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SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDER DELC RAI]ON <br />I hd.by ,mfln und6 pfirlty of p.riury lhal I m cx.mpt frlo lhc conlnctoR l,ic.nse Lls for th. tolloNing ia$! (se.70l 1.5 <br />lrusin6s d Prolsion Cod.): tuy Cny or coonry whicfi rcquirB a Psflil lo oBitud. all6. improve doolEh or r€pan i <br />srrucrE Fior to its i3!udc., al& r.quiB thc rpplicdt lor such pqnil to 6le a sign.d slaidnat lhal h. or shc is licos.d p@d <br />to th. Fo\isio6 olth. Contrclo.3 Licens.d law (Ch6prd 9. Comn.ncin-! Nilh Sdioo 7000 olDivision I ollh. Busincs ed <br />Profesions Codc)orrhal hcorshc is exdfl rtld.fro &d lh. tasis tur the allcs.d cxnprion AryviolalionofsaltunT0ll.tbyony <br />applicam for a t mn srbjslsrh. applicsfllloacivilpcnaltyotnoldorerh&fivchu.dreddolles(S500) <br />l. s ownq oflh. pdpoly. or oy mplor4 *nh va86 s li€t sol€ orrpoerion, $ill do thc mrk ud lh€ sl,uctuc 6 nor <br />inrdd€d or ollq.d for elc (sd 7044, Bosins ed Prc lsioN Codq Thc Controclois t,icorc La\e do6 nol apply lo m o*nd of <br />rhe rroFry r'ho hil& o. nnFovs l}l@n. ed s h. dod such *trt limsclf or h.elfor rhmulb his or hd oM cnploy6, <br />,iorid.d rhar such i,nprovmls e rcl nldd.d oroEotd [Jt s.l. l( hondc. lh. toildu:g r idprovmr 6 sld wnhin onc )s <br />otconpktiod rlE Omd Brildd will h!\€ ltE hrdor oarrovin€ lha h. or sh. did ml trild or ihFore lh. propaly aor rh. plrpos€ or <br />-1. <br />NoMaol$. pmp€ny. m.rclsivcly conrt.lins $irh licmd .oniraclos lo conslrud rh. l'ojer (Se 704'{, BEinG <br />{d hDftsion Coder Th. Cd.lr.crols t-ic.M Las doe nol apDlylo d o{no oaprop(tly Rho builds or inprovd rhd@o. <br />and uho cod6 s lor erch projccls wilh a ConlEclo(, licdd punmr ro lhcConrtdors Lice6c L0w). <br />-l <br />e.roF @d6 Sction- B. & P.c. lor lhk t!e.. <br />Dtt.: Orno: <br />lla85[Sf..CaucElsarox <br />DECIAB{IIQX <br />I hs.by amrm und€r p€nally of pdjury onc oafi. fol,owi.8 d(ld.iions: <br />-l <br />h.vc md will ,nainr0in a Cenificarc of CoIMt ro srll lN@ for worksi .o rpenerion. & pmvid.d aor by Sction 1700 of rhe <br />Llbor Codc, for thc Faonroc. of thc *ort for whi.h lhc pcrir 6 s!.d. <br />l have and will flrainrain wdrk.rs conpcsdion insuinn.e. s r.luted by Sel in. lT00 ol the bbot Code. for rh. pdfomdc. ol <br />the work ro, rvhich rhis pmn is Gsucd. My work.rs coflpasarion iNur&.. ffid tnd policy numbE sc: <br />PolicyNumbdr-Elpt6: <br />-I <br />c.ni& lhat in rh. p.rfom cc oflh€ work for which rhis pemit ir issu.d. I shall nol @plq oy pdsn in any mann.r <br />I2I(L\AII!)] <br />I he.by amnn und.r pdahy of p€rjury thal I ndo lr.sision ofchaplE 9 (co'ndcncing u nh Sdlion 7Cr00)olDivision -r <br />oa lhe Busin6s d P$raio6code. md,ny licdsc is <br />I hdlby amnn und6 p.nalt <br />nsusd (sLr 1097. cn (-). <br />is , .o.srtuctio, kdins asmcy for lh. IBlommc oflh€ $!rk tDr {hich this p6mn is <br />AITLICANLDICIAEAITO! <br />I hdrty arnn und.r pd.hyotpqjury onc oflh.lollori.s d(learions: <br />Danolnion Pmns-Asb6ros Notificatio. r.ddal R.!ul.rio.s (Tnk 40. Per6) <br />Roton d L.rt6of Norincdbn <br />I c.nitu rlrd rlr lcdc'al rrrtrlaltDs <br />flysiihalLC,rlrnd coui(y <br />ity d Colnryk, md W.ntho <br />,..t.o lvv lA <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Roof Sheathing '//t"//.1' ,"4/47?r+//D,--' <br />Shear Wall <br />Framing <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />FINAL ///1//k fra|nt/)/{2- <br />Certificate of Occupancy 'I I LI <br />Notes, Remarks, Etc <br />BUILDING- INSPECTOR RECORD <br />Set Backs <br />l..nder cAdds <br />- <br />uc nor .mli.able ro rhis l,mj€ct. <br />( <br />tt