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BUILDING- INSPECTOR HECOHD
<br />SITE-WORK DATE ID/SIG COMMENTS OWNER BUILDEN DELCARATION
<br />I h.idby a,rrm uid.r ll.halry or ncrjury rhar I e cx.npt ronr lh. ConrdoE Lacn$ Ijw for rhc followhB r@n (5(.701 I 5
<br />gusinc$ arl Prolcssion Codc): A,y Ciry or Counly shth rcquirci a pcmil lo .onnMr. 0116, implot, &@lirh or ftFn my
<br />tucrxrc.,irn ro irs issudcc- o rquiEs lh. ll)pli.ad for such,rh
<br />'o
<br />filc r siSncd tdcnEnr th0t h€or shc is lkcnsn pu6u l
<br />ro $c E.vis,oN of rh. Ctrnbacror's Lic..*d Irw (Chapr.r 9. Commroi.g wilh Salion 7()(x) of Division I ofthc Bu\itus od
<br />Pmfcsions Codcl or rhar h.orshc n cxcry)r llErctom nnd thc blsh lorrheflllcgcdcremprion. An, violnti.nofsccrion 70ll.5bym,
<br />aprlicanr ,or r pcmh subjdh th ppli.mr io,.ivil pcrux,ornor mrc rhm fivc hundEd dollns (S5L\)).
<br />I. as owmr olrhc ,".trny. or my cq,lorrcs eirh wagcs 0s rhct slc mmFnsarion. will do rhc work alld rlE sEur@ is ft,
<br />i cftlcd or Dficrcd ro. $lc (Se.7014. Busircs lnd EDfersiotrs C.d.r Th. C.nrrdors LiccM tlw docs ml alply ro !n owrcr ol
<br />tn.pmpcty qh builds or idpims lhcrcr a who d.B ssh qo himclfor h.elfor rhru8hni or her o*nc]nployccs.
<br />providcn rhrr su.h inltrov.n.nb m n imcflldl n or.dl for sL. ll, h.w.rr. rhc blihin8 or rril'mlcEnl is $ld wiftin onc ]@r
<br />oicoq,lclio., rhc O*tur Btrilld will haw E burdci.tpovinS thar h or shc did d biiild or inFolc lhc pmpsly lor llE puqnsol
<br />-1.
<br />as owncr ol rhu nNrqry. am cxclusivcly co rudins wirh liccn*d conrr,.ro* ro eNruLr rhc pmidl (sN. 7044. BusrEs
<br />.d Pniessn Codc:1'hc Cotrrrslols Liccnsc Law docs nor q,plyro anowncrcfphFnywho boildl or inprovcs thcren,
<br />.nd who,!.hchrorsucnpmjcchwnhrClnrftcrorls)lie.scdlunuDlrorhcCorn!'croasLien\clf,s).
<br />-l
<br />lnre'nfl un<ld S6rion-, B. & Pc, ror this usn
<br />Drlc: Omer
<br />UABtrEES:IAIIIINIAIAN
<br />DECIABAII9N
<br />I hcrcby rfllm uNl.r Fnilry of Frlury on. oi rlr lollowirg deltroiions:
<br />x,,..,,,",
<br />ill mintlin o C€difi..rc ofconsnr ro SelHnsuE ftr workcB .onqf,nsion, .s F)virn}l for by SNtion 3700 of Ihc
<br />rh. pcdorEftc ol lhc !oi( for vhi.h lhc lcnnir is iss!.n.
<br />Iltuimain hrkr* ohpcnsdion i.sfidmc, as roluird by seib. l7m oa thc t horcode. for $e p.rfmrcc of
<br />M, w*kcrs c. p.nslon i-fr @ Co
<br />LtuJop ol rl I
<br />l.cnirthd inthc p.rfoflMrccol'lhc uork ltr whi.hlhnFrmir i\ Fsu.d.l shtu n.r .Ruloy sny rEMn inatrymnm!
<br />w f,s t, lf,co r strbjccr ro rlt mlkftc con{rnsrk,n hws or Cnlifomir, Md .erc ttut if I slsuld bccom sutrcc' ro tir
<br />wolte6 coDl,ctrstiotr t',ovisions oISdion:1700o, rhc Lat rCodc.I dull. ronhwirh sndy wnh rho$ PDlirioN.
<br />W RNING, Frilud r, suE w.rkois .ompcnsrion .ovm8. is utrkwful. and shall subjcct M cmplorrr Io qini.al Fdllhs and
<br />civ nncs o,, ro onc hunded rnousod dollds ($l0o.0oo). in dirion (. rhc.osl oaconlE,$lion, dflnuscs,s providcd lor rhc
<br />sccrion 3076 of rh. hhlr Gidc. inlcEsr nrl ariorrcy r lccs
<br />LIIENIE!.C9NI8AEPf,
<br />!&CLAMfIAN
<br />I hcrbr rflim unlcr lxnllryof Frrury rh,r I M Iiccn<d Dndq pmvisio, otCh.pts 9lonmrcitrB pilh S..lkrn lom) olDilhion 3
<br />or Ih. Busifts and Prorc$ions Codc. dn my ltctrE is ifl tull forc ad ctlR--I.
<br />c4r:1bt lnaT
<br />CONUBICUqNIINDINC.ACENIX
<br />I hcEby affimi ldcr Fulry ot Frjury rhd rh.N is a 6.{turti,. LndinS 08cmy for rh. pcrlomrcc of thc *ork for thih rhh Fnni! h
<br />issucn (Sc.. 1097. Civ. C.)
<br />AIBLLEANIDICIAaA]JON
<br />I hs6y.frm und.r Fnolty of psjury orc o{ thc followin-s dsl{llions:
<br />D.@lnion Pcrniq Asb.slos Noli6mlion l;.ddal R.gulalions (Tillc40, Pon6)
<br />-RcquiEd
<br />lrlrcr of l'lorifralbn
<br />#ffi;ffiffiildilffi:#ffi*,,*
<br />itnvc rmnlioncd Dropcny Ir
<br />/l0nlicrnt or AAdn SiAn ,r"//IU
<br />Set Backs At
<br />Forms/Steel/Holdowns /)/2)/a0 tfu.*,n h8(
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />X
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />tl /,
<br />FINAL LlqlTt
<br />Certi{icate ol Occupancy I ' I
<br />Notes, Remarks, Etc.
<br />Rev.0B-07 2015
<br />>*."'
<br />tu1-241,
<br />Pool Fence
<br />Flood Zone Certif .
<br />4tb
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