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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BT]II,I'ER DEL(:ARAIION
<br />I hcrcby amrD undo pdrlty oi pr.ju.y rhd I m .rmpr aron lh€ Contsdof' License LaN for rhe aollowins r.Nn (Scc.?011.5
<br />Busin6s md Prolsio, Code) Any City o, Counly Nhich r.luirs a lEn ro consNd. olls. improv.. dmolish or r.pan my
<br />structu., p.ior lo its isu ce. also r.qut6 rhe arplicd aor 3uch pmni lo frlc a siso.d aldndr (hd h. or slE is I'coE€d p$q l
<br />ro rh. p{ovisioB oflb€ Contacloas Lic..sed lrw (ChaPr6 9. Conm.n inS Nith Sdrion 701{ of Divisi.n I ofth. Dusins .nd
<br />Prcfsions Cod€)orlhal hc or shc i5 crcnB Ooefton dd lh. basis for the allex€d eremfl'on Anyliol.rionofs.<lion 70ll 5 bydy
<br />aprlicant forap.mit subjck lh. applicer b tcivilpen.hyofnol mor€lhd lire hundr.n do trs($500)
<br />1 ptk *.. t*.
<br />^-ry.
<br />or my nproye virh w'!6 ar rh.L $re cornFroaiion. wirr do rh. *oi( ind rh. srn ruc i' mr
<br />inrodsj or orlred aor salc (Sc.7o44, Busine md P:'ofsions Code The Contacrols Li.ro tjlv do* not apply lo o os d ol
<br />rhepslgiy who tuilds or io!.ov6lh6@.q and \rho do6 such qoIl hnBellor hmdlorlhuEh hi orhr oNtr.mployc-
<br />p.oviddl rhar su.h inprovans s ee nor inlqrdql u ofiscd lor ek Ir, ho*66. fi. buildi.g o, imlrovmdr t $ld wnnin ooe y€r
<br />ol co'npldior. rh. OMd Bundd will hav. tnc budd of lrovin-! lhd hc or shc drd nor build or nnfro\t llrc p,lp6ly loi O. P,pos of
<br />l, &s osnd oaihe prolslr, m erclusively conlmci ifls viln licFred conta.rdu to constn,cl lnc prci&1 (Ss 70'14, Blsns
<br />tu Ponssion Codc: 'l he Conracrof s Lic.mc Law do6 nor .pply ro osnsorpropcnywhobuildsornrprovcsrh.rcon.
<br />and who conkalb lor such Folecls with a Conlra.lo(s) lics*d pu^trmr io rh.Conlrlcrois Licc6e k$l
<br />V*"4
<br />DECIdAAIIAN
<br />I nd€by amrd und( poalr, of Fjury o". of th. aollosins dcl&.tioc:
<br />-lharc
<br />d sill @rrain a cdin.are of Co6d lo S.lll6ure lor wotksa conP.lsal io!. s rovid.d ror by Sario. 1700 oflh€
<br />t bor Codc. for lhe psfom&cc of rh. solt fo. whi.n rb. pdmn is iasucd.
<br />I halc and will
<br />'naioraio
<br />workcrs co,rpeNatiotr irsur.ncc. s requncd bySdtionrT00 ollh.l,.bor Code- for lhc pslonn ccof
<br />rhe wo,k lor rvhich Ihis ponit is issucd My work.6 composalion iNurane cein d policy nurnber tre:
<br />Polr., Nobo- Frpnca
<br />!llf;(*,D ,*, , *" -"man.. nt rh.lork ror qhrhrhispdmi is Lssued.l stDrlnot dnploy.nyp6$o in@yndn.,
<br />' qi .r ro &!.m. subj(r ro rh. $ od(6 comf.red 'nn l.ws o r Calitona. Md 08e ihal if I should b..om. subjd to rl'.
<br />\orroj (mrcsron Drotilioc otSdion 1_00or !h. Lsbq ' oJ..lih,rl fonhurh compb vrrh lhr* fln\tsic6
<br />TVARNINC tr.rlurc ro Ku€ sorkc cotr,p-Mnon covd,s. is u.la$tu|- d shallsubjdr d cnployq lo suiBl Fult'6 d
<br />cNil fines up ro on. hufttred 'hnutud dolld itltro.C$o), i. addirion lo lh. coi oa conp.Narion, damasB a povid.d aor lfi€
<br />S(rn n 1U76.rrhc !2For
<br />,",",r/r18
<br />Codc. inrod dd itro.nd s ic /,rbF,&,
<br />IICENIID-CONISAqIOA
<br />DECUAAIIO!
<br />I hqcby amrm undq pmaly o I !.rjurl lhll I m li.cm.d rnd6 pmrision ofChapld 9 {commocins Nirh S.clioi 7000).rDiri(ion 1
<br />of lhe ausi,r6s dd Proasions Cod€. ad ny licoic t in rrll for.€ dd ciId.
<br />coNlIaLllIIoNrEdDAqAcENcv
<br />I h6€by !fim unds FnaI, of pflury ih.l th6€ is a coNlrudioa krdins agm., for th. psfommcc of rh. worl lor whici this p6'nn is
<br />issucd (Sa.1097, Civ. C.)
<br />AXIIIGILDECIdSAIIOA
<br />I @amnn und6 paalry of p.rjury on. of rh. aollowi.B dcleations:
<br />Dctr$ lirion Pcrmirs-Asb6los Notilicat ioo Fcddal R.8llations (Tnt 40. Pel6)
<br />R.quired kttd olNolifi olion
<br />I rir'l) ,hJ rh. f.dtrJ rcEularons rc/u,Ing 6\6rb 'cn,c"l-0 nor odrcablc ro t'r't fl t,'
<br />#l-cdrr rh th c rqd rh6 apphcar'on dd i.tc r har hc abolc irromarion n coddr I aB,e ro mnply wirh all cny.nd cou.tv
<br />i'rdin.nc6 md srare L3ss Elaldx 'o b{'ld'nE codtudion. dd hd.by aurhortu rcpr66lari!6 oalhis City dd Cou.rtro drd rp..lh€
<br />,h.v. rd ion n propdy ior iBp6lion
<br />E\ppli.!nl or Agenr signrtnr€:
<br />ft{rire n.ne (p.n,r): F),*';rl CA)ae
<br />*,",rf,r1tt;
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL tt I
<br />Certificate of Occu
<br />Notes Remarks Etc
<br />)
<br />Set Backs
<br />I
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