|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.. ,. COMMENTS OWNER BU!LDER DELCARATION
<br />I lrr€b, amnn undn Fn.lry oa psjory thd I an cxcmpr non th. Contr.ros Lrc.Nc tjlv for rh€ aollowins rcMn (5€.703 1 s
<br />Bui.6s and Profsion Code) Any City or Counry which lequt6 a lcnnir to coNrru.r. alre. impov€, ddolish or rcpan dy'
<br />sttudu., Irior ro ils isoanc€. also r.qun6 rhc apnlic t aor such p.mir ro lil. r signed sl6tcnEnt ihal h. or sh. i! licdsd lufuet '
<br />ro thc prevNi.c oilh. c.nractois Lic.ns.d lj\r (Chapt6 9. Gnm.ncins vilh Sdlion 7000 of Division I ofrh. Busin* dd
<br />Prcasbns code) or rhar hc o! shc is cx€npl lhselrom ud lhc b.sis tu rh. all.ldl crmp{ion. Any violalion of S..rion 701 I 5 b) ani
<br />applicanl ro! a p€nnir subjsrsrhe applicrm ro acivilp.nrhyofnol morclnan five hundr.d dollds($500).
<br />l. s own6 ofnr pmpely. ornymployG $lth Nas65 $.ir $lc..o!.Mrion. willdo lh€ $or( and rhcnME is ml
<br />inlod.d or oflcEd ror el. (Se.7o44. B6in6 md ProfsioB code: nE conraclot s I i.6c la! do6 nol .pply lo m o*Td of
<br />rhc l,opdy $ho toil& or nnpov6lhso.. dd *h) dG such Mlt [nnsclaor hcgltorthmugh his or h.r orh.mploy6.
<br />prov'ddl rhd sNh nnprovmls m nor int d.d or olTsed lor eE lr, hoxtvd. tbt hrildins or i F ovfldt is eld *nhin one t€r
<br />olcompl.rion, rh€ O\r€r Buildo wil tav. lhe htrd.n of pm! i,g lhd hc or she drd nol build or nnpror. th. P,lFry tur lhc purFs of
<br />-l.6oMs
<br />orrhc tmtcty, @ crclusiv.lycontodins Eiln lic€Md &nlrado6ro conntud rh. p.oj..l (Sd. 7O1{, &6in6
<br />and P,rasion Cod.: Thc Conrractoi3 Liccnsc l"as do6 nol apply lo Mo$na ofprcreny who buildr dr improvB thdmn.
<br />and sho conrEcrs for such p@jds wilh aconlr.cro4s) lic€n*d puEu l loth.cdntactois Li.eN. t!w)
<br />I r n.nflr tr rld S.!Lr,
<br />,,^," rt/s/rt
<br />Ull-I"![l!1
<br />I h6.b].mnn und6 pcn.lryofp6l lrh€lollosintsdtrl ari.ns
<br />I ceniryrhar in rh€ p.rlotuce olrh. *ur for shich rhis p.mil is issu€d. I shall nor onpl.r an, pmon in any mu.s
<br />e d lo b..dme subld'
<br />'o 'h.
<br />Mrl6 comp.nsation lflss of Caliromia, ed aac rhd if I should bsomc subj6! ro rh.
<br />*orlds.orpr arionlrovisioNolScdion3T00ollhcl,olirCod..lshall.ionhwnhcomplywilhlho$ptovisions
<br />\IARNINC: trsilure ro scue xo dc .onp.Nrion coveag. is unlowlul. dd shall subjd( d mrployd ro sir.ioal lFall6 and
<br />cilil liflcs up lo one hun&d rho$dd {tol16 irion ro th. con oa.o6p.Nrion. dsMs6 ae p,ovidcd lor rhc
<br />secrion 11076 dirh.lihy (od.. i.rnda
<br />T {(9
<br />DECI,A8AUq!
<br />I h6by 6rDn und6 !.nrny o aFjury lhal I m licaE d undd Forision of Cbapro 9 (co,mscins with Sedbn 7000) oa Division I
<br />ol thc Auio6 sd PmleioD codc, dd my lic6s is in full forcc d €[.cl
<br />CONSTEI]CTION I.DNDING ACENCY
<br />I ncby afiim undd porahy ot pdjury rha $d. is a odtudion Lnding osmcy lor lh. p€fomc. o f lh. m* ftr whict lhis p@nil i
<br />issucd (s*. 1097. civ. c. ).
<br />ATIIICANLDES,AAAUOX
<br />I hdt, arm und6 paalt, of r€rjury one ol the tollos ins dcldaliom:
<br />D.nohion Pd,nn s,^sb.st os Noti ficar ion l:cdqal Rqulalions Onk 40, Pd6)
<br />R.qut.d tdrooaNorifi cark n
<br />-l
<br />cglify rhal rh€ lcdgal rosulaions esfidi.8 6b€ros ramval de nol agplic.ble ro I [is Prcj<'
<br />n adstare rhal rh. abolc infomrarion is coded I alre lo Nnrply wilh all Cil, and County
<br />rg coBlrucrioi .nd bd.by rrhoriz€ r€prMlalir6 otlhG Cn, md county lo o16 upo. lh€
<br />J.r-r Q.-c,"tef
<br />v/t /tt
<br />Forms/Steel/Holdowns / <.// -5h *ructutst< \-,4r\
<br />Erection Pads "4 ;a cg:.ztll ,d+>-')iot-
<br />UFER Ground 3 7Y)nrzrn i., tt*'t l-\
<br />SLAB Floor /3//<5hk<4^A <L-A; dh,,,ot ftrt
<br />Subf loor/VenUl nsulation Utu{,{ a'
<br />Roof Sheathinq
<br />Shear Wall ,<)
<br />Framing D v9
<br />ln su lation/E ne rgyl )M "flL rfgl,l/n/h4'*dh ,
<br />--*\3,,th>,ll
<br />Ext./lnt. Lath rh{tru\ zffii iV*rn
<br />Brown Coat {z tl,rxs'' c W IrGTA)
<br />lt4ason ry LAtli' Lst' t4tiq-'
<br />Pool Fence
<br />T-Bar 2Jza/r,j .<,14, Gr.
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />[" \ t1\ \1 utq$)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Vftrtrt^f
<br />h(r a,\ *rq1L,{lt \Ar rc
<br />FINAL
<br />-l
<br />havc od will @inrain a C.dificar. of ConHr lo Sclt-lnsu€ lor wort.B compem.lion, 6 lroid€d for by Selio. l?m oifi.
<br />libor Cod€, fo,lhe psfomd..olln work aor whict lh. p€mii is isucd.
<br />I ha!. a.d willmrintain sbrr€rt conpcBalion icurance.6 reqon.n by Sdion 3?00 ollhe Labor ( od.. aor ln. p<fomac. of
<br />rhe wor* for which tht pmnil is isu€d. My wortd! cooF@rio. iEur.nc. cdi6 ed l,oli.y nunbn &.r
<br />I
<br />----+---
|