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BUILDING. INSPECTOR RECORD <br />SITE-WORK ID/SIG.COMMENTS OWNER AUILDf,R D'I,CARATION <br />I hseby amrm und6 poalty of pdjury lhar I d .xoryr liod lh. conlncloB Lic.nse tis aor Ih. followins r@,n (S.70 1 t <br />Busins anJ Profdio. Cod.): Any City or (ouoly shich rcqutB a p.rnil lo conslruc1. ah6. mpor., &nolilh or r.P.n dt <br />srruclue ptr'r to irs issumc.. al$ r.{uir6 rh. applic! lor su.h pcmn b fik a si8n.d salmdt lh.t he or slE is liccB.d pmuut <br />to rh. pmlisiore ol rhe Conlr.cloir Liccnsd Law (Ch.prd 9. aom.ncins wirh S(tion 7000 of Divisioi I oatl. Busin s ed <br />P,oacsioDs Cod.) or rhll hc or sh€ is cxmpr lhscnom a.d rhc bsis lor rhc all.g.{t cr@Fion An} violarionofSc.lion 70315 by any <br />lpplican! lor a p€mn subjftlsrh. appli.anrroacivilp.nahyoanor'no'.rh fivc hun&.d dollds (S500) <br />L s oNnd olrh. t'.peny, or my dnployG with wos6 6 rhct $L conlpoglion. sill do $. wolt md th. slrklue is nol <br />inrdd.d or o,Is.d aor eL (Sd.7014. Busin6s dd Pro&sioB Cod. Th. aonlr.cior's Li.ft. L1w do6 nol appiy to d ornd of <br />lhc pr.pdy wto hilds or nIprov6lhq@q ud *ho do6 sch rrcrl hims.lfor h6.laor rhouahhi orhd own mployc6. <br />ffovd.d rhsr su.h inprDrmn6 @ nol inrar:Ld or ofid.d for sl€ I I ho\r6,6. lh. tuildins or inFormdr is $ld wilhin onc )@ <br />ol conpkron- rh. C)tr nd Buikta will h,v. th. hnrkn of prc'in{ $d h. or she did rct boild or imForc lhc I'.pcly lor thc puqs* of <br />_1, al o$nd olrhc pn'pdr. an .rclusiv.ly .onr.d in8 snh licNd conaacroN to conslrucl r hc proiccr (sd 7tLl4, BEos <br />aM Plrlsbn Cod.: Th. Conlriclois Lic€ns€ Law do€s trol spplylo a ownr dflrop.ny \rho brilds or nnprors lh6&n. <br />and who conrmcls fr such lrojds * irh a ComB(d(s) lilded puBuer b th. Conlracnn s l,ic.6. l is ) <br />_l d er.'npt undq Semn <br />t2-//- / <br />DESAAAIIOX <br />I her.by amnn undd poDltyofrdluryone ofihc lollo$ine deldmiom <br />_l hi( axl will ftai.rain a cd incar. of Co'Mr ro s.lfiBur. aor workcc conrp.ns.rioh, a rmvid.d for by Sdion 3 700 o i lhc <br />Llbor Code. lor rhc p6rodd<. oflh. wort aor Niich rh. F@n i! isu.d <br />4ha\ . ed ! ill rnamr.in q ort .a .omp.nssr ion rnsuranc., 6 r.qut.d by sdion lToo of rh. b6or Cod.. tur lhc psfomdc. of <br />th. "ork for Nhich lhis !.mil is isuql. My wolkda onpsEdn,n iBurdc..ni6 atd r.licy.ombd rc <br />/U/non' I ( <br />,'4 4z- <br />l.diayrhd io lh. pdlorm.nc. oflhc *ork lor shich this pdmit is ssu€d. I3hall nor.mplot.ny p.Bon in any mann6 <br />e 6 r" b(onE 'ubt(r ro r\. tr0116 c,,mrot'on l,trs or Cdhrcm'+rnd a+'e rhr ill sh.Jld b.r.me suhR J rh. <br />\"116 (,,mpm$ nn ptuvsrons ol Sd'on 1700.r lh.libo, C"d9r'l nDll, f.nhqirhc^,nph irhrl-oqpo!s'cN <br />wAllNtNC: Failu. 16 $u. \vor[.u compgsarion .owr./unhtr f'r l. ard rhall uh]cd dnrh)d !,) dimnilpdxhiG and <br />rivil lin.s up t, o& hundi.d rhousd dollm (rl <br />serion :1076 of rh. kbor O)d.. i dc! sd ari,El <br />o^. /?-1/^/l' ^oru** <br />'t*/ <br />ro rh. co$ oac.rp. aron, dmaB6 6 prorid.d io. th. <br />EECIdSAIIQN <br />I hr.by afiifln und6 pcnohy of p.rjuy lhal I m li.dN.d und6 Fovdion ofchaptd 9 (comaci.8 *iih S€ction 7000) oiDrisnr. r <br />ol tn. BGinss Md Pof6ioB Cod.. ad <br />'ny <br />licm. is in tull forc. ed.fiel. <br />C I ic tr {oA- <br />COIIIAIICIOIJ.MINGrIGINCI <br />I h.6by amnn trndd p.nally o f pdjury lhot th6c is r coinruclion lmdin-s aaocy lor lhc p6rolmc. of rhc sort for n hich this tqnit is <br />Bsu.d(S(. :1097, Civ C.). <br />a.Etuc .NfD[c].aBAIat <br />I hr*ry arm uid- Fnal'y of Fjury one ofrh. aolkrwing d€clsdio.s <br />I)cmolilion Pcrmils-Asb€sros Notificario. F.ddal R.8uhr n tu (Tnl. 40. Pd6) <br />R(tui'&t l-eirerof Nor'fic.ri(nr <br />,l .dify rhat rh. fedssl rcsular ioN resudins 6b.stos ronoval de nor appl'cable to rhis projd <br />lcdl'ryrhar I ha\ e r.ad thi! dppli.arionddst.l.rhd th.at!v.infom.rion is cord I arretocorplysnhall Ciry.nd aounry <br />ordi@nc6 dd Sralc liss elaring lo blildinS io( dd ha.b, adhor n repr6oialir6 o l thB Ciry &d Comly lo 616 upof, tn <br />.bov. md ioned pDp.ny aor insp€ctron <br />l\pDlicinl orAE€nlSignrtlrc <br />Y"-e.- t-uPL Ga*- <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[/asonry <br />Pool Fence <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL ftl 5 lfi M<r4tt ) <br />Certificate of Occupanc/ <br />Notes, Remarks, Etc <br />DATE <br />Set Backs <br />Subf loor^/enVlnsulation <br />T-Bar <br />l..trJi,'. AJLIj6s <br />tt