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BUILDING- IN!JPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER B!ILDIiR DET,CARATION <br />I hereby arrm undd p.nalry of p€rjury lial I d.xhpr lion lhc (onlracro Lic.ns. t-aw for rh.lollosios B@n (s.c7011.5 <br />ausinBs and Prolsion Codr): ny cily ot Coud, Nhich r€quns a pdmt ro co6trud, ahs. ihltov€, de$olish or rcpair uv <br />srrucru€. linor ro irs isuo.., ,l$ r€qun6 Ihe applica ror such pcnnil <br />'o <br />fi1. a si8ned slaldd that h. or sie ie licded p6omr <br />ro rhc FovisioN of ih€ Conractols Licensd ljw (Chafl€r 9. Co,m..ci.s *ith Sdrioo 70t{ or Division I oflh. ItNinas &d <br />PmfNtuos Code) or rh nc orsh. is ercmpl Ihgefiom dIhcbdi. for rh. all+€d crdnorcn Anyvioldionofs.dnrn70:ll5 hran, <br />,,AT <br />r io a penir suhjds lhe applicanl lo a or il Fnahr o l n.r Eore rhdl li!€ hondEd dollas ($s00) <br />ovn.r oirhc preF ty. or ry.nplolt6 sn h $a!6 6 lhen $k codp.6ar ion. will do th€ \ork a ltn studuetsnol <br />or ofieled for sl. (s* 7014. ltlsinss and Il ofssio s code: l he conracnx's l-i.m. l-a* do6 rct aptlv ro .n o$ nq of <br />rh. !,openy eho toil&.r nnFov6 fison. md rvno dos such so'{ hirelaor n$llor rhough his or hs ow cnPldv6 <br />provid.tj rhar such inprov.lMls m nol i dddl or olIs.d aoi sle lf, hosdd. thc txildi.! or imFownEn n $U wntu one )@ <br />oaco,npldion. th. O\rrs Builda $ill haw the btmkn ol Foliog lhd h. or sh. dd rcl Uild ot itr$f,ov€ thc Flpdy aor th€ purFF ol <br />-1. <br />d omd olrhe proFly. m erclusively .ontldin! lhh 1ic6$d conlra.loE ro co.shd th€ roj..l (S< 7044 DlrinEs <br />lo doNnd olpropeny*ho builds or nned Atrlission Codrr 'l h. conlrr.kn s Lic.ns. L.$ do6 nol apply <br />and who conkads for such Foj..ls with a Co! raclo(s) licded pruunl lo Ihe Conlnclors L <br />t hd.br am,m undq FnahJ or ps,o oncorrrrc rorro* 'ngffiHs <br />'144,,.r*u, ^" ,*.('dilicarc or('on5r h \.li-rN,,. for mrkds. .onP.nenon. 6 p,ovddr ror bv sarion rToo orrh. <br />/l/-6or toae tor rtc notomcc orth. $oar rot $hrch rhcpqnir . (qd.d. <br />-l hav. &d wilt nainlain sortd coDp.Nalion insuran .. s !.quned b-\, Sc.lion 1700 oflhe Libor Code, for Ihc pa lom ccot <br />$c vorl loi vhich lhis p.mil is isscd. My so.kdt conpm.tiofl insurdce ffid tud policy nuobd 4: <br />Poli.! Nutr1bn:-Erpnes <br />I ccnilyrhal inrh.p.rformMc.ofthevo for \yhich rhis p.mn is issucd.I shall nol mlloynny <br />so s kJ l'comc s"biel lo lh. \ork4' cooposrion l.ws oacaliaomia. dnd tsre rhar if I should b(on. <br />\.r k6' .o,np.Mlion portioB ol Setion l?oo of lh. hb.! Code t shell. fonhwnh coflply rvith thos prcvisions. <br />WARNINC: railr. lo su. *ort€u compselion cor€B!. is ultwful. and shall subj<r s andotq h aiord <br />ciril fins up k on. hundrcn rnousd dollafi ($100.000), in ion ro th€ con olco'np.Mtion. dsnascs 6 provided <br />DECBAAIION <br />I h6eby lmdn md.r paahy ol psjury lhal I d lic..s.d und.r Fovision ofchapld 9 ({,nm€ncins s ith S<rio. ?000) of D'visio. l <br />oa lhc Busin6 md Pof6ioG Codc. od my licoF is r lull for.e trd .fiecl <br />CANIIBIJEI]ONTENDACJCETCI <br />I h*by afirm unds pcndty or prlury rhar lh6. is a consruclion L.din8 a8.n y lor the ,nlome.. ofrh. tork lor $hich rhis pnnn is <br />is$udl (Scc. 1097. Civ. C ) <br />6rtllcANr.tlEclradlla! <br />I lErby afEn undq p.flahy orpcrjury on. oIlh. tolloNins ddlealiobs: <br />Dcmolnion Pdmns-Asb.sios Nolincaion F.d6tl Rc8ulalions ( I nE 40. Pd6) <br />R.qun.d tnr6 olNolilicaln. <br />noi applicablc t rhis piojc..t <br />mply Nilh allCiyand ( ount! <br />ah.Ye <br />'ncntnrncd !rcpd) ntr irsrBl <br />,\pt'ltrnr o' \8rtrr Sisnxru <br />h.rncrcpr*nlaln6 orl <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathinq <br />Shear Wall /-,\ <br />Framing s -ffi <br />lnsulation/Energy <br />Drywall 2.ZKt9 Y,WTd <br />Ext./lnt. Lath U l_/ <br />Brown Coat <br />Masonry <br />Pool Fence A I <br />T-Bar 4-'r-J1 YW,n <br />Handicap Req uv <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />A <br />FINAL l-2a-41 vlqJd) <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />I _- B.f)o <br />L.nJ.r s \.me <br />- <br />L.n,ler's AJd* <br />csrily tllal I have r@d rhis.pplic0tion <br />ffi-w