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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BT]ILDER DEI]CAN TloN <br />I hcreby .m.o nnd.r F.ahy ol lErturr thot I m €rcmpl Iiom lhc Conrrado6 Lic@ I2w fo. rn. lblowing ree" (5(.7011 .5 <br />B6in6s Md Prof*ion Codc): Any City or Counry whi.h tqun6 t lanil lo constud. alla, imprcve dflolish rr rcPn y <br />ntuduq p@r lo nr Bue.. al$ r.ltut6 the appli.d 6r such pcmil ro 6lc . sis..d stat.m€d lhd h. or slE i5 li.cc.rl puBud <br />to rhc povisions ollhc Conteroas t-i.drcd l5v (Chapr6 9, Comm.ncinS sith Selion 7()O0 ol Division I of thc BusilN d <br />Poisions Codr) or rh h.orshcis.r.nq thd.from md th. bsis lor thc all.s€d crmplion. Any violario. ofsanion 7011,5 6,d, <br />.ppli.mtaorapenrilsubjatsth.applicanlloacililp.nahyolnolmoElhdfirehonli.ddollts($500). <br />-1. <br />ar oM.r olrhc prcp.ny. or ny .nployc *nn sr!6 6 th.t sl. comp€Galion. will do th. work and dE ntu lrc is nol <br />'dad.d or ofi6.d aor sl. (Sa.?044. BGins Md Prol6iom Code: Thc Coffaftas Li.re Lrw do6 nol rpply ro M oMd of <br />rh. Fnp.rr, who hrildj.r imp.ov6 $60., .nd who &e 3uch w* himelf or tGlt or ltrcust his or hr osn cnployc, <br />plovidcd lhar such implovoMrs ruol intrdcd or oltuql ror ek. Il tsw6, th. t ildidS or inprovffit is $ld wilhin on. ,r <br />oacon Ltiotr ih. orrd alitlq (iI lBw thc bq&o ott .vnB thd hc or sltr did ml hild o. iEFolt U. FDFty aot $. Ftrpo* of <br />I, s 0"16 of rh. Fopdy. an .xclusively conrra.lins * ith lic.6cd codractoB $ @nntud rh. pmjd (Se. 7044. B$h6 <br />ed hnlission Codc Th.Contracrori Li.c.s. Law do6 nor apply to &own€r olprcp€nywho builds or iep.ov.s rhoon. <br />md !,ho conhcrs aor such lmj€€:ls wirh a Coflr6.lo(, lictucd p6@r ro rhc Contraclor's Licffi Lav). <br />I m.x.npl undd S(lion <br />uoaaE[s:lqMt[N.:allor <br />DES,AAAIIOA <br />t hqeby alfid u.d6 ,oahy ofDojlr, on. oath. follo*i.! delaalio.s: <br />I hav. dd will minlain a C61ificatc of CoNdl lo ScIHBlrc for Mrk6 .onp6srio{ s trcvid.d aor by S{tion 1700 of the <br />Lrbor (}d( aor th. psaom:mcc of th. trolk fo! $hich thc pmil is issud <br />_ I haw and * ill nai.laih work6 .onpc6,rion imurmcc, 6 r.qut d by S{tion 1700 olr h€ Labor Code. fo, lh. Faom@c. oa <br />rhc {ork for wnich rhis pnnn ir issudl My vorl6 co rp.Nlion insurance cuis ad policy nunbd a.: <br />I cdiay thal in lh. p.rform.nce otlhc sork for which Ihir Fnn is i$u.d. I lhall nol dploy any Fson in any msnd <br />$ a ro b..oo. subjd lo rh. sorl6' @npo..riod la*s olcrlifohi& ed aar lhli it I should b..ooc lubjcl lo rb. <br />work6'corparalionprcvisioBofsetio.lT00ofthcLaborCod.,lshall,forlhwilhcosplyvidrthosporisioB <br />WARNING: Failur. to su. work6' comp.nsarion cov.rar. is uhwtul. dd sh.ll tlbjd e 6ploF lo aioinol tqqllil: ed <br />civil lin.s up ro onc hun.lrcd rhoumd dollm ($100,000). in addilion lo rhc .o$ of .onp.Mrion. d.mBB a providcd for th. <br />Scrion 3076 ofth.l,bor Cod., intdsl ud atrom€y s 16. <br />Appllotrl:_ <br />uc[NsED-CqNrS crgE <br />DEcrdtano! <br />I tftby amm unddp@alryolpclury rhal I m licftcd undd pmvirion olchapld 9 (codacn.inB wilh Stlion 7000) ofDivision -1 <br />of rh€ Duin* &d P.of*ios Codc. dd 'ny licmc i. in full (r.c ei .,Id. <br />D.le conrmctor: <br />ca!flB.ucuoM,ElDlxclc <br />I h@6y arm trndd F,iahy of pdju., th.l fi6. is . coBrruclion lddins asdcy lor lh. Ffon@cc of rh. *oi{ fo. which lhir Frnh b <br />issEd (s6. 1097, civ c ). <br />dTTUCINLDICIdEAIIAB <br />I ho$ amm u.dr pdthy oa Fju' r-' on ol$. followins delearioBl <br />Dcmolirion P.rmits-Asb6los No[licalion Fed€ral Rcsul.tionr (Till. 40, Pan6) <br />Rcquircd lntd of Noli6calion <br />/ffi;d rhe lcdral rclrlarios r.UednrS <br />I h.vc r..d rhis aptli.ario. sd rcn is cor€.1.1 asr€ to .oEply vilt rll Cilyard Counly <br />ar. L4s rch'inr lo brildi.S authoizc rcpr6drrir'6 of rhis Cny &d Comr, ro 6ld upon th. <br />atrrrc Denttrnd propcrly lor <br />D,t" O/..P/ -ZcZo <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />D rylva Il <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 2-/l/?.o'Tr,tzlwa <r'.2.2-2 <br />Certificate of Occupancy ut <br />Notes, Remarks, Etc <br />nor applicable ro rhis projel <br />( <br />Set Backs