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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erectron Pads <br />UFER Ground <br />SLAB Floor <br />Subf loorA,/enUl nsulation <br />Roof Sheathing ?-la.'b al lz>**=rc'tt-.t <br />Shear Wall <br />Framing <br />lnsulation/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 />Engineer Final Report <br />FINAL 2-/>to U{l/at <br />Certificate of Occu pancy <br />OWNER AtII LDER DI'LCARA'TION <br />I hdcby aiii,n und6 pdahy of pcrl!ry tbal I d crcmpl non thc Conta.lon Li..N tzw for rtd lollo*ing i.Mn (Sd 701 I 6 <br />Bcin6s ed Protesion Code). Any City or Counly which r.qun6 a pdnit lo co.slruct. alr6. improvc dflolish or rquir m) <br />slflctue. Fior Io irs isuMc., alio r.qriB !h. arplicmt for su.h ldmi to fiI. a sig..d stddnt lhd h. or she is li.mrcd p@61 <br />to rh. povsio6 oithc Conracrois Licenscd Law (Chapt6 9. Comm.ncins vith S4rion 7000 of DivGion I ofthe Buin6s d <br />PmaesioB Cod.) or $al h. or.hc ir crenp rhqcfion dJ $e bas6 for rh. all.s.d .xdFion Ar) violarion ol Sdion 70115 by&! <br />rplicant for . pmit subjals lhc applic&l ro a cilil p.@lry of not 60r. rhd 6!e hun&.d dollds ($500) <br />-1. <br />a( o$n6 ofrh. propery. or ny cmplo)6 with v46 s rheir elc conpssaion. sill do lhc work dd lh. srrucr@ is mr <br />inlqd.d or .fi6.d aor eL (S@ 7044, B6in6 ed Prof*io6 Co<tcr Tn ContBdocs t-icffc L.* do6 .or .pply lo d oMa ol <br />rh.lnopd, who builds or idF6r6 tl6oq ad who doe such w* himsclf o. hqFlf or lhrcush hG or ho om cmploycB. <br />plovid.d tn,t such imprcvmts e not inlanlol o.ona.d for eL If, ho*ffi, rh. toildin8 or inprrvmt is $lc *ithb on. rd <br />ol m,ngldion. th. O*ne aliBe {ill hav. $c htrda oaprovinS thd he or shc did d hnld or inFo!. <br />'nc <br />prcpdl, for th. purpo* ol <br />. !, d orntr o fth. propsry, m crclusively contactin8 $ ilh lica$d co rzdou to conslrucl ih. pNjal (Sd 7044, Bushs <br />Md A$l6snn Cod. Th. Cont&roas l-icm. ti* d.6 nd apply lo d oNnn o f propdly * ho builds or inprcrcs t6@n- <br />and \rno conl,icts for such p,oj.crs w h . conradoil9 licreJ pursudt lc th. Conhctois Ltme kwl. <br />t en€r.rpt under Sdtun ,a & Pc. ao.rhisr.aon <br />D.le:_ __ OPrci__._ <br />rloiB[E8s:roMrgNsAnlo! <br />DECI,AEAIIq!Ihn byafli6 uidd pd'altyotFjuryon ot$c followi.s {tccldrrio6: <br />- i havc {d u ill mainkin a C6riarc,l. olcoNdl b S.lr-lcor. for wortqs' conpoerion, 6 prclid€d aor by Salion 1700 oftb. <br />L3bo! Code for lhc pdfomecc oalh. wort for which thc p@il i! islucd. <br />rul h.v. .nd x r ll ma rlam n 0116 cornp.Nauon i6urtuc., s ratuircd by Sd ion 3700 oflh. L.bor Cod€, lor lh. psfonmc. oljlh. tro' k for { hi.h lhis p€mn is iso.{ My vorlss compe.snnon iNuE*S--X"f,:tfu T.ns <br />\,1_-\-zO <br />I .enri, rh.t in rh. lEformancc of rh. woik lor ehich tht pci,nn is asu.d. I shall nor dDloy any !.&n in any mmn6 <br />$ 5 lo b..omc subjd to lh. *0lt6' ompcnsarion l,vs oacalilomia ud asre llul it I should b..onc subjat lo th. <br />*o (qt co'np€calion prcvisDre oas6lion l?00 oa the Ubor Codo I s\all, fodi,silh mmp,y wnh lho* prcvaioN. <br />WARNINC: hrlu!. ro suc work6' compaeio. cov6ra. is unlawful. md sh.ll subjel e dploya <br />'o <br />aiminal FEhi.s dd <br />civil fin.s up lo one hun&cd lhouend doll6 {1100.000), in oddilion Io th. cor olcomp.Nrio.. dmagcs s provid.d for rh. <br />s6lion 3076 ofrhcljho!code inr.r6l ed aromcy s fc f',t *f ,n c,ol(Ce(+t --) <br />l-t( ltNs}]D coNr'&{('r'oR <br />ulct4-BAr]gr <br />I tmby amrm unds pa.ky of pdjuy lhal I u lica*l @d( Folision of ChlPtr 9 (.o,m6cing wilh Sdbn ?040) of <br />of rhc Buin6 bd Pmf3siom Cod., and my lic.@ ie i. iull 16r. ad crer <br />c-jq Li.cN. Numb.r <br />q56gq 3t -q-1 o ? <br />coNsT(u(:t loN t,tiNl)tNc A(:til( \' <br />I hq.5, amm u.d6 Fraty ol p.rlu.y $ar rn@ n a oNlruclioD knding a8ocy lor tt lqtomtuc€ ollh. wod( for whkh lnis Fnil b <br />isu.d (sm.1097. ci!. c.) <br />dl8llcl LDICLr$AIIO! <br />I '(q+ afm undo p€.ally oi p.rluD onc olrh. followin* deleations <br />Dcmolition PGnrlh-Asbalos Nol ifical ion F.dn lRc8ulati.ns (Tillc 40. Pan6) <br />Rcquired L.ll6 ol Norifi calion <br />. _ I .ar'6 rl 4 rtc lalo d r.sulauoN Esddrnr bberus r movdl e e nor .pplr dbl€ h lhE proJ.dal/ <br />I Lal .di6 rhd I ha!. dd rhi! alpli.arion and srar h, $. rbovc inlomalion iscor..r.I lsc lo.o,nply sirh all Cirydd Counry <br />oftiinec.s md Starc Lawr r.laling ro bnilding coGttuclion, ed h6.by a horizc r.pr.slariv6 ollhis Cil, md Cou.ry ro ols upon $.r L-5-9-oV-o <br />Flood Zone Certif. <br />Notes, Remarks, Etc. <br />tndd s Ad.lr6s: