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BUILDING. INSPECTOR RECORD
<br />COMMENTSSITE-WORK DATE ID/SIG.
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framina
<br />lnsulation/Energy
<br />Drpvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />FINAL 5r\8Y
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER BUII,DER DELCARATION
<br />I hdcb, .mnn !nd6 p.nalty of p€'rury lhal I d .rc'np lon rhc aonl,aclor' Li..ns. Ln* ror rh. aollowi4 r@n (Sc 70ll t
<br />trusins md Protsion Cod.) Any Cny or Counry \hich r.quir6 a psin lo coNrtu.L .he. improv€. &noli.h or EP0rt my
<br />srrucruc. pnor ro ns issuuc.. rlso rcqutB t hc appl icaot for such p€noi lo n E a s i8ned sl.tqnol I hal h. or sh. ie lic.N.d plm l
<br />ro rhc prcvishns ofth€ Conta.toa! Liceh$d tjw (ch.ptr 9, (ommcncina w h Ssriod 7000 ofDivisio! 3 olrhc BusinB md
<br />Pror.$ions Code) or rhar ne or she is cx.nrpt lhqefion ud the bdis ror rh. all4ed erenption. ny riobriod olsslion 70115 by any
<br />aprlicanl lor.p.nnn subietslh. applica.t io acivilpenahyofnot morclhln nv. hundr.d dollds(8500).
<br />-1,
<br />N ownd oflhcpropcny, or ny.,nploy!6 {ilh {arB s rhen ek compqelion, silldo rh. *ort ard lhe nrucl@ b nur
<br />inlad o, oftdcd for elc (Sa.70,14. BEi,6 ed Prcfsions Cod€ ltc contr.clol s Li.dsc taN do6 nol apply lo o owno of
<br />rhc Folrny who buildr or ihproG fiaan. ed who do6 such roi( himcllor hffiltorlhroush hi or hr oen oployc,
<br />proridqi rhar such imPIovo1Msm noi intad.d o. ofidEd lor sk. l( lD\'66, rh. hiklina or inDro!@l is $kl wihi. on. )@
<br />ofcompldio.. lh. ()wnd Buildd *ill h,\! lh. hrda oaprolin8 (hd h. or she did nol build or iftpm\. fic p{rFly lor lh. $nFo* ol
<br />l. sosnffoflhcpropsly. @ erclusiv.ly.ommciins $ilh licssd conlrado6 to codtu.{ rh. Foje.l {S(. 7044. Busins
<br />and Pr.fsion Codc: TneCdntractois LicenseLawdo6 nol applylo oo*dd ofprop€nywho buildror inprov6thd.on.
<br />and sho co.racrs lor su.h !.ojek wnh 0 contacto(s) licm*d puuuat lo ih.conlr.clols Licmr Law).
<br />! m er€rpl utrdo Sd R & l'C ru lhis rc6on
<br />D.tc o*ner
<br />rvonxecs <-olt rrtrsl tLott
<br />D!!!A!IU!O!
<br />I lNcby rlfinn 0nds peMLlyot,Krury onc olrhc tullN\ ilr! de.lar.rtns
<br />I havc ald will m.inrain a Cdin..tc o I coBd to Selt-lnsurc lor \ drkes' onrpcnsalion, s prlvtled r(r h, sdion 1700 ollhc
<br />Iibor Code lor ih€ pslomece o f rhc wor k lor which rhc pdmir is isucd
<br />-lhavcandrill
<br />nai.rai.woik.rs compcEarion i6uranc., as r.q!t.d l,y setion 37(r(rollh€ Lab{r Cod.. fo, thc pstomdcc ol
<br />rh. work lor unich rhs Fnir ir ie.d. My xorr.(- comp<rsslio! insurdc..Mi6 dd Policy numbs de:
<br />,!t
<br />Sdion 1076 ofrh€ hbor Codq inr66t ed zrtorEy s fe6 ----- -)>-
<br />,,,,",Nov l5 2018
<br />DICLASArIOX
<br />I heEby aflinn undq poa[y or p.rjur y Ihar I e. liccns€d undd ptuvirio. o I ChaPls I (coonrdcn,s * ith setion 7000) ol Division ]
<br />of lh. Alsin6 and Proresions Codc. md my lic4. is in full lorc. ud .Ifect{3 t O D,-lq OD\
<br />,,,,. Nov I 5 20lg ,-,-*"4,(N,^- -
<br />CAXSIBIEIIAII TJIDIACJ(iEN(I
<br />Ihcr€byoflimund.ypenolt,ofp.iurylhglrh6cisaconn'lcrir lotira03scyforIhcP(ronnm..ollhe\vo!kror$hichrhhpanrilG
<br />issucd{S.. 1097. Civ (.)
<br />AIIIICANI.DICI.AsAIION
<br />I hcdry a1iift und( p.nahy ofD.rjury on olrh.6llowins deLr.liobs
<br />DcEolilio. PmiG-Asbdos Nolihcslion F.ddal Rcgul6tioG (ri(b 40. Pan6)
<br />R.quir.d L.116 oaNoli6cario.
<br />-l
<br />cqli8 lh, rh. f.d.r!l rceul.lioB r.ssdins abGlos ldoval 4. .or aPplictblc to thb pDjc.l
<br />,4dr$ r h, I hsv. Hd rhs appl'( d
<br />'on
<br />dd s,rr. r h, thc ahov. infonmrion is codd, t a8re ro omPl, wilh .ll Chy sd Counly
<br />oillnd.6 d Shr. tiB Elariry lo burBrns consn.rion and hden, auth.rize r.r.6alalir6 of$is Cily md Counly lo @lo uPon lh
<br />above mcntioned pmpedy aor iNp.dion
<br />ADlirmr or.\genr Sig rlur.
<br />&.4a
<br />,;Nov I 5 2ots
<br />lufiffii,
<br />Set Backs
<br />-l..nifyrhar
<br />i.llE perfoiinancc olrhe worl lor*hichrhisp.rnn is Gsue!.1shallnll d ployanrrdsoo in.!yrain$
<br />s, 6 ro b€comc subjer 1o rh. worl6' co,trpqsation lavs ofcalilomh. and trr.e lhal if I should b.coo. sbjed lo lhc
<br />Nort6 comp.Nrionl)ovGioosofS.crion 1700ofthc L,bor Cod..I thlll. lonhrnh o'nply wnh lho*ptuvisioN.
<br />\VARNING: Failurc lo su. *ork6 co,np6.rion cov.6S€ it nlnsall. &d 3hnll subjd an dtlors l. sinnml pdoiiG sd
<br />ci\il fin6 up ro onc hun&.d rhoMd doll6 (lloo.L{o). in addilion kr rh. cos oa conrp.6arion. d.ia88 6 prolid.J lor lhc
<br />L.nd(! Adtt6
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