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BUILDING. INSPECTOR RECORD <br />SITE-WORK ID/SIG.COMMENTS OWNETT BU!I,DER DET-CARA'IION <br />I hdebr amfln und6 pqalry otpdjury lhal I e d..rl)l nom th. Conxadou l-icosc lirv lorlh. hllowi,8 rNn(S(70ll5 <br />Busin6s dd Profsion cod.): Anv ('ity or aour y shich requirB a rsnil lo constud. ahd. improrc d4olish or rcp€n uy <br />sfldd.. ,rior ro irs issu.ncc. .lso rcqunB rhc .pplicanr for 3uch tqnil ki fi|. a siln.d strhc.l lhal h€ or slt t lico3.d tumanr <br />lo rhc riovisioB olrhe conlracrois Liccnscd bN (Chapt6 9. Comr,.nc'n! $irh strion 7000 of Dilision 1 ofrhc B$ioer &d <br />Polsions Codc) or rnar heorsh€ is c\€mpr lhs.lrom and rhe l{qir iorrh.all.!.J crmp{ion Any violalioo of sdion 70:ll 5 brany <br />alrplrcanr ror E pnir subjeb rh. a0licmr ro r civil ,m.hy o f tror mor. rn fi\. h!.drerl dollds ($500). <br />l. 6 o*ncr ol thc lralFry, or my .mplo!r6 with \va86 6 thcn soE com!.nsal ion- sill do llf, {olk tnd thc shrclxc is ml <br />inrnd.{ orof.r.d for el. (Se.7Ol4. Busines and Prcfsrcns Codc Th.Conttcroas l-i.dBc Lo\v doB not aprlylo o o*nd of <br />rlrc prelioq who builds or i'.pro!6 rh.6n. and uho do6 ${h \oit hiflscllor hsd,or thmush his orhd oM c,nploys, <br />Drovided nlal such iDp.ovdrcnls o! nor i 6.led or ofl.red ft,r $lc tt howe_c, $. b{ildi4 or improvmol is soll \ irhin o.. !6 <br />ofcompldion. the (nvnd aui1d6 $ ll hav. lhe bu dm oi provins thar hc or $h. did mt llild or ihlnole lfie prop€ry lor rhc !uqi* oI <br />L,l.6o\$ncrotthe lrorEly. onclchsn.ly contadins $irh I'cm*d.o mdoR to conslrucl thc pnjecl (Str 7044. Busil6 <br />Ililfabn ( odc, Th.conra(kx's Licctrs. L.\'do6 noi apr,lt, ro oNncrof[openy\!hdbuildsornnprorcslh(@n. <br />who c.nr.cis aor such [oje.ls trith a Colnndo(s) licosed pursuanr tu rhcCont.dors Liccnse t:N) <br />I hcrchy afiinn trndd pdrhy ollEjury oncofthe lollo\irs d(l..alioi1: <br />I lFvc ed will nai.r,in d Cdili.arc of adBor ro S€la-Insure lbr \mrk6 co ,t*hsarion,.s providcd for br Salion:1700 oalhc <br />I abr Code. ror thc pdlonnnn.. o i rh. N.l{ for which the pmil is isu€d <br />Iha\catrd\ilLmainrai'r!ork€r{co'npeiiarnn,instrr.n.e,asrcqri'edb!S(rnrnlT00olll,el.ahorCodc.aorrhcrcromm..of <br />rh. work lor vhich lnis p€nnil Lr ssuei. My sork6 (ompssarion insmn(e caBiet md policy nunber ee <br />Pt**il ****r*:r*s;u:* xr *:-** r issu.rl. I d'all nor dplo, a., p6on in any m.n,6 <br />ediBmrhat if I snouB b6omc subjEr lo th. <br />lhall. fonh$ith comply rvilh lho* povisiDns\o.lm' conrposrion povisioosof s.di6n.!700oarh. Lab.r c.de, I <br />1VARNINC F.ilur! ro *sute \.rl(C onrpo,erion covra8e Ls ur <br />cnil fitres !p ro on€ hundrcd rhorsand dolld (t10o.0m)- ih ad.h <br />srtrl, tud slr.llsubjL{r .n $tloy.. ro oimmallHxlti= and <br />ro rhe cosr of coDpeMrt'n, ddas6 6 provid.d fu lhe <br />( ode. i' crsr rid artrnc) s rL\ <br />tt z <br />I h.Ebyamm 0nder |xnill) olI{ jr) lhal laD li..isdlutr c! |,o\I ol( [itri!)l(ni ncncn,! \ hS..ritn] 70rll)).ll]lisi{r l <br />colslallEllaxl.};llllltcSlirlcr <br />I hq€by amm unds Fnrlty o i p6ju.y rhd lh@ is a conitudion kndins asocy lor lht pofomec. ol th. *ork for shich lhis !6nit is <br />isso.d (S(.1097, Civ. C.) <br />L.ndd's Nm. <br />APPLICAN'T DECLARATI(}N <br />I he$y aIltu undcr tdahy dipdjury on. olth.lollowing dsld.liom: <br />Demolilion Pcmits-Asb6ros Norifi.rrion I'.doal R.gxlarions (Till€ 40. Pan6) <br />-Rertutcd <br />I cneolNorin@r n <br />I cclifyrh.r rhc lcdsal r€sulir ioN rc! ding asb6l6 rdoval r. nor applic.ble lo lhis proiEl <br />y",I ..nity rh.r I hr\. rLnLlrhR atl)Lr^(lon .t rh..bo!c infom.rion s cotr..1. LgG ro conply $irh all Cily and Counry <br />ion..nd h(cby surhorizr reFMtari\B oflhis Cny and Countylo dl6 lrmn th.nrncsandSritc LJssrcld n! b MikliiA <br />.rl,rr rnenri'{r,lnrrr cn\ 1,tr n\!hrtr' <br />rnllicanr or rgcnr Sierurrrr * <br />$"-t)o.>,'-t <br />,^. ultzl,.t <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lt4asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />FINAL II wla <br />Certificate of Occupancy I <br />Notes, Remarks, Etc <br />DATE <br />of rh. Businasitrd PDLssions ('odc. ud nry License is in full lorcco{ efl.cr <br />Lrft. Numb.r: