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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE rD/srG.COMMENTS OWNER BUILDIiR DEI,CAR TION
<br />I hocby amnn und6 poalty ol Ddju.y liar I an erdrpr iion rh. Co.traclos Lic.ns. Larv lor lhc tollowi.s rwn ($. 70:l l s
<br />Ausin6s atrd Prol*io! Cod.) A., (ny or Counr, \rhi.h r.quic a lsmit Io codno( allo, iftprove dmolish or.Ep€n uy
<br />sltucE , pdor ro irs irsu c., rlso r.qut6 the opplicml tor such p€!, lo filc a s'gn n sbhal that he or shc it lic.@d !fe&r
<br />ro rhc p.ovisioG ofrh€ Co.tracrois Lic.n*d Law (chapr6 9, ConmEncinr {ith Sdlion 7000 ol Divirion I oflhc BusinN ud
<br />ftofNions Codc) or rtat h. or sh€ Ls .xcmpl lhqcliom and thc baris for rh. alle-!.d .roupliotr. Any violalioo otsdrion 70115 by my
<br />appli.am lor apedn su6jdbrh. rpplicantioa.ivilpc..llyofnotsorclh liv. hundr€d doll&s i$50o).
<br />-1,
<br />s oMcr of th. proFny. or my cmplorG wnh {aE6 s rhcn eb comp€n$tion, vill do rh. *orl dd lhc nnEt@ ir mr
<br />i.rddql orolleed for 3.]. (Sa.7014. Busins and PloasioN Cod€r Tn Conractol s Licru tjs .106 nol ,pply |o e oMd ol
<br />rhc pFpd, who hril& or impmv6lhsoG ad who do6 sucl $ort hiGclf or h@lf or lhDush his or hd own .op1dyc6.
<br />provided that such irnprovmls e rer hloded or offord ror eE. I f. ho{6d, rh. ttuildif,s or imp.orocnl is $U wnhin on. td
<br />ofomplclion, tnc GFs Inius sjU halc lh€ budo orl'ovins rhd h. or sh. did nor ttuild or iinrrov. rc prepqiy tn lh. purlDs or
<br />l. soMcroflh€ prop61y. mcr.lusiv.l, co"lra.li.8 wnh licsed conlmckrs lo en$tud rh. Foj.d (S(. ?Oll. BBDds
<br />ed PJtFs6. code Tn. Conlraclois l-ic.nse Las do6 nol apply to e owh.r o f rroBrrly Nho builds or improv€s rhd@n,
<br />and *ho coolracts ror sucn ,'.jeB wnh a conimdo(s) li..Bcd pluu r ro thc ContMttr'3 Licdsc La*).
<br />woRl(ERs coittPtiNsaTloN
<br />!!ic!A-BArp!
<br />I her.by amm ond6 p.nnlt, of pdjLrry onc oalh. loll$\ iry ddaal rc6:
<br />-l
<br />ceniryrhat inlh. Flomd..oafi. wort for vnich rhis pdmn is issued. I shallnol onploy a.y pmo. in any mMnd
<br />$ e lo bq!,ne suqe.l to the work6' compsstior laws of Cslifom'!. snd age rhd if I snould bccomc subjel to $.
<br />wor(6' comFMlion prolisioG of Sdion 1700 oilh. Labor C.d€, I shall. aonhwnh comtl, vith lhos provisio6
<br />WARNINC: rrlo. ro su. woik6 smpmaiion covdagc G u.hwtul. tud ,ull suhjd e mploy6 ro siminal pEEltB tnd
<br />civil lin6 up ro onc hundr.d rhoudd doUm ($100.000). in addnion lo the coe olcomr.Narion. drnt86 s pr{vad.d lor lhe
<br />Scdk,n 1016.fr& I rhn ( tiJ.. n1c'6r
<br />I hr..by allnn u,rdd paally o f p6jur, lhar I an licasl Foviso of Chaprd 9 (comnmcins wilh S€dio. ?0o0) ol Dilisio. l
<br />ol th. a6ins dd PmlBionsCode. d mr licose k m lulllorcced€flkr
<br />r"r /2 z, )lQ-7727
<br />I hocby amnn utrdq p€nalryotp.rjurythat r
<br />is$,.d (sR l0I)7. civ c.).
<br />nrn hdints a8scy for lh. psfoma.cc ol thc $ ort for wl ch lnis p6nil is
<br />ATII.ICANLDECI,AAAIIoA
<br />I hd{5, arrn ud.r p.n.lty olpdjury on6oflh€ lolloNinr dtrleariods:
<br />Dtfrolnion Pcmn3-Asbalos Notification f.drsl R.suhbns (TnL 40. Pan6)
<br />-Rcqoired
<br />t tt6of Nolincdion
<br />r+ularioN rc8ddins sbstos rcmov.l d. nor appltablc ro rhis p6jd.
<br />thisapplicalionedsrarerh{rheahrErronharioniscodEr lasretocomplyNilhdl(nrandCountv
<br />rclnring nr buikl,n! consrr(nnr, od h€rcb, turhori,t r.0 6e ari!6otlhisC(r. dd ( ounr!ro $rd trlon lLc
<br />,,",. ,r/t /t,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing V r.AIlrut 4^/Vt--41 t/
<br />Shear Wall 't utvo
<br />Framing
<br />lnsulation/Energy
<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 />Flood Zone Certif
<br />FINAL o/,,3//"2 '2 1
<br />Certificate of Occupancy va:-
<br />Notes, Remarks, Etc.
<br />Subf loor/VenUl nsulation
<br />_I dr.rorpl und6 sdtion . B. & P.C. for thn Edo.
<br />I have ad will inaim.in a Cdificat. o I CoNdl lo S€ll-lNurc for Mrkdt comp.nelion. s pror iden aor by Sdtion 1700 of th.
<br />Lrbor Cod., for rhc DsaonnMc. of lh. "olt for $tich lhc Dmil b (9u.d
<br />I halc and will maintain worl.rt comp.tuation isuran... N requirol by Sct ion 3700 otlhe l$or Codc for lh. pslonn ccol
<br />rh€ *o for *hich rhis p.mit is iscd My workEr .onp.nerion LBurmcc cdis dd policy lumba @:
<br />Ai:-:-=-
<br />l . Jer s 4,i.[,\
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<br />4-/ aaJ
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