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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUITDER DELCAR,{TION <br />I hd.br rftnr unds p.nalty ofpdjury lhal I M cr€ rpl arom rfu Contdo6 Licds. Lw forlhc lollosing r.en (S(70.11.: <br />A6in6s dd Prol6sion Cod.): Aoy Cily or ( ounr, shi.h requts a pomil to coNruct alld, inptolc damlish or Epan my <br />srrud@, pim b ns irsuMce, .lso rcaunB rh. applicst tor such pcmi !o fiI. , .isn.d ddar thrt fic or dE b liccns.d plNall <br />io rlE FolisioN ofrh. Conrackr's Li.c.s.n tjw (Cfiogd 9, Commcncins *ith Selion 7009 of Divbion I oflh. Busins md <br />Prcfesb6 codc) or thd n. or sh€ is cxcmrl ths€fron uJ the b.sn fot Oc all+.d danplior. Any viol,lion ols.clion 703 1.5 by dy <br />appli.afl fora p6nir subjetsthc applic&t ro a.ivit pc.alryof.or,nor.thm fiv. hundr€d dollas {$500). <br />l. s ornr olrh. FoFny, or oy .mplor6 with *ae6 6 rh.ir el. compeis.iion. will do tlE wo.l &d lhc sME b m' <br />mhd.d or o,Is.d for el. (S* ?044. B6ins 6d hlf.sioN Code Th. Contradoa3 LictM tiw doe rol eply lo d oM6 of <br />rh.p6Fiy $ ho hildr or improvB rlE6r ad who do6 $cn N& him.lr o' h.&lf or ihmush tis or hq oM .mDloy.6. <br />providcd lhll ruch iiFovo6a e. rcl inraddl or oftdql for sl.. ll hows. th. tuiBiir or i"'prD!.nd t $ld qitnin on ,Er <br />ofcompldr.. th. Owos Builda sin havc rh. bu.do otFoviis thal tE or !n did lot hild or inFov.lnc FnDdy for th. Ftrpoc of <br />I, ar o\vnd nfrhc prepsly m cr.lusrrcly cohba.ri.e sirh li.msed conlractos io mNlrucl lhc Foj.cr (s(. 7044, BcmN <br />and PlDa6ion cod.: Th. Cont.cro.s Liccnsc Laq do6 nol applyto e ov.6 oatropdywho builds or impro!6 thq@n, <br />a.d $ho conrrds tor such lrojcrs *irh a Co.bac'o(, lic.is.d puuml lo lhcCo.'l,elu s Lictue La*) <br />-l m.rcnpr unddsdnJn . B. & P.C. lor lhis r6on. <br />uaBaEs[cQMtrrsAIIo! <br />DDCIABAIIAN <br />! hdcby altrm und.r Fnah, ot p€rl!ry on. ot Ihc lollouins dcldalioB: <br />-l <br />have ed will @iniai. 6 C.nincat. of Cosdl to Selil6urc fo! work6 ampderion, piolided for bySelion 1700olthc <br />tibor Cod€. lor the psfomdcc of the {ort for which rhc pmn is issx.d <br />-l <br />ha!. sd will nEihrai. wolkd co,npcnsaliotr insurancc, s r€quircd by Setion 1700 oarnl rjbor Cod€. fot lhc paaom ccoa <br />t cdriryrhal in th€ Ffomn.. of rhc wor* fo, which lhir Fnil is isu€d, I shall nol Gmploy &y Fson in any msnd <br />s d lo hqo6. rnbjct lo thc snl6' conposliotr laps olcaiifomia. ed aS@ rhd if I dEuld baom. subjdt lo lhc <br />wort6'conp.MrionproisioBoisc.rionl?00oflheLalorCodetsnallfonhwilhcomplrwilhthospmvisioro <br />WARNINC: Failu. ro su. w..t6' comFMrion coldB. is ! awtul. d 3hall 3ubjdt m mplorq ro Eimin.l Frtis ed <br />ciil fi..s up ro onc hundr.d rhousd dollm (t100.000), in addnio. to th. con ol c.np.Ntion. d{886 a prcvidcd for lhc <br />skrnii 1076.frl[ l16.r adl. inrdniandar <br />t< Z..vt 5 I >-z <br />I htr by aili.n uod6 pnalry of pcrjory rhd I ar lic.oecd indd prcvision of Chafld I {cormm.ing snn s..li.n 7000) oa Division l <br />ol rh. BNin6 d Protsiod Cod€. dd ny l(dc is in tull turc. dd.fld. <br />Las qqsE <br />W <br />I h@by omft u.dcr Fmny of pdju.y rh{i ilrm is a connruclion lcndins asdcy for lh. pnfommc. oath. wrt lor whjch this p6nil is <br />issu.d (S€c 1097, Civ. C.). <br />AIfI.TCAI{LDIC]I8AIIOI <br />I hotby aFm undd Fnaxy ol pdury 06. oath. aollo{i,s del[al iors: <br />D€'nohion Pmirv^rbdos No'i6c,tion l:.ddal RcBulatiom (TnE ,r0. Pdl6) <br />Rcqured LdlaolNorifi .ario. <br />I cdi& rhd rhc f.ddal resular iom r.sddins sbBtos rdoval d. .ot agplic.bl. to lhis p,ojdl. <br />I c61i8 thal I havc rdd rhisaprlica'ion od st,tcrh.r fic.bo\c infomulion s cotrecr. I asic ro comply wnh allCilr.nd Counly <br />oldinanc6 dd Srdr.t ** clainE ro hildinS consirucriotr ad aurhorn! rep.Mrarivd oafiis City Md Cou.ty lo qls {pon lh. <br />ab.ve nBlioned pmpe^y tor l2tqt n,\pplicint or,\Eent SiEnnltr <br />o €.r:y <br />Forms/Steel/Holdowns <br />Erection Pads <br />LJFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulalion/Enerqy <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 />Enqineer Final Report <br />Flood Zone Certif. <br />FINAL z/z;z/24),tMt;- <br />Certificate of Occu nc <br />Notes, Remarks, Etc <br />Set Backs <br />"ilrz+n/ I \ <br />a"."*a,*. t I,,,. :1zJg1 8 <br />A <br />c.l\ <br />fT