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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDI'R DELO\RAAION <br />I h6eby sfim undd penah, ofrclurr lhal I m €x.mF trm lhc Contrclon' Licens L,w for the fouovinB lten (5(7011 5 <br />BBin6 and Prot6ion Cod.): Any Cily or Cou.'ly shich rcqund a pdnh ro coNtxcl. ahe. inprolc, dcmolish or rclAir my <br />srrrcrure pdor to its i$uecc. al$ alut6 rh€ ,ppli.d for such p.mit to filc a sisn.d sladnor rh8l h. or stc is licoB.d p6uor <br />to rhe provisiotu ol tnc Contractois LiGnicd La* (Chrprr I, Co6mcnci6S $ilh Se.lion ?000 of Division I oarh. BushN ud <br />Proaesio.s Codc) or that h€ or she is.xcmfl rhftnod add rhe tusb for thc allcs.d cx6nflion AnyriolarionofS.clio! 70ll t by.ny <br />applicnnrroraFnnirsubjersrh.applicanlloacivilpenoltyoinolmorclhannvchundr.ndollds(!500) <br />l.6orndo|lhcp.o!.ny,o'6y@plotGsnhwa!6s.irel.conrp€dsalion.*illdo$.wo md lhc slrudE. n nur <br />inrfldcd orolTold for salc (Se 7044, Bosins and Prof6sio6 Codq fic Co.tnclols Lic@ L€* do6 nol arpl, ro oNnsof <br />Ihc pmpdv uho btrilds or inp,ov6 rh@n. od*ho do6 su.h kri( hims.lfor hmclfor lh.oush his or hd oM dnploy.6. <br />rrolidql rhar 3uch iittuvomts e. mr i odei or olIqEd lor el. I I hoNdr. rh. huildins or inProlmdl is sld rithin nn. )d <br />ofcomplero( lhc O*Ts Builds {iU h^ c lhe lEd.n of proins dd he or si€ did nol build or imFovc rh. propd} for rh. purlDs ol <br />-1. <br />s o\sd ollh. propdy, mcxclGi!€lyconrncriis wirh licdsed contactoG to coNlrucl rhc ,@jd (S(. ?044. AGin* <br />and t\oli:sion Codc -t'h. cotrlEcioas Liccns. Law dos nor 0pply to e owns o lprordy qho btilds or inProvd rhden, <br />and \no codnds for such pmjats silh a Cont6clo(r ltdcd pu6udt ro lhc Contracrd s Licosc t-d*) <br />ll*,///^vL< <br />PECI.ASAIIO! <br />I hd.6y rmrnr.d6 p.nahy ofpsjury on. oflll. tullosins d<ldalioa: <br />I nav. a.d will mainrain a Cdtia,€le oacoNnr lo Sdf-16@ for mrkdr @n9.n!ario\ s providdl aor by S6tion 1700 of lhc <br />Lahor Code aor lh. pdfom c.otlhcworl fo, {tich lh. pdnn n su.d. <br />-lhsv€andwillmaflainwo*.B.omp.s.(io.iBuranc..6r.quncdbyS<lion3700oflh.bborCod..forficpdlof,n..oirlE vorL for wnich lhis p.mil is isuoL My vo,k6i conptrdion insurec cri6 a,i Flicy .!mbq rc: <br />Polr! Numbd Erpn6 <br />I ccniryrhar in rhc pdfomoce of rh. wo& for *hich this Fnit is i$ucd.l shall nol dnploy any Psen in anyndnn <br />$ s kJ h.comc lubj<t to E work6' comp€Nlion hws ol Calilod'!, dd.grslhar if I should bsone subjd' b tnc <br />vorl6'.onp4ario.pmlisiosoas6tionl?0OoatheLaborCode,lsttsll,fodhwilhonplywilhlho*pN <br />NARNIN(;: Failue to sculc \orkc6' comp.Bario co unl.wful. aod shall subjd d <br />civil ntrcs op tu on€ nund,.n llouend dollds ( <br />s(riLnr 1076 olrhe l2tor <br />DECIAIAIIQN <br />I nmby aiim uod6 poalry of psjory rhar I m lic.oe.d undr pmvtion of Chapla 9 lomnocins vilh Sd ion 7000) of Division l <br />of lh€ Busins od Prcr*ioG Cod.. md nr li.cM is in foll aora od cfid. <br />calllalcllQN-LElDllclcDlcr <br />I hsrby aftm undr !..rlr, oa palury lhar th6€ is a coNlrudion l€.dins asm.y lor ihc psfomance oflh€ sor[ aor ehich rhn Fmn b <br />issucd (S(.1097. Cir. C.) <br />ATTLICANLDECIASAIIO! <br />I @ afim unds pdaltyoapdjury onc of ln. aollowint delealions: <br />D.holirion Pmtu-Ast6ros Notilication F.ddll R.sulations (Tn[ 40, Pan6] <br />RqoiEd L.rt6 otNorilic.tion <br />I cdilyrhal $. t.i6alr+"l.tioN resddins 6b6tos rdroval & nd appli.abl. ro lhis projd. <br />I.dilvrhar I h.ve rad rhis ed sr .nh thd atsrc nrfonnalion is co ro..nlPly \rnh all Cilyand Counry <br />ordinatrcs and Shle lAVs rclanry ro ofrhis ( ny md Cofryto cnr6 urrn rhe <br />dhovc nEdtion€d pmlEny for <br />r cc!",/4s//-t' <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathino <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <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 />n <br />FINAL ///ta//Y .rrffi> <br />Certificate of Occu anc <br />Notes, Remarks, Etc. <br />--------r------