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BUILDING- INSPECTOR RECORD SITE.WORK DATE IDiSIG.COMMENTS OT NERBI]ILDERDELC RATION I hdcb) amfln unds paaly ol p€iury lhal I an .ieofl Eom rh€ ('o.traclos l-icense liw li'r lhc followinA rcNn (56.7011.5 Busin6s od Poa6snn Codel A.y Cny or County \rhich r€qut6 s lidni ro coNrud, a1t6. imprcv.. dmolish oi rup"ir my srtu.rdc, pnor b ns isu c€. atso rcquir6 the tpphca.l lor such pcmn lo filc a sisned slalool rhd n or sh. is liccn*d pusul ro rhc sDvisioN ofrhc Co.traclois Lic.nfd L2w (ChafldI, Conm€ncin! wirh sstion 7000 ol DivGion I ofrh€ Busins 6d P@f.$bn! Cod.) or lh.t he or shc is crcmpl lhgefiom od rhe bd6 lor rh. alL8.! eidnption. Any violarion olSetion 7011.5 by any applic0 lor a pmil subj{ls lhc appli.ad lo a.ivilpe.anyolnol mDrclhan livc hundr.d dollds ($s00) -1. as oNDroarheproFny. or nry cmplor'6 $ilh N.s6 6 thcn &E comrdstion. \rilldo thc sltr and d. sndr b mt inrBrlln o! oirs.d lo! slc ISE ?014, BBi.6 ed Prof6sio6 Cod.r 'ft€ Contacror s Li.@ t:v dos .or .pply lo a oNdd or rhe preFry \rh. builds or improve rhq6n. ad who do6 such Nlk himsclad hNlf orrlmtrsh his or ho orn.mlloye6. provid.d Ihat sucn i'npror@rs d..ot idsd.n or ofr6d tor el.. I[ how€v6. thc buildii! or imptulGmr is $ld tr irhin !n. ,E of conpldion. lh€ Owner Auilde $ill hav. rhc hndar oaporinB rhd h. or she did nol build ot ihpm!. $c poFly lor $e B,Fr ol l. aso$nsorrhe rrkrpdiy, er.i.lusivelyconlraiins Nilh lic.rFd conhado6 ro cDNrtud rh€ prcial (Sc 70'14. BNmG Md Prol6sion Orde: rh. Cotrrraclor s l,i...s. Law do6 .or apply b e os n6 ol prop€ny $ho builds o! irnprov6 lhercon, and who contmcrs lor slch pmj.ds qilh a Conria.lo(9 licas.d pusudl ro rh. Conlractois Licos lrw) I dn exenrpl xndd Sdio DECIANAIICB I hdcby artr'n unds psaltyofpdjury I havc d$illmainrainacdificar.ofcons.nt1oSclf-lnsurelorwork.6'conrpcnsalior,6 prcvidedrorbySdionl7C{ofinc tibo! Code for lhe pdfomecc ollhe sort aor trhich lh. pmnii is isued -l lDlc and *ill nrrinrain wo,k.6 conpdalion i6urac., d r.qun.d by S(r ion 1700 oi thc l-ahor cod., ior tht Isaofrm.e of rh. $.rk for shich rhis pn ir is issued. My worlere' &dp.@rio. i6omc. cui6 ud IEli.y numbc d€ Poli.yNuNber-,i1pi I cenifythal r rhc !.rfoman eoflhcworl tor whichlhis p.flrl is issucd.l shall.ol emPloy any Pcson inanvn ns $ as ld b..om. s tNl b the worlss cornpdsalion latr3 ofcalitufria. Md isrc that il I should bccohe srbj€cl 'o lhe *,orks..mpcNalionprcvisio.sofSclio!lT00oIlhcLrbor(.od.,lsh.ll.aonhwnhcomply*nhrho*prouisio6 WARNINC: ljailurc lo su. s 6 .onpm.rion cov6.8c G unlatrful. dd th.ll subld dnPloyr to crnninal FEhis .nd ciril li.cs up lo onc hun&€d rho@d dolld ($l00.Lro0). in ..ldilion to lh. con of .om!*Nlion. daMs.s a pBvidai for 'h.sdiM'tor6.f rh.l atrr aodd inr I hs€by amrr und6 pLdalty of tdjury I DIiCIASdIION und6 p.ovisio. olchaptd 9 (com'n€ncins wrh S<rion 7000) of Divisioo 3 of rh.lrosi.6s drd ll.l6sioNCode, dd mylicFs. is in lull torcc d elT(l colirall:I&u.LExpuclc}:lcr I heby afitrD und6 Fflally oa p6jury thar rh@ is a coNrddion kndins asdcy lor rhc Faomanc. ollh€ q.rk aor {hich this pdnlh is issu.d (s( 1097. ci! c.). AIIIICANI.DECI.AEAIIAN I h6cby armn t6dd pdrhy olpcrjury one of$c follosins d*learions: D.oolirion Pmirs Asbctos Norinc.rion Fedral Resulatioos CtnG 40. Pd6) -Requncd Lclrs of Noincalion ;ad rhis.tpli.arion ed srarcrhar iheatFvc irlomrrlion is.otrdl.I asraro comply N h all City and Counly in8 conslruclion. erd h6€by au$ornc r.plMratil6 ollhh Cny dd Countyto al6 ulon lh. I Sel Backs Forms/Steel/Holdowns Erection PadslYrr.tf4,h LAt )V<ls *QA UFER Ground SLAB Floor Subf looriVent/lnsulation Roof Sheathinq Shear Wall Framing tt/axlta '8ff4,*-bd,t lnsulation/Energy l/ Drywall zJr[n )IZr'fl) Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL z-llL-tll1 tO{47 4) Certificate of Occupancy Notes, Remarks, Etc L.nJeiq add6 - rerulalions regad'nr {rhcsr(,s r.noval.rc nor arulicabl.lo lhis pR,id *-,rry'y'r, = =-