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SITE-WORK DATE ID/SIG.COMMENTS <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 />lnsu latio n/Energ y <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 />l r>. <br />FINAL I 0lLLlt\wno <br />Certificate of Occupancy I <br />Notes, Remarks, Etc <br />O*n..aui|&r D.clrBrio. <br />I herehyamrn under pen.hyolperjury rhrt I aD.x.mpt form rheConractoB L'censetlwlorlhefollowinsr6son(je.?Oll5Busin.s <br />&d Prol6siotr Cod.): Any City or counry*hrch rcqutd a D.nnir ro.oBrtud. rlicr. i'nprore d.molish or..ran rny ntucrur.. pnor ro is <br />issuancc. also lcquir.s rh.appli.anr lorsuch pcrmil to nhasirn.d srarcncnl lhat heorshc n lc.nscd puuudr ro thc pmvtins ot ih. <br />Conrrdois L'ceB.d h* (Ch'pi{e. Conrm.nc'n! * hS.cron70ooofDrvsD.Iofrh.BusrnBsindprof.sroBCod.)o.rhlrh.or <br />sh. is cx.,npr rhd.rion and lhc brst lor th. sllc8cd.r.,nprion Any viol!lion ofScction 70lt 5 by any applicrnr ror. p.mir subj.crs rhc <br />rppli.d.r r., cililp.o0hy of nor morc rhm nr. hundrtd dollm (9500). <br />1.6 own.rofthc prop.dy. orfry c'nrlo)c6sithwis.sas rh.n soh comp.ns.rion. will do rhcIorkandrficslruclurc is nor inl.nd.d <br />or orT..cd for *le ( Sd 70-4,1, BurnBs rnd Profesnois Cod. Tht Conhcrois Lic€nr. tlw do6 nor rprly to in oqns ofrh. prop.d, <br />wh. buildso! inDrovesrhdsr. md who do.s slch work hims.llorhas.laorrhrou8hhisorh.,owncmploy.6. providcd rh.rsuch <br />improv.m. s e. nol inl.nd.d or o,Icr.d for $1..It how.!rr, thc buildrs or improvcm.fl G sold wirhin one y.ror.d6pldion. $. <br />Orn.FBuild.r will hav. rh. bnrd.n oaprolinS thar h. or sh. nor build or Lnprovc for rnc purporcoasaL). <br />I.asosndofrh.propcny. am cx.hEivcry conradin! eirh tic.ns.d conhcros to consrErr rh. pro]d ( Sec.7044. Btrsir.ss.nd <br />ProLsionCode'lheConkrdoisLicensel.sdo.snorapplyroanownrofpropenvwhobu'ldsormprov6t|eroi,lndwho <br />conracts ldr such pror(h wrhsConracro(s) ticens.d pureuni rorheConkacrois L'cens.liw ) <br />_I m.x.mpt @dd S.crion __.8. & P,C. ror thi. i6on. <br />D.r.r Owns: <br />\vORl(NRS CO[IP[NSA'I ION Df CLARATION <br />I hercby amn undcr penalr, olperjurr- on. olrh. aollo{'ng d(larat'06: <br />I h{!c and sill mtrinttrin a C.ni6..t. otCoNenr ro S.ll-tisurc lor worke6'conrp.nsr'on. as prov'ded ror by S.crLon rToo otrtp <br />hbor cod., ror rhe p.rrortunc! olrn. qork forvhich ihc p.r6il ir LsEd <br />I haveand will niartar workeB compenslio. iosurincc, as requtred by Secr'on 1700 ofrhe tlborCod€, fo. rhe pslomrnc.oathc <br />work for wh'ch rh't lsnnl 6 $u.d My *orkes emp.nsron tuutrc. .Mier dd p.lry nunbcr &c <br />Exrt s <br />(Tht s.crion nc.d nol b. compldcd ifrhc p.rmn is ror O.. hundr.d dollan 1gl00l o! lcs, <br />I ccnify rh, i! lh. p.rfomncc of th. rvorl for rhi.h rhis p.mit is isucd,I shallnor onplot a.y p.so, i. any m0nner nr as ro <br />btrrm.subrcciIorhc*o e.s anpensarion lrws olCal'forn'a. sndoSre.th.t rfl should hccomcsubl.d rorh.wo*e6 <br />compcflsarionprovisio.sors..rionlT00orrhcl.borCod..lshall.fonhtrhhcomplywnhrhos.pNvtions <br />WARNING Fa'lurerD seut worl.ts coDre,s.iioncov.rageisunbwful,indshrllsubrccran.n,ployerlocriminalpcnalticsandciil <br />fin6 up ro on hmdr.dthoBanddolles{$100.000),inlddnionrorh.conorco.rr.sslion,daro!.s6provid.dforrh.Sarion1076or <br />rh. ljbor Code, i,id.i rnd r orney s les <br />LI('ENSED (]ONTRA(TO&S DECLAIIATION <br />I h6.b, rilinn und.r pcmh} orprjury th.t l.m licrns.d u.d.r pm\isio6 orCh,prd 9 (colroctrcios Iirh S€clion 7000)oiDivision I or <br />rh. ausincss snd 0rcfessionsCod.. and m),licc.s. is in ltrll forc. dnd cff.cl <br />CONSTRUCTION I,ENDINC ACENCY <br />I hGbyamm und.rp.@lryofpsjuryrhal thd. kacoNrructio. Lndin!r!.ncy ror rh. pdfomnc. olrhcwo lor which rhn p.mir i! <br />issu.d{Scc 3097. Civ. C ) <br />d!t!!ca!Lr!oEg!aaar.!9N <br />D.molirio. P.rmirl^sb.nos No!ficaron Fcd.dl R.sular'ons (1 nI.,10. Pin 6) <br />R.quir.d l.llcr otNotifi cation <br />lc.niaylhar lhe lad.ral rcgul io.s r.grdingdbcslos r.movalare norappli.able ro rhis prqd <br />I ccnifyrhat I har. r.adrhh.ppli..lion ind slalc lhal lh. above inlonn.ttun is concd.l urc.roco,nply$nhall( ity and Counry <br />ordin.ncB and Slarc L,*s r.larins ro building .oturtu.non. and h.r.by authonz. rcpr.s.nrlliv.s oirhn Cirr.nd Cornrr lo cnr.r upon tt <br />abo\c mcnlioncd prop.ny lor insldio.purpos6 <br />Aptli.mt oralol3ig..IP.rmnr.. n.n. (prinr) <br />BUILDING. INSPECTOR RECORD <br />-- <br />MlWP5l\Permit-lnspecIon s\Alildioglnspection Record doc 03 31 06