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathing p tt t9't?tAAar^J()/ <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 />De puty Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL lol a,'+Nqdl 2r\) <br />Certificate of Occupancy rl AI "=- <br />Notes, Remarks, Etc <br />BUILDING- INSPECTOR RECORD <br />DATE <br />Set Backs <br />----T------