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BUILDING- INSPECTOR RECORD SITE-WORK DATE rD/srG.COMMENTS OwF Build.r D.claration I hereby affm, undcr peMlryofp.rlurylhll I ao,.r.nr aorfl rh.Contrdors Lrc.ns.hw forrh.follosrng rason Ge 7011.5 Bosin.$ and Profsion Cod.): Any Cily o, Cou.ly ehich r.qoic r pdnn ro.oBkucr,ah.r. i,bpN!.. d.molirh or r.piir any srrucrs., pnor lo ils issuance. rbo r.qut.s th. rppli.am aor su.h p.mt to il. 3 sisncd narocm rhlr hcorshc ir licctrscd ,ursua.t rorhc p.orisioBoflt Contraclo.s l-'c.ns.d l-!w (Chipts 9, Commencing wnh S(hn 7oo0 ofDrv6on I ofrh. BBrnd3 rnd Prof6nom cod.)or rhd h. or sh.is.xcnpttficr.fiomrodthcbasisforrh.oll.8.d.x.mprion.Anyviot.rionoaS.crionT0ll5byaoyipplicafllorap.mn3obj.ckrh. appli.rfl lo a.ivilp.nahy 6anor hor. rhan fiyc hundr.d dollic ($500) I.6o*nr6rlhcprop.ny,ornycmploy.cswilh*is.sierhctsolccoop.hsarion,$iUdorhc*ortr.drhcstrucru.i!norinr..d.d orof.red lor*1.( Sec 7or4. Busi..ssand Prof.srotuCod. 1'h.ContictoasL'cens.Lawdoenorirplyto.nownerofrh.pmp.ny qho buildsor implovelh.r.on. andqho dodsuchaork hins.lf or hm.lf or through hk or h.ro\rn rmployes. provid.d ihar such inrrov.mcnh ar. nol iil.nd.d or.aLr.d aor salc. ll howcvd. rh.6uildins or improv.mcnl is sold wilhin on. y.sr ofcompl.lion.lh. Ownd-Builda willhrvc rh. burd.n ofprovine rh h. or shc oot build d, inlrov. for rhc purro!.6fsil.). l. ao{n roflhc prop.ny. r'n.xclu$r.lycontradine trilh licctrscd coalrocloc to coNlrucl lh. protcd (S< 70,1,1- BBr6s lnd Prcf.sionCod.'lh.(-onhcroisL'c.neclrwdo6notapplyro.nownerofpror.nywhobu'ldionn,provGrh.r@n,sndwho cont&ct aor such prcr.crs *irh r Contrcro(s) l'..ns.d puuunllo rh.Co.kacrors L'c.n3. hw ) I d ex.nfl und.r S.crion .B & rc lo,this r.oson roaxEal.larlrErs llar-DEcLAaa.I9! I h€tbyaflirm und.rpemlryofr.ri,'ryon.oath.a.lloNin!d.clararn,ns, I hlr. and will hrinr.i. ! Cdificar. ol aod.m ro S.lf-l nsur. for *ork.6 comp.Mr'on, ds pro!'ded lor by S.cr'on3700 olrh. hbor Cod.. f.r rh. pgformnc. olrh. sorl forwhich thc r.dir ii ilru.d I h.v.and willfrarnrarn wo.kcra onDensrion rnsur.nc.. ds rqur.d byS.cr'on 370Oolrhe lnbnr Code. aorrhep.domanc.ofrh. work lor wh'.h rhB p.rnr i r rsu.d My w6rk.E @mr.nsl'on 'nsuranc. caftir ,.d poli.y nunhe ir.: ( llris scclion ne.d nor bc conrpl.lcd ialhe pennn is aor Oi. h!.drcd doll.6 lll00l or l.s) I c.nify thal in rhc pdlornhnc. ofrltc wd for shich rh's p.rmir 's issu.d, I shall nor.mrloy 0n, n.^oi in a.y 'n.nn.r $ is ro b.Gmesuhjdr ro (h. m,ke6 con,penstrrLon lawsofC,l,fornLi. snd !a'e. rhat 'fl should becomcsuhrecr rothe Borker- cor.p.osrion provisions olS(tion 1700 oflh. tnbor Cod( I shrll. lonhwilh complt sirh t eftrl. znd shllsuhre.r rn en,rlover ro .ri,ninal pcn.hi.s and.i\ il lin.s up ro on. hund.cd tho6Md doll6 ( $ 100-000).in addilion to rhc cosr ofcomp.nsarion, damlscs 6 provid.d ror ln. Serion -1016 of rhcbborCod., ihler.sr lnd ttomeyt fes LICENSED CONTRACTORS DECLARATION I h.r.by ifiinn undcr p.nally ofpcdury th0i, am lic.ns.d undcr rmvisio" ofChdpir9(co,nm.ncins vilh Scdion 7000) ofDivision I oi rhc Busin.s and PmfcssionsCod., md my lic.tr. is in folt [or...nd.ft cr I hdcby arm und.r p.,rll, olprjury rhrt rhoc i! ..oBlruclion l.ndi.g .8.m, lb. th. pdromlnc. oflh. wor* aor wbicb rhir pmi i! issu.d (S( 3097. Civ. C.). 4r8UClrr.l9EC!AAAL&! D.rolirFnPermns Asbc osNorific.rion Fcd.ral Rcsuhrtuns(lirlc40.Pan6) R.qutcd ldt.. of Nori6calioo I c.nifr rhar rh. a.dml r.*ul!r ions r.strdiu abdrosrchovrlrc norapplicabhro rhh pioj.cr I c.niay rhd I h!!. r.ad ihisapplic.rionands{crhii rh. ibo\. inlom.rion is.onc.r I 4r.. ro .omply anh all ciry rnd Cormy o.dinanc.s.trd SI.l. ti\rs r.lalins ro buildins coBrrucr ion. rnd h(.b, aurhort. r.pr.s.nhliv.sofrhis ('irr.nd Cornly lo dl.r lpon lh. abole n.mi...d prop.ny fot Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsul Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL oiltAh<-r19{,. -t vuht, Certificate of Occupancy -l'- | V U u-/ Notes, Remarks, Etc M:\WP51\Pormil-lnspeclion f orms\A!ilding lnsp6clion Record doc 03.31 06 Brown Coat -t\<ft+w(Y5 -----r-- t