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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Erection Pads <br />UFER Ground <br />Subf loor/VenVlnsulation l <br />Rool Sheathin s //:-44ns.itt <br />Shear Wall <br />Framing <br />lnsu lation/Energy <br />Drywall <br />Brown Coat <br />ryIr/ason <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />FINAL zls Dt*t n o \.fi 6a <br />Certif icate ol Occupancy Ir <br />Notes Flem arks, Etc. <br />OWNER BUII,DER DELCARATION <br />I hcrcby rrfinn und.i p.Mlry or Nrjxry rh,r I a .rc'nfl tnnr rhc Conra.lon Liccnk bw lor thc lollowire rcrv'n (Scc70:llt <br />Dusinc$ ,nd Profc$ion Codc) Atry Cit, or Counry shich rcquner a pcnnil ro conslru.l. alrcr improvc- dc.blish r trrt rny <br />slrucrurc. prior l{, ils hsulncc.aho lcqlircs lhc applicrnr for such pcn.ir ro nEasisned {r'cftnr rhrr h.or\h. n lrc.scd puAuonr <br />lo thc pmlirions of rhe Conta.ror's Li.cns.t Lrw (Chrpr.r 9. C.nrm.kirs wirh Scctiotr ,m0 of Division :l ol rhe Bu\incss lnd <br />PmltssionsCodc) orlh.r hcorslE t crcflpt llrrcliofl!trd rh! b.sk tu.lhc ntlc8cd crcn{'lb! Atryviolrrknrors.clioiT0ll5hyltr, <br />rnplicnnr n u tcnnir subFcrsrhc trpplicanr tJ acivil pculryofnor mx. ihrn fiv. hundrcddollars($50O) <br />-1. <br />as owncr ol rhc !o!crty. or nry cmDloyces qirh wo8cs !s l,rcn sob conDen\al ioo. uill do rhc soA ,nl trt stu1r is ml <br />inrcndcd or ofidr.d lor {le (Se.7(N.il. Busincs and Pmicssn,ns Codc Th. Conkr.ttr\ Liccne bw docs mr at y to mosmr ol <br />th. tmp.ny who builds or irumws lhcmn. lnd who des such *rit hmsclfor hcr$lfor thrcuEh his or h.r o*n cmpl.yccs, <br />pmvidcd rhar such i'npmknElt uc mr inrcndd o! oftcRl for $b Il howcrr lh. ttrildirg or ispmwnE is k,ld *irhin orc F{ <br />or compLrion. rhc Owncr Build.r will hlE rnc hndcn of pmviry rhd hc or shc dil tr.r buiH .. inD.otr IIE ImFny for rhc puryn{ oi <br />L rs owftr of th. ln,l).rly, mr.xclxsivcly .onha.ring siih lic.nscd &nrr.hE lo .otrrlrucl lhl pr+cl (Scc 7(}|1. Buri,tcs <br />rnd PnrssionCodc:ThcConrEroist-iccns.l,awdocsnoriDplyb.nowrcrorpror.n,whohxildsornnpii'vcsthcrcon. <br />itrd who <, nds lor such pmjcB wirh 0 On hcb(9 liccnsd lursunr ro rhc Co.rradol s Liccos ljw ) <br />-l <br />!mcxcnr uDdcr Scclion <br />Dalq O*Nr: <br />won,'Ls' cotnpr,'isarro,n <br />PECIIIIAIT9N <br />I hc]jt) Jflirm un.lc, Fmrr) "f lcliurynnc Jlrhc folln*irF dc(L,6li, 'a <br />lLlr"* ",,a <br />* irr *i"*i,' <br />" <br />ccd'ficarc or con\cnr ru scrf lnslrc ,n' *.'kc^ s'npcn$rion. 's Eovidcd ro. by sNriotr l?u) or rhc <br />trt-r Codc,lorrhc pcrio.mrc. olthc *ort lor whichthc Frnrir h s\ucd <br />. nrvc and will nkimain worko, compcNdriotr insur.kc, ns rcquncJ byS.crionsT00ofrhc tibor Codc. for rh. pcrfortutc of <br />thc \f'k l(tr \l,nh rIn tc'n,y workcrJ .ohlcn\ar6n nNutur..Gricr i Oni.ynumb.rtuc <br />el,lnlR, *,*,,Z <br />-l <br />cnilylhlt in rh.pcrl'onnanccoflhc wort lo, whichrht pcrmir is k\uc{l.l shallnor cnpbysnyr.rson in any n'an cr <br />so $h bccom subjc.r ro rhc *orkcB conip..sdrnr hws orcnliromD. rnd rBEc rlur ifI should t .om subirr b rtf, <br />workcrs.o'nr.nsatn,nlrovirionsofScclion3?(xrolrhcL.bo,Gxlc,lshlll.ronhwirhco'tplywirhrhMptuvisiotrs. <br />IryARNIN(; F"ilur. t' *cur. wDrkcrJ..nr!.nntrion..v.dgc i( utrhwful. and \holl suhjat !n cmt'lo)rr ro aimimlpcuhL\ and <br />civil fincs uf ro onc huMrcd rhotrsand dollffr ($100.(Xx)). in rddirion to rh. corr ol.omn nerion. d]rogcs.r ln)ridcd for Ill <br />RUale <br />DECIJIAIIQN <br />I hcrchy rfimundcr pcnalry ofpcrJury thd I am liccnsd !trdcr E.vGion ofCtuprd 9(.o.rmncing wnh Soriotr ?Uro) ofDivisk,n l <br />ol lh. Busincs,nd Profc$io.s codc. at nry liccn$ is h lull iore arnc&cr <br />o 8, <br />Z 0 t4 c o <br />AITUCANLDICLTBAIIO! <br />I hcEby nmm undcr pcnslry of perrury orc oarnc folbwinS declnrations: <br />DcnFliliotr PcrnrirsAsh.sos Notilic0rion fcdcral R.Eul.rions (lillc4l). P0n6) <br />-Rcquircd <br />t.trcr of Nolifr calbtr <br />. _l ccnify rhd rhc lcdc ral r.Er hr nnN Egfding a\hcios ftnrvalarc nor nmltrhlc r. thn [l(ist. <br />!lrcnryrhJrIhr\cNaJrhrannl'. on dxl qJrcrhx, rhc trt[rc inftnndion hconccr.I nsrs r,r comply {irh rll ciry idCoutrry <br />.rdin.mc\ rnd SI c lrff rLrling b buildin(.onnrudion. tuJ hcrcbyaurh.rizc r.rrcsnldivcs oirhn C y rnd Counr, kt cnld uPon rh. <br />rh,vc ,.trri,nrl pmn nyln' iNl,.cri{nr <br />\pplichnr or,t!.nt Si[trrlurr ,*," t fz_Ttz< <br />Forms/Steel/Holdowns <br />SLAB Floor <br />,//)/b , <br />Ext.i lnt. Lath <br />/z-9 .-,*.,*l[ <br />c!)NtlBlJcugNtENIltNc lNlI <br />I hcrcby allrrn und.r tfMlry oftcrlnryrhar rhcrc h i cotrsructiotr lctrdirB ogcncy for rhe pcrl'ommc olrhc *orl lor *hi.h rhi( p.t.rir ir <br />is{cd (SN. -1097. Civ. C.) <br />I.iJ.''\ AJdr.$ <br />(brcra, <br />?-o