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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS Ow-Builda Dclantion <br />I tucby rflm unda pculty of psjury thet I u qcmpt fom thc Conrnco[' Lic4c bw for thc following rur (re?03 I . 5 BuilB <br />and hoferion Co&): Any City or County which rcquiro a pemit to coBtruct, rhq, improw, dcmlirh or rcPrL my ttrus'tuq prior to itr <br />itrune, rlro roquiro rhogpliont for ruh Dsmit !o fil! r li8Dcd ttrtffit thrt hc o, the ir liccrocd putunt to tho provirior of thc <br />Contncror'! Liercd hw (Chrptq 9, Commaming with S$tior 7000 of Divirion 3 of thc Buitrs ttrd Profaioro Code) or thrt hc or <br />rhc is mmpt thee&om rrd thc b.tir for thc rllcgcd qcmption .Aay vblrtion of Scction 7031.5 by uy tPpliant fot r PcrBit subjdtt thc <br />rppliont to r civil pouhy of not morc tlun fivc hundrcd dolbr ($500) <br />I. I ow of thc propcrry, or my mploys with uga u thcir rclc ompcmtioq will do tha mrk rnd thc rtructua ir not intodcd <br />ii-offqod for slc ( Se.zog, SuitB md Profssionr Cods Thc Coilr.clor's Li*Nc hw dod not rPply ro u ow of tho propety <br />who hrildr or improvo ths@L .nd who do6 ruch work himclf or h@lf or tkouih hit or hcr ou cmploye, provilcd tlnt rucl <br />improvomats rri rct intsndcd or offcrcd for ralc. It howvu, rhc building or improvcmcnt i5 soH withitr orc ya of omplotion, the <br />Oms-Buildq will hrvc thc burdm of provitrS thar hr or lh6 rct build or improvo for thc purporc of ub). <br />_I, a oMq of rho propsty, rm ficlurivaly @ntncting with li@rcd @otrrctott to @uttud ths projrc ( Scc. 7(X4, Bqinqr rnd <br />F6-fwion Codo: Ttro Contnctor'r Liccroo Irw dG rct rpply to u omq of propqty who builds or improu th6@n , ud who <br />coilrrd! for tuch projcdr witfi r Contncto(r) limcd pwuat !o tbo Coorlctor't Liccue lrw.). <br />-I <br />u dcmpt utrdq Sotion <br />-B. <br />& P.C for thi raotr <br />Date: <br />WORKEBS COMPENSATION DECLANATION <br />I hqcby rflum undc pemlty of pcrjury orc of tho following dclantiom: <br />tbrcrndwillmintrirrCrrrfiqt6ofcoMttosclf-I[ucforwrtm'mmpcurbqu providodforbyScrion3T00ofthe <br />Irbor Codc, for thc psforrone of tlt rcrt for which tho pcmil i! iscd' <br />I hvo rnd will roirtlin worka' @mpmtion iNnffc. u rcquircd by Setion 3700 of thc lrbor Codc, for tlrc paformae of tho <br />-rcrk for which this pamit ir irrucd. My wrlm' @mPcution iurme mic md policy numba uc: <br />Policy <br />Cfhi5 rcction ned mt bc omplaed if thc pmit ir <br />I cdiry thrt ir tlE pcrfom* of thc work for <br />bcerc rubjoc to thc wrLo ' ompcNrtion LB <br />Onc hundrcd dollur {tl00) or lw) <br />which thir pamit ir irucd, I rhrll not mploy my pmon in rny runq s r to <br />of Crlifomir, and rg16 thrt if I rhouH b€orc subj€l to thr wotlo' <br />@mpcnsttion ofScaion 3700 ofrhc lrbor Codo, I 6mply with thoto provisios.. <br />WARNING:to tccutc rcrk6' ompcultioa @vsrgc md lhall tubjet m mploy{ to siniml p6Blti6 rnd civil <br />fins up to one hudrcd thourud dollur (8t00,000),in tddition <br />thc hbor Codc, intq6! rtrd .ttomoy't f€. <br />ost of compeostio4 daroges u providod for thc S*tion 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hacby rffirm undcr pcntty of prjury that I em lieucd uodor prcvirion of ChlptGr 9 (@mmctrcitrB with Sstion 7000) of Divirion 3 of <br />thc Burins rod Profainu Codq md my lieuc ir in full fore rnd ofrca <br />Li@Ec <br />Drtc: <br />I heely efim undr pmlty of pajury that thcc ir r rgcocy pcrformnc of thc work for which thir pamit ir <br />Civ. C.). <br />I4nd6'r Addr6; <br />APPLICANT'S DECLARATION <br />Dcmlition Pmitr-fubqtot Notifiartion Fodml Rrcuhtiou (Titl6 ,{0, Psrt 6) <br />_ Rcqsircd L.n6 of Notifiotion <br />I Etify tlLt tnr fcdml rcgulrtbil rcgrding ubotor rmnl rc rct rPplirbb b rhit P.ojcct <br />this with ell City rnd Couty <br />rbovc mcntiomi propsty for <br />Appliont or Eg6t <br />Pqmitte [mc (print): <br />to <br />purpol4. <br />ul6 upon tho <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enUlnsul. <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt.Lath <br />Brown <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />/1 <br />+4 ,t './ / .r' / <br />FINAL 7.-lgl o7 -r v""tA/ \tlrzY <br />Gertificate of OccupancY / <br />Notes, Remarks, Etc.