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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUITDIR DELCARATION <br />I h(cby aflirft und6 pdDlry ol pdjury lhal I m ermpl lion rhe ( onl.aclos Li..nse Law fdr rhc folloNins rcei {5e.701 1 t <br />Rusin6s and Pr.asion code): Any Cily o! CoEl, Nhich rcqrt6 a p6nn ro .o'etud. slls nnptove. donolish o. rcP0ir v <br />srtu.tu.. prior ro iG isu c€. also requn6 rhe applicMl for suh p.nnt lo lile a si8ned {sleDc thar hc .r sh. b licosd pusuanl <br />lo rhc Fovisions olfi€ Co.ta.roas Lic.ns.d L2w (chtPltr 9, Comm€ncins *nh sdrion 7&0 ol Division I olrh. BtrsiiRs and <br />Prcf6sions Cod€) or rhal he.r sh. is.rcmfl lhq.lro'n trd lhc bists ror rh. all+.d ermprion. ?\., violoiion ofsen$.7011 5 bv tnv <br />appli(ad for a pmn subjcG lhe applicor ro a ciril Pm.lry of,ot morc $ 6re hundr€d dollds11500). <br />1.6 o$r{ olrhc propenr. or nryc'nplo)E6 rvilh wa-!6 6 iheit sol. comp.6alrn. will do rnc wort dd rhc slod@ t mr <br />iddd.n orofiacd tor elc ( Sd.?Cr4,l. BBincs md ProlsioN Code: -r1]. Conlricloi s LiceN t w&snol tpplvlodomrol <br />rh.Ixlpdy who hiilds or imp.ov6lh6d,.. &t $ho do* sEh $oai fii,trElfor h@lf or rhrou8ir his orh* ovneoDlov.6. <br />pruvidcd lnal such nnprovmdrs m nor inhd€d o, orEqi lbr elc. ll how*6. lh. buildi.g or imProvder is $,u wnhin one )@ <br />oa.o,npldioD. fic Ownd lruildg vill have rh. htrd6 of prcving lhal he or shc dxl rel t{ild or imtro\t lh. p,iFry aor lhe purFe of <br />-l.6ow.d <br />orrh. pmt61y. m exclusivcly comrtdin{ qnh licm*d co rado6 ro cocnld lh. Ixojal (s<. 7044 Blrinds <br />and Pisfsion Cod.: -lh€ conl.r.lois Lic se L.N do6 nol apply ro m owna of ptopcny *ho huilds or impror6 rh.rmn. <br />and sho co ads lor such Fojels Nnh a Co.utcro(s) lic6*J PUB@! rd rh.Conlraclois Lictu.Irw) <br />oDcLtSarror <br />I hsL't y amnn uod€r p€lalry ofpuj , onc oi <br />I h.vc dld will mai.rain , c6liarc.r. of ConHr lo Sclr lsurc for vort.6 conrlenstrnrn, as Provid.d fo. bv sdtion 1700 of lh. <br />hbor cod€. lor lhc p6romd.. o ath. solt tor shich lhc psmn $ isu.n <br />,l haveand$ill mainlain sorkd! cohrrualion insuraocc. os requn€d ty S.clio. r?00ofth.l,abotCode, ror rhc pcfomrdcc oa <br />rhc \or* for shi.h rhis p.mil is NUei My workft .onrp.B.tion insu! c. cnio dd t-slicy nu.rbd o.: <br />Policy Nuibd:-Erlira <br />I.cdifylhar in lhc p*nimd.. ofthe work fo! {fiich lhis pdnrn is i.su€d. I shall nol @ploy ev !.ma in dv m&n . <br />s 6 ro h.codc subjd lo ln wolk6 smpselion laws of( .lilomi& and asre lhd ia l should b.cooc subjd to rh. <br />\orkc' coDrolrarion provisio6 of Sd tun l7O0 of rh. kbor Cone I slEU. fonhwilh ohPlv $ ilh lhoe polisioN. <br />WARNINC: Failurc lo <uc lorktrl compdsrion cov€rase is un],*ful. d shall subjd d malot€r lo oiii.al ldlallie md <br />.i\il lincs up to orc huidrud rhousat dol l$lol],l]O0). in addnio. to Ih€ cosl of coop.Ntion. dmascs 6 providcd fo,lhe <br />S.crion 1076 olrhc lrhtr C.Jq ii d6r <br />l)fcl B!r&r <br />I hdeby arm unds penahy of p.dury lha I m li.sEdi unds Provisioa oacnaptd g (commcnci.s Nnh selio. ?Uro) ofDivi.ion l <br />ol rhe llusin* &dProa6ioNCode. udmylic6* is in full lorc. md efid. <br />collrauquoNl[xuac-acENl:r <br />I h6.b, .mnn undr p€oahy ot prjor, fid rhd€ is a cooslrudion hding armcy lot thc p6lnnnM.. ol lte work lor whi.h rhis pmnil is <br />issudlScc 1097, Civ. C.). <br /> PPI I(]ANTDECI {NATION <br />I hod'y arm undd Fnalry o I p€rjury on. 6f rh. aollowinS dcldot ions <br />Dcmoln ion Pnmireasbdos Nolificol ion Fed@l R.gulation. {TnL 40, lan6) <br />_Rquncd l-c1rd oaNotifi cdion <br />-l <br />csrity rhal rhc Ldoal r.gul.tions r.sedins dbGlos rsroval dc oor applicoblc lo rhi Pmi&t <br />i.n md sarc rh*r fic.bove inlonnaxon is.ond lasreloco'nplrwnh.llCilyandCouniy <br />ildins .oNtucrion. dd hcrcby aurhor;c rcFMlaln 5 oflhis Cirymd Counly to mrs upon lr <br />t/tt/Lt <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads)Wf.{.tt 4 4!^L4/c 5br<3 <br />LJFER Ground <br />SLAB Floor <br />Subfloor/VenVl nsulation <br />Roof Sheathing <br />Framinq a /^//4 \lflan 6/. <br />ln s ulatio n/Ene rg y <br />Drywall '/t (tl '.Qrtr) <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 />) <br />FINAL Z/rt+//4 /.'c4(E/ <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />Shear Wall <br />Flood Zone Certif . <br />l.nJn ! AJ.l,6s <br />-