Laserfiche WebLink
DATE ID/SIG.COMMENTSSITE.WORK <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsu lation <br />Roof Sheathino <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lMasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enoineer Final Report <br />Flood Zone Certif <br />I I I <br />7/ 2/ /4tlt.*1'z lt IF!NAL <br />Certificate of Occupancy / - 'v <br />Notes, Remarks, Etc <br />-+ <br />BUILDING. INSPECTOR RECORD <br />I hcrrhy alllrm uilcr Nntlly ()l pciury lhat I arr cxcmpl li1)m lhc Conlrack)rs l-iccnsc l-aw li)r lhc tollowirlp rcasr)tr (Scc.70-11.5 <br />IlusiDcss anJ l)ro['ssrrn (ixlc): Any City or County which rc(luircs a ncrillil kr crnrslruct, altcr. imp()vc, dcnx)lish or rcptir any <br />to thc pft)\'isi(Ds ol'tlE Contractix s l-iccnscd Law (Chrplcr 9. (ommcncing wilh Scclion 7U)0 of Divisioi J ol'lhc Bu\irlcss riD(l <br />ipplicatrtiortNrmitsuhjcetsthc lpplicanlk)acivilpcnillyolnotnx)rcthdnlivchunrlrcddollars(S5il)1. <br />_1. as rlwncr ol t hc pnrpctl y. or nly c nlpk)yecs with wrgcs rr tlrcir solc corlpcnsaliur. will ,lo lhc w(n k afil lhc slnrclurc i\ ilil <br />thcptr)ff,ny wh()huildsoriilprrvcslhcrcon.atr(lwh)d{rssuchwrkhinrsr'll'orherscllorthnrughhisorhcrowncurployccs. <br />salc). <br />_1. x\ ()wncr ()l'lhc pfi)pcny. inr c\chsivcly crnilrictin8 wilh lict'nrctl erllraclorr |) con\tntct lhc pll).icct (Scc. 7(I44. Bustrl(-.( <br />and lloll\\imCodc:l'hcConlr{elor's[-i(cDscl-awdr]csnolapplyloiDownrYollropcrlywhobuildsorinrprovcsthercon. <br />ind who ronrr(ts l()r sueh pfi)icrts wilh a Corilracl(il1s) li.cn\cd pursnrnt k! lhc (i)nlrrcl()r's l-iccns!- l-iw). <br />I xrl a\cnlU urklar Sccl B. & ['.(. l(tr'lhr\ rcr\('n. <br />(l*'ner' <br />tvonrsns' coltptns.trF <br />I'ECLARATION <br />I hcrchy allirm undcr I--nnlty oflcrjttry oDc ol thc li)llowi,re dcclxrrtioIs: <br />I htyc {Bl will nuinlnh a Ccdillerlc ol Cr)[\cnt k) Scll:Itr\urc li)r workcrs cr)mltnslli{il. as pi,vtled li)r hy Scclxr .]7(X) (}l thc <br />t-trhor C(xlc. li)r thc pcrli)rmanec ol'lhc work lix which lhc pcrmil is issued. <br />_lhtveandwillnlaintxinworkcrs c(mrpcnsiti(rrirsurancc.as rcquircdhySccli(m-17(Xlollhct-ahorCodc,li)rlhcpcrli)rm{nccof <br />thc work lirr whlch this pcrmi( is issucd. My workcrs conrpansatioD irrsurilnce can'icr an,l Jxrlicy tltmhcr uc: <br />Pohcy Nurnhr'r: ' <br />_l c(.tttly thrt in thc l[rlifnan(c ol thc work li)r which lhi\ lcrnril i( l\sucd. I shxll n()l cnrphry any pcrson ln any n]rnncr <br />\() ts to lrc(nnc suhiccl t() lhc wrn-kcrs ci)nrFnsrlr()n hws ol Crlif)rnri. atJ den'('lhrl il l \h()uld lfc(nnc (ulE'(t to thc <br />IVARNlN(i: l:rilurc lr rr'crrrc N()rkcrs (rtnll)cn\rlir)n (rr\'.lxlc r\l. xDd-shall \uhjccl an onl)lolcr lr) erirninrl l^-nxlli( <br />n\{lir)[. drnrrg('s as prolidrl lirei!il Iirrt's up k) r)nc hundrcd thourand rlollarr 1$10{).(xX)). nr ld llx <br />Srel('!r lO7() ()l lhe l-alxrr (ixlL'. ililcrcsl an(l rlloflNY s <br />i)l thcllu\trrc\\rnLiI'l1,l.s\iorlsCr\lc.rnrltnvltecnrcl\irllullIn(f inJ.llctl. <br />a <br />W <br />issilcd (Scc. .1097. Civ. C.). <br />l.cnrlcr'r Nrntc <br />lrndcr'* A,l,lress: <br />APPI,ICANT DECLARATION <br />I lrNhv allinn undcr IEnrltv of lx dury onc ol thc li)lk)wing dL'clarntioDs: <br />l).nx)lition Pcrnrils-Ashcslos Nolificilli(nr Frcdcrnl RcgUltrlions (-l ille 40. t'n!16) <br />RcqrireJ lJltur ol Nolilicilirl <br />I .crlilv lh.il thc <br />'il"nr.r,'nu,uu'" <br />ttdcral rcSuliti(nls rcgarJitte aseLslos rcn$vnl arc n(il lpl)licablc t) lhis Pfl)icct. <br />rcill thr\ rfpli(rt(),r rD(l \lrle lllrl lhc irlxr\'.wilh rll ( (v rnrl (i)[nly <br />rnri (itrrnlv l() cnlcr ulx)D lh.or(linnnccs rld Slatc l-aws rchlirlg to <br />rh)v(, o(Dlirill.(l Irrl)ciy lor i[(l)ccl(ilr <br />Appli(anl 0r Afrill <br />Itrmrilce n{nre <br />ilx! <br />. <D4ff <br />,^,",, y'lBr/lq <br />,r.-.t-7/./Hiq <br />u^,",, 7y'gy' ?