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BUILDING. INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Energy <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 />Enqineer Final Report <br />Flood Zone Certif <br />u^fr1h1FINALtlrrlll <br />Certificate of Occupancy I <br />Notes, Remarks, Etc. <br />OWNEN BUILDER DELCARATION <br />I h6eby amrnr unds pdahy or pojury thd I m d.Dpr fmm thc Contacrois' Licen* I5r aor rhe follovins r.Mn (Sd 7011.5 <br />Buiin6s tut PiofKion Codc): Any Ciry or Couory which r.qun6 a pdmi( ro coNruct. .116. nnDro!.. dmolish .r rtPan my <br />srruclure Drior to irs isud.., ato r.q!n6 rh. spplicdt for soch p.mrit to fil€ a signc! srar@d rhat h. or sfic b lictu.d p@ad <br />ro rhc lrolisioB of dc Conhcloas Licens.d ljw lch.plq 9. Comn.ncins Niih Sdion 7000 of Division I oathe Busins dd <br />Proa*io.s Cod.) or lhal hc or shc is cxmpl lheEon 6d lh. bart aot ih. .llcs.d cxmflion. Any viohlion ot S.€lion ?01 I t by &y <br />rpplicanllo!ap.milsubjtrlslh.applicdroanvilp.ntlryoanoimoterhefiv.hunttr.ddollds($500) <br />l. 6 owne ofrh. psp.ny, or ny mployG wilh wa36 6 lhct sl. omtdMion, will do th. wort &t Ih. ntudu. is tror <br />i.rortdi or ofid.d lor saL (Sc 7044, Bsin6 d Prcfsioc Code Th. (onrEcrofr Liccns. t4 do6 nol +Ply k, o oMs of <br />lhcPlDpqly *ho b!il& or inprov6 in@n. ad wno do6 such trlrk hi'sclf or hmclaor rhrouah his or hd o\h mployc6. <br />providcd rhar su.h inprovcffirs e d i dt{l€d orofiEd for eL ll-, ho+'M. lh. ttuildiry or inprov@l b eld wnhin onc }@ <br />;iconpLlioG fi. (\ M Buikld will hlrt th. bml6 oaproving lhd h€ or shc drj @r hiild or imFov. lh. FDpqly in rhe p4os oa ' <br />l. 6 owna oflh. prepsry, d d.lusilcly co.raclins *irfi licNd col1r@.ro6 ro snsrtud rh. ploicl (S<. 7041. Busins <br />and }}nissiod cod., Th. Co.lraclois Licens tiw do6 nol .pply ro d ownd o I plopsly who huilds or nnpov€s rhso.. <br />and who conls.ls for such projds with a Contmclo(s) lic6cd puu@l b th. ConrEcn i Licnc IrN) <br />l nq.nrtr unddserio. -B &P.C rorrhisrGon <br />\loRklRs' colllPENsAtloN <br />o[claBA]ta! <br />I lr.r.by d|irnr undtr p.nah, oips.,ury onc oalhe lollosins d&lirarionsl <br />I have ed sillmainrain. CdiificalcolConFnl lo Sela l6urc toi so*st conp.nsrnrn,6 prcvid.d aot bySdlion 1700 ofthc <br />sdion 1700 of rh. lnbo. Cod., for rhc pdlomalc€ oi <br />cMiq drrlicynudbe dc: <br />q <br />-l <br />c.nify rhar in th. psao.M.c otrhc Nork aor $hich rhis pdmn is su.d. I shall nor dnploy .ny pqs! in dy nmft <br />$ 6lo b6on. subjd lo (h. sort6 compcns{ ion laws ol Crriaomia Md .Bte thar il I should b..6n subi..l lo th. <br />*0*6 onpderionprcvisiocotsalion lT00oarh€ l4orcod.,l stEll. forlh fi comply $irh lhoF PtlvisioN <br />wAnNlNC: riiluE ro *m mrt B comp€nsalion @v@se is unLwfol. and sholl subjcr m .nploF to ainiBl FEhi6 dd <br />civil nn6 up lo onc nund,ed lhousd dolls l$loo,ooo). in tddnion lo lhc.osl olconp.Ntio., dmas6 a provid.n a.r rh€ <br />sNrbn 1076 oithe Labor Code inlcrsl sd a :rJ((Lr,c- <br />u!&!sux.attr&!cl2B <br />I I hdcbyn&m rndcr pBallyoiprj <br />DEC].ABAIIQ! <br />und.r povision olChaprd9lcommencins silh S.(]ion 7000) olOirhion 3 <br />ol rl[ Busircss.nd Pr oa6sios Cod€. sd 'ny li. <br />3a,ttl,'l> <br />t\-)r .tct 5?;1,t <br />I hd.by .mnn undd p..ah, ot pcrjury rlut <br />isicd {Ss.1097. Civ. C ) <br />n ladins+ency forrhcpdfonnsnccofthe*o lor which lhis p6,nit is <br />AITIICAILDICLAAA]IOB <br />I holtry .IIm uodcr p.aalry of pdjury one of d. aollorin8 de.l&at ioos <br />D.nolirion Pdmirs-Asb6los Notilicat ioo Fcd6al R.gulalio.s (TnL 40. Pal6) <br />R.!un J ldrdoaNolificslion <br />rclularioc l+ddin8 sbgios rmoval de nor applicablc to lhis ptojtcl. <br />r6drhis.pplicalionudstarcrhatrhcat{!einlonnarioniscotrcl tarrdro.o,nplywnh.llCilyandCou6ry <br />ad hdebyarhort r€!.*nlaliv6 ofrhis Cny md Countyto md lFn ftc <br />,,,/ <br />,"", \t,)'.tt{ <br />Forms/Steel/Holdowns <br />L.n,l.is Addd <br />- <br />\\At <br />----+--- <br />: