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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE tD/srG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lns u lation/Energ y <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 />Engineer Final Report <br />Flood Zone Certif <br />FINAL u ,lt?E >r) <br />Certificate of Occupancy ultr <br />Notes, Remarks, Etc <br />+ <br />OWNER BUILDER DT]LIARA'IION <br />I lM.by amrm rnd6 p.nallt of pdtury that I an €rcmpt 6orn lhe Conra.ros' License tr\v for rh. lollo$in8 rcMn (SN.7oll 5 <br />Businds and Prclsion Codc) Any City or Cou.'ly *'hich requiB a !6nir ro todtu.r, ah6. nnprove. dmolish or rqstr o, <br />stnrcluc. prior 10 irs isuace, ale r.qui6 rhc appli.dl lor such pomn ro nE r sisn.d stat.'n€nt lhar h. or $c is licds.d luNer <br />ro rhe provisios offic Conta.iori l-ice.sed l.w (Chapt6 9. Connn.ncins snh s.crion 7000 of Divhioo I ofrhc BBinds dd <br />ltorNions Code) or rhd he or sh. is er.,nB $deftoh ard ih. basis for the aUcs.d ercmplio!. Any violali.. of sdion ?01r 5 by aby <br />0ppli.anllorapmritsubjdslhcapplicanrloacnilpcnahyolnolmorerhdlircbon&.ddolltrs($500). <br />-1. <br />d osn6 oarh. ptuF1r. oi ny enlplolB wnh waSB * th.ir solc compsalion. sill do lhe solk tnd thc snrclre is ml <br />intakin orolf6€J tor slc(56.?0.1.{, Busin6s d t'rorsioas Cod. Th. Conlracror's l,ico* Law do6 nor apply ro an os'nd or <br />rhc tlftrElv who h,ilds or improrB th@n. and s bo dos such wa hins.lf o! h*ll or rhmush his or hd .rn .mploy.6. <br />pmlid.d rhzr such ihFovmrs 6s ,ot intodal or olIqed aor sl€. I[ hosds. th. buitdios or inlPrors6r is sld Nhhin onc !u <br />ofcompldion. tn. O*trd Buiklg rnl havc thc hldd of provins thd h. or sn€ dd tul build or imFo\. lhc lrtrFly for lh. purlDF ol <br />I. N oN nd of th. propsry. m€xclsn€lyconrrscrinr sirh licc.ldl.onl,ado6ro conntucl Ihc prej(l (S( 7or4. aGin6 <br />ald EDrGtFn Cod.: Th. L'ontr.clois Lic..sc Law do6 not,pplylo an own6 orpopqly sho builds or imptov6lh46n. <br />.nd who contmcrs aor such projccls$ilh a Conhcro(, licoscd pmu&l lofi. Conlradois Li.eM Latr) <br />I atr cr.'nfl lndd Sdtio ll & l'a f{n rhis rN,n <br />ltEcldaarJg! <br />I hsenr artr,n undB poalty of pgiury on€ otlhc followin! dslearions <br />-l <br />hav. .nd will minrain o Ccnificalc olcoogt lo Sclf-tNur€ lor \brtdr conrptrs.iion, 6 provid.d tu by Setion 1700 o f thc <br />hbr codc lor th. pdfommce o I lh. sort for vhich ln. p.mn n issucd. <br />I halrandNiU mainlain workers' .o 'nre6,r io. ituuian... s rcquted by Sslion.1700 ofrh. Latsr cod., for lhc !6fomocc of <br />Ihc sork for Nhich lhis pcmlir is isucd My wolksr conlpdr$lion iNuldcc carir a.d pnlicy.umbd ac: <br />..--_- <br />in rhc pda..man.c ofrh.Nork for \vhich rhis p€mit is su.d. I sh,llnor dnplo' any pcBon in any Ddn.r <br />subjar ro rhc $0*6' cofrr.@r io. las s of Caliaomi.. ed .8re lhar il I should b..on& suuidr ro th. <br />tvol{m' corpeNtion prcvisions of Setion 1700 oalhc lzbor Codc, I &h.ll. fonhsilh comply sirh thoF ptuvilioB <br />WARNING: F ilue lo sc. sorlc6' comp.Gation cors.s€ ir unlawlul. and shall subjd e dplold l. sininal pouliG dd <br />civil lin6 up r. on. hundi.d rnouwd dollN (1100.000), in addnion lo lhe con ol.omptralion. d.mas6 5 p.ovid.d lor lh. <br />sdli.rn.1076 olrh. Lr&tr codr, i trsr md arrom.y s-i? l- t <br />l.lc[lllD-coNraacroa <br />DICI.ABAIION <br />I hftby afiirD und6 paally of p€rju.y tha I e licdscd undd Fovirion o I ch.Fd 9 (commocinB wnh S..1ion 700tr) ol Division I <br />ol fic B6in6 dd ProasioE Codc. ud my licm. is in full forc. ed elIdr <br />&b> <br />\90 <br />co!$al]glolLDlDrlclcENcr <br />I hrcby amm undr lEnslry o a pajury Oat thd! ir a coffttu.lion kndins sscncy aor the daolfucc .arne Nort tor shich this Fnil is <br />issu.d(S( 1097. Ci! C ). <br />ATTIICANI:DECIA8AUAN <br />I hddn amnn unda D€..lyoaDqi'ryonc olthe lollo{i.s d*laaliotu <br />D.nolirion Pd,nne^sbdtos Norificarion,:eddal Rqulalions (Tnk 40. Pan6) <br />R.qut d Ldr.r ofNDrif(dion <br />I cglirylhar th. rqlEal r.gularios rcgmdih* 6b6ros r.moralarc nor.pplicablc lo lhis rojccr <br />-l <br />celiayrhal lh,vcrqdrhisapplicarionandsrarcthalrheahJrc infoonarion is cond I agre lo comply Nilh all Cily and county <br />aullnriz. r.prMrar i!6 of lhis Cny d Counr, r. drd tF)n $. <br />,*@lKrE D"1",'tt- | - l3 <br />Subf loor/VenUlnsulation <br />Nudbo: r Expt6 ' <br />-::::-=-- <br />Landn s addrs <br />o inancs and Stale ljss lehlin8 to <br />rh\r nrnhon(d f'o|{ny ln' <br />t=-