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BUILDING. !NSPECTOR RECORD <br />SITE-WORK DATE ID/SIG COMMENTS 0lVNER III )II,I)ER DEI,( :ARAI'IoN <br />llusinc'ss and l'rolLssi<il Code): Any Cily or Cou0ty s'hich rcquircs n rcrmit to coil\lnrct, xltcr. improvc. dcmrlish or rcpat any <br />stnlclurc. prior b il\ issuntrcc. also rcquires lhc npplicaill for srch Frmil tr lilc a signcd slillcnrcnl that hc or she is liccns(l pursurnl <br />lr) lhc provisions of lhc C(ntrraclor's Liccnscd [-nw (Chilplcr 9. (i)ilnncncing wilh Secli(n 7(XX) ol Divisi(rn 3 ol lhc Busincss rnd <br />rpplicanlli)rapcrnilsuhjcclslhc applicnllbrcivilpcnullyofnolNorclhxnllvchundrcddollars($5U)). <br />_1. ar owner ol-lhe profrcny. or my cnlpk))ccs wilh wsgcs as llrcir \olc conlpcnsxli(nl. will(lo lhc sr)rk md thc slruclurc is n(,1 <br />irlcndcd oroflcrcdlirrsalc(Scc.7(144.BusinctsandProltssionsCrxlc:'lhcCoiltraclor'sLiccnsclllwdoesn(ilapplyr)anowncrof <br />lhcpmlEiy c,hobuildsorinlprovcslhcrqnr.ands'hod(rcssuchwrrkhinrscll'orhcrscllorthroughhisorhcr()wncnlpkiyecs. <br />providc(l lhal such iillpro\rnrnt\ xrc not i0lcndcd orotTercd li)r snlc. ll howcvcr. thc huildirrg or inrpror'crnnl is sld wilhin onc ycrr <br />ol cotrrplcliur. lhc Owncr Iluildcr will havc thc hudcn ofproving lltnl hc or shc did n(il huild or inprovc thc pmFfy for thc purF)sc of <br />salc). <br />_1. as owncr of lhc liopcfly. an cxclusivcly conlrilcling wilh liccn\cd conlrilclors t) conslrucl lhc projccl (Scc. 7()44. BusiDcss <br />d&l ProlilssifCodcrThcConlraclor'sLiccnsc[-xwdocstrolapplyloalosnerofpropcrlyrvhohuildsorimprovcsthcrc()il. <br />ilnd who cotrlrilcts lirr such proiccts fursuilnl k) lhc Conl'flck)r's [-iccnsc l-ilw). <br />_l anr I). & t'.(' lirr thir rcason. <br />lralc: l <br />J-o <br />\\ oRKttRs' ( ()IIPt,:NS,\1 tO\ <br />t)t,t( t,ARA'il()N <br />I hcrchlrllirmun(lcrpcnrltvofpcriuryo,rcol'lhcli)llosinlrlcclnrrtion\ <br />Latxrr Crrlc. frrr thc pcrli)flnancc ()[ the \\rrk for $'hich thc l^-rmil i\ i\\ucd <br />thc work li)r ulrich this I-.-rmil i( i\{ucd. My workcrr' conrpcnsati()n insurr0cc carricr rnd F)licy iluilllrcr arcl <br />Policv Nunrbcr: Lxnircs: <br />_l ccnily ihal in thc lrcrfornuncc of thc s ork for which lhis prnril is issucd. I shrll not cnrploy any ner\on in aily ilrnnncr <br />s() rs lo lrcoilrc suhjccl lo lhe w(nkcrs'corripcnsati()n laws ol Cillili)rnin. iltr(l agroc lhill il I \lx)uld bccotN \uhicct k) <br />workcrs'compcnsrtioilprovision\o[Section]7(X)otthctahrrCftlc.lshlll.foflhwithcomplywiththoseprovisions. <br />WARNIN(i: Frihrrc k) sccurc workcrs'conrpensillioil c()vcragc is unlawlirl. an(l shall suhicct an cntploycr k)lu)rllics rrtrl <br />civil lincs up l(, onc humlrcd lhousantl rkrllnrs (Sl{X).(XX)). in il(ldilion lo lhc co\l c(,nrlcnsrl ion. dililtilscS li)r lhc <br />Scction 3076 of thc trtx)r Codc. intcrcsl <br />D,'".d oGl!'lin and attorNy's fccs. <br />t)t,.( 1,,\R,\ I l())i <br />I hcrcby ilffirm undcr pcnrlly of pcrjury thill I an liccnsd uldcr provision ol Chaplcr 9 (conrmcnciilg wilh Scclion 7(Xn) of Division l <br />of thc Business trnd Profcssions Codc. and mv liccnsc is in full lorcc and clTcct <br />l-iccnsc C <br />Date: <br />l.icensc Numn{r: <br />(lonlr{(lor' <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby aftirrr undcr Fnillty of pcrjury thal thcrc is a conslruclion hnding agcncy lbr the Jrrlormancc of thc wr)rk for which this lErntil is <br />irsucd (Sec. .1097. Civ. C.). <br />hnder's Nnmc: <br />Lcndcr'r Adtlrcrr: <br />APPLICANT DECLARA'IION <br />I hJl'byallinnundcr pcnahy ofpcrjury onc ol thc li)llowinS dcclarotions: <br />Dcilrolilion Permits-Asheslos Notificalion l:cdcral Rcgulali(rrs (Tillc 40. Pilfl6) <br />-Rcquircd <br />Lcttcr ol Notilicati()n <br />I ccrli[y lhxt thc tcdcrrl rc8ulali()ns rcgilding n\tEsl()\ rcrnovrl arc nol h this lrejccl. <br />_l rcrlily lhal I hilvc rcild lhis ilpplicalion rn(l slillc lhal lhc iltx)vc inli)rnuli{,n i\ <br />t <br />with all City dxd County <br />nnd Counly lo cnlcr upon lhcorditranccs rnd Stllc lis s rclnling Io hilildiilg conslruclion. rod herchy auth()rizc <br />atx)vc mcnti()ncd propcdy lor <br />Applicant or Agenl <br />Pcrnritee nsnre lpiln(t aQansG Iza.rd ^",@1s $.D <br />Set Backs <br />Forms/Steel/Holdowns alilho ,r '?b ) <br />Erection Pads I I UI <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsulation <br />Roof Sheathinq <br />Shear Wall <br />Frami <br />O qo-c) <br />t Z/,€ 27 *4 <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />ftlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I <br />F!NAL o/cl /zcnl .4 t<4i/ <br />Certificate of Occupancy ?L/ <br />Notes, Remarks, Etc. <br />?h,t-l