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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG COMMENTS Ow-Buildd D6l&tion <br />I hccby rfhrm undcr pculty of pejury thrt t u qompt fom tho Cont scroE' Lic4s hw for tbc following rGetr (te.7031 5 Buinsr <br />urd profcrion Cortc): Ary City or County which rc4uira a pcrmit to oEtrucl rltct, improrc, demlilh or rcprir rny ttnctuc, priot to iE <br />i$uncq .lro rcquirB thaappliont for nclr p{mit to ,ilc r tigrcd rtdffit that hc or rhc i lierocd putuDt tro l[0 provishu of thc <br />Coilncror'! Liercd Llw (Chlprd 9, Commsrsin8 with SElion 7000 ofDiviiioo 3 ofthe Eurinst cnd ProfssioE Codc) or thrt hc or <br />shciremptthcrc&omrndthcharisforthcrllcScdqcmption.AnyviolrtionofScaion7031.5bymyrppliontfor!pmittubjcct thc <br />eppliont to r civil pculty ofnot morc thrn livc hundrcd dolhr (t500). <br />-I, <br />u oM6 of tha propcny, or my cmploys with EBs rt their rolo comlcnutio[ <br />;;ff6cd for Elc ( Sw.7d44, Burims rnd Profslioro Codc; Thc Contrrdor't Liemc Lsw do6 not apply to m oma of thc proporty <br />$,ho boildr or inprov6 tluorq ud who doc rwl work himclf or hmlf or tluough his or ha om cmploycol proviiod thrt rucb <br />improvcmonts ari rct inrcndcd or offqcd for ulc. I(, howcvor, thc building or improvcmcil. ir sold withia onG yar of @mplstion, thc <br />Ow-Buildq will hrw the budo of proving that hc or rhc mt build or improvo for thc purpos of rlc). <br />_I, u oma of tlrc prop6ty, rm dcluivcty @ot[diDg with li@iled @ntrsqtort to oEtruct the Ptoi4t ( Scc. 7044, Buiaq ud <br />F6-fsbn Codc: T'lrc Cotmcor't Limo hw du mt rpply to e ow of propoty who build, or improu thson , rnd wto <br />onrrcr for ruch projcas wirh r Contnclo(s) licoGd plrotrt to thr Cordndot't Lim bw.). <br />I m qmDt unds S@tiotr .8. & P.C. fo] thi! ruotr <br />P16; OwE:- <br />WONKERS COMPENSATION DECLAAATION <br />I tschy rffm urds pculty of pqjury om of tho fotbwiag dchntior: <br />_IhrvorndwillmrinuintCdtifi6t6ofCorentoSclf-IuuroforwrLar'omporrtiot\u providcdforbySctiorST00ofthc <br />bbor Codc for thc prfomne of tlrc rcrk for *hich thc Pqnit ir isucd <br />_I hrvo rnd will maintain workqs' @mPeBatiotr irouancq u <br />work for which thir pcrmit ir isrucd. My workm' compcmtion <br />rcquircd by Scction 3700 of the bbor Codq for thc pcformno of thc <br />irouue canic md policy numba rrc: <br />Policy <br />(Ihir rcrion oed not bc @mplacd pomit ir for Orc hundrcd dollan {$l0o} or Iu) <br />I 6tify fut in t[ pcrformn* of dr mrk for utich thir pcrmit ir ixucd, I *rll not mploy uy pcnon in uy Mnd s I to <br />bcqmc rubjoa o tho wrks ' ompcn$tion hu of Cdifomie, md r8r* thst if I thould bccom subjoct to tho wotk4' <br />mmpenrdion provirioru ofScclion 37oo ofthc labor Codq I rhall, forrhwith 6mply with tiorc provisions . <br />WARNING: Fdtuc to !@ro workqs' @mpflrtion ovdrgc ia uahwful, ud rhell tubj*t m mployq to qimiml porltig rnd civil <br />fina up o orc hundrod thoud douu (t100,000).in eddnion to thc ost of ompcrutior\ drmga u provilod for tlr Sction 3076 of <br />rlE IJbor Codq inrqdt.trd roomy't f€. <br />LICENSED CONTRACTOR,S DECLARATION <br />I hscby lfiirm undq polty of prryy tlrrt I m tienred unds pro6ion of Chrprq 9 (@mming whh S*rion 700O) of Division 3 of <br />thc Burinot rd Profotioro Codc, rnd my licw ir in full fore and offot <br />Li@BG Clrs:- LicGNc Numbq <br />- <br />Drtc: Coiltrdot: <br />CONSTRUCTION LEIYDING AGENCY <br />I haoby rfirm unda pcnrlty of pajury that thsc ir r outnrction lcnding rgcrcy for thc pcrformne of t}c worh for which thir pcrmit ir <br />Civ. C.). <br />lrndq's Addr6: <br />ATEI.ICANIILDECIIBAIIAN <br />Dmlition PamiB-Arb.rtot Notiliotior Fodc0l Rcguletioor (Ii& 4q Prft 6) <br />_ Rcquircd l*ca of Notifiotion <br />I dti& tlut th! fodarl rcjulrtioru rqrding ub6tot r@nl rro not tpPlicrblo !o thb proicca <br />_ I stry dLt I hrvc rad thl .pplietion ud rtrtc thlr thc rbow informdion L coro.t I rSta !o 6mply yhh dl City rnd Couty <br />ordi[rcq rtrd Strt6 Lrw rclrtmg to building outrudiot\ rnd htroby .uoDriro rGprdontstircs of thn C[y md Couty to cotc. upon tho <br />rbovc mcntioned propqty for iEpetion pupos <br />ApDlient or rgat rig.: D{c:- <br />Pmiuenm(print): <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SISB Floor <br />SubfloorA/enulnsul. <br />Roof Sheathing <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 />t <br />F!NAL /tq/tz-4#1n IT-r 7-WCertificate of Occupancy <br />Notes, Remarks, Etc. <br />Shear Wall