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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE rD/srG.COMMENTS Omr.Bcildcr Docludm <br />t hcrc! rfllm undtr padty ofpcrjury thrt I rm cxcmpt form tho Coltrrctqr' Licarrc Lrw for $c following rcuon (rcc.?03 1.5 Burinilr <br />ud Prcfc[im Codc): Any Clty c Cornty rhlch rcquiro r pcmh b cdrntr.t d&r, irrprcvg dmolirh c rcprir my rhcruc, prior to lolfucg rlro rcqds tho pplicat lir ruch pqrnit to lil6 r ,i8ncd stlllmt thrt h. a fic i, licdtod punumr to tho provlrlonr of thc <br />Cmaac'r Llcanod l,n (Clr+tr9, Cmradnl with Scrim ?000 of Dvhio 3 of thc Buina md Prcfqrim Codc) r thil hc q <br />rhc lt crcilpt th.icfrdlt rltd $a b.tia f6 rh6 dlcjcd acrnpdon .Any ylolation of Sccdon 703 LJ by uy rpplicmr for ! pcrmirubjccr rhc <br />+pli6t to r clyll pcndy of nd mom tie fivc huadrcd dollm (t500). <br />_l,s Mqoflhcprop<ty,trmyc4loyawl$*qouthcirrolconp<rrrtim,wllldoticworkudthctructurcirnotinrcndcd <br />c oficd fc rdc ( Sc.70,14, Burha md Profdrlm Code Tho Canrrctr'r Licarrc Lrw-doq not lpply o rn owna of thc propcny <br />who bull& c impro!rc, 6qtm, ltld f,lro doaa ,E,l wfik hlm$lF ff hdclf tr thiruth hir d hq om mploy6, provided thrt ruch <br />inprcyfiiatl rc not liladod a off@d for tdc. lf, hoscv6,thc building c imprcvafit it lold within m6 ycrr of complction, thc <br />Ovna-Buildcr will hevc tho burdm ofprodnS thrt hc or rho not build c lmprcvc fw thc purpmc ofnle). <br />_1, u ma of thc pogaty, m cxclulvcly cmtrting wlth licilcd mtrutoft to cflhrct thc projcct ( Scc. 7044, Buin6i ud <br />Prcfdio Codc: Thc Cotrdor't Lia6s Lm d6 nor spply to s oma of prop<ty who buildt or imprcvcl thqu , sd who <br />cilErctt ffi ruch prcjdt with r CdrErt6(t) limcd puut to thc Cdrtr&tor'r Licatc Lrw.). <br />_l m crmpt undcr Strtlo & P.C. fa thir rcuon. <br />Drtc: Ornc_ <br />W <br />I hccby rllim m&r pcadty of Fjury ooc of tho follnloS dcclrrdil: <br />I haw md wlll rndntdn r Ccrtificlo of Coorat !o Sclf-lilura fc wckm' cmpca:uim, u prcvidcd for by scction 37oo of thc <br />frbc Codo, fc $c pcfmnce of thc *ck for whlch thc pcrmit h irucd",/ <br />+l hrvc ad ?ill ilintrin *q{sr' cmpourtim inrumcc, rr nqulrcd by Smtlm !700 of thc Labor Codc, for thc pcrfomonoc of thc <br />wort for whid thir pcmit it Lruod My ?oltcd' compamtion inrurrncc crnicr rnd policy nmbcr m: <br />tr <br />Pollcy *=i,?- 2<ro/.-, <br />(Thir r*dm bc 00) orlal)t/\s'z <br />of tho wqt fa which $ir pmit <br />of Cdlfmi!, md <br />lr kucd, I rhrll not mploy my tn <br />lawr ltrcc that ifI rhould bccomc thc workcB' <br />mpcroedo Fovirionr of tho lrbtr Co&.I rhdl.comply <br />WARNINGI to walctr'mPansrlm <br />($100,000),in <br />m cmploya to lnd civil <br />fincr up to thou8d&llrl rdditio io fic cort of dmt86 a providcd for 3076 of <br />thc L&acodc, lntrcrr [d tttm€r't fcd. <br />I.ICENS'N CONTRACTIORS DFCL RATTON <br />I hmby rfllm m&r p.orlty of pdjury $ll I m limrcd undr povidm of Chlptd 9 (@mmctrcin8 wirh Scoion ,0oo) of Divirion 3 of <br />thc Buincr;nd Prcfoimt Codq md my llmrc it in full forcc md cffcr. <br />Licmc <br />I hcrcby und€r pmdry of Fjuy thtt I ofrhc which I <br />Civ. C.). <br />Lcndcr'r Addror, <br />AIPUC^NTIS DECI.ARATION <br />Doolitin Pmitt-Albatq Nodllcaim Fcdml RcSulrrin, (Titlc 40, Pur 6) <br />_ Rcquirtd Lam ofNotificrtim <br />Emonl [c not rpplicrblo to rhit projccr. <br />I wlth rll City md Counry <br />Applicmt tr rtat <br />Pcmltrcc <br />rhc It <br />Md lo mtcr rhc <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SI-AB Floor <br />S u bfl oo rA/e nUl ns u I atio n <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brorn Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Requlrements <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certiflcate <br />EXI 'll',(Eu <br />t A <br />FINAL JUN UO auP Y,Y\ <br />556, <br />Notes,, Etc. <br />of