Laserfiche WebLink
BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS ()IVNI]R BUII,I)ER t'EI,CARATI(-'N <br />I hcrchy nlltrm undcr pcnilty of pcrjury thrt I am c\cDrpl liltnr lhc (:ontrackns Liccnsc Lrw li)r lhc lbllowtrrg rcasu (Scc.70.11.5 <br />Irusi,tcss {Dd Prolcssion Crxle): Any City or County whirh rcquitc\ a fcrnril lo ronstruct. altcr. improvc. dcrnrrlish or rcpuir any <br />shlt(ttrr-,pri()rloits isstrancc,alsorcquircsthcllpliednlii,rsuchFrnlitk)lilcasi8ncdstatcmcnl lhrthcorshcisliccnscd pursinnt <br />k) lhc pfi)visi(nls of thc Contrrck)r's Liccnscd l-aw (Chaflcr 9. (i)mnrcncing wilh Sccti()n 700{) of Divisiril -} ot thc Ilusincss atd <br />rpplicxnrl{}rtlErntitsuhicctsthc applicantk)rcivilpcnallyol-nr)lnn)rclhailfivchundrcddollars($5(X)). <br />_1. as (,wncr ol't he proFrcrly. or my cmpl)yccs wilh wagcs rs lhcil solc e oillpcnsal i()n. will do thc work and lhc stntcltw is nol <br />uilcnd&l orollcrcdli)rsrlc(Se-.T044.BusincssandProltssionsCodc: l-hcC(nilraclor'sLiccnscLawdocsnolapplylonnowncrol' <br />thc fn)l^-rly who huilds or improvcs tlrcB)n, drl who d(Es sue h wo* himscll or hcrsclf or through his or hcr own cntploycc\, <br />provid(l that such imfrovcnEnts m ftil intcrrdcd or otlircd lor s!lc. Il: howcvcr. thc huildiDg or impnrvcrrcnl is soll wilhin rnrc yctr <br />ol'contpbli(nr. tlR Owncr Buildcr will havc lhc hurdcn of provulS lhal lrc or shc did n)l huild or improvc thc Jn)lfry li)r lhc puqr)s (]f <br />_1. !s owncr ol lhc prolrcdy, am c\clusivcly conlracting wilh lrccnscd c()nlraelors lo conslruct thc p()Fct (Scc. 7044, Bu\irrc\\ <br />arrd Prrltssirn Codc: 'fhc Contractor's Liccnse l,aw docs not rpply k) an owner ofproFrty who huilds or improvcs lhcrcon, <br />lnd who c()ntrxcls ti)r such projccts wilh a Contracl)r(s) liccnscd pur{uant k) Ihe Clontrrck)r's Liccnsc llw). <br />I rD) c\crnDt undcr Scctiirn , Il. & P.C. tirr this re$otr. <br />lVORKER,S' CONIPI'NSATION <br />I)!]CI,ARATION <br />l hcrchy allirnr unrlcr pcnxlty ol pcrjury onc oflhc lblhwirrg dcclrratirrns: <br />l2{nvcttnlwillmnintainrCcrliljc{teofCotrscDtk)SclLlnsurcli)rworkcrs compcnsalion.as proviilcdlorbyScelx[.]7(X)o1 lhc <br />t-abor Coilc. Ior thc pcrfi)nlancc oflhc work lor which lhc pcrnril is issucd. <br />will nrrinlain workers'i()nills0rrn(c.as rcquirc(lhySccti(,n.l70Oofthcl-xbrnCodc.li)rlhcfcrli)rDlincc(!tI hxv(' an(l <br />lhc w(trk l(n is issucd.insurancc canicr anrJ policy nunrbcr uc: <br />1/r/=ol'olicy <br />_l ccflily that in thc l--rli)rmancc o[ thc work lor whrch thi( pcrnlrt is isruc<I. I shall not cmploy any Fcrson in any nranncr <br />$i) r{ k) bccoillc suh}cct k) thc workers conlpcnsali()n lnws ol'Cxlilinrir, rnd agrcc thal il I sh()uld hce()nrc suhjcct nr thc <br />workcrs'(onrpcn\rli)nprovisionsofScction-l70oollhcl-ah)rC(xlc,lshall.li)rlhwithcomplywilllthoscprovi\(rns. <br />IVARNIN(;: l;ailurc k, sccurc workcrs'c()mpcnsrlion covcraSc is unldwtirl. xnd shall suhje(l an cnlployer lo climinal Frmllics and <br />crvil line's up to (!nc huntlrcJ thonsand dollrrs ($l(x).(xx)), m rd(lilxnr l()of compensdti(il. danragcs as providcd li)r lhc <br />ilt)rDcy s l'cc\. <br />I herchy al I ir nr unrltr lurlly r)l l)cr iur y lhxl I trrr lt(tn\c,l utrlcr llr()!isir)rr 9 (conlmencing wilh St'etion 7(XXl) ol Division .1 <br />r)l thc Bu\rnc\{ rril l,n)lc\sx)ns C()(l!'. rrrl my |ctrrsc l\ flr lull li)r(c itr(l ('lli'cl. <br />l.iecnsc ( lass:NuDllrr: <br />I)illc <br />CCINS'TRUCl'IoN I,I,]NDIN(; AGENCY <br />issucd (Scc. -1097, Civ. C.). <br />[andcr's Namc: <br />l,cn(lcr'\ Arl(irc(si <br />APPLICANT I)ECLARATION <br />I hch..by allirm unilcr pcnrlty oI pcrjury onc of thc Ii)llowinII dcehrxtions: <br />Dcmolilion l'crnlils-Asbcsk)s Notilication Fcdcral Rcluhtions ('l illc 4{), P{I16) <br />-Rcqrircd <br />lrtlcr ol Nrililicaton <br />_l ccrlili lhal lhc tcdcralrcgulations rc8uding ashcslos rcnt)v!lnrc nol applicahlc k) this pr+ci. <br />_l ccrtily thrt I hsvc rcad this application ilkl slalc thrl thc ah)vc inlbrnlrli([ is corcct. I as@ k) comply <br />ordinanccs an'l Slatc Laws rclding b building conslruclion, nlj hcrchy autk)ruc rcprcsentativcs of this Cily <br />with all City and Counly <br />to cnlcr uF)n thc <br />atx)vc mntioncd lrolEny for inspectionu( <br />Applicsnl o. Agent <br />Itcrilril(a.nililrc <br />rnd <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsu lation <br />Roof Sheathino <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[Vasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />FINAL 7-2{ -2o2o Jda{r{,@ <br />Certificate of Occupancy <br />Notes, Remarks, Etc