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BUILDING- INSPECTOR RECORD <br />COMMENTSSITE.WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathi <br />Shear Wall <br />lnsulation/Ene <br />allD <br />Ext./lnt. Lath <br />Brown Coat <br />I\4a son <br />Pool Fence <br />T-Bar <br />Handica Re <br />De u Final Re ort <br />En ineer Final Re rt <br />FINAL <br />Gertificate of Occu nc <br />otes Remarks Etc <br />r)\\ Nt.R Bl I Dt]R t)t l ( ,\ll \ r,(,N <br />I hseby afltrm undo p.nolly ot psjury lha I an ex.npr lion rhe (oatadom' l-iccnsc tns for lhc rolbsins r@. (Sec 7011 5 <br />Busi.6s dd Profsion Codc): Any Cny or Counry which t.qut6 a psmir ro connrud. all6. nnpI.v( ddolish or reFn v <br />nruduq p'lorro ils i$uec., aGo requir6 lhc applic&l lor such !.nnn ro filc a sis..n sr,rcmd lhal tr or shc is licGal pusuul <br />ro th. pmvi,io6 olrhe Conr0do.s Liccns.d Ltv (Chaplq 9. Con,nm.ing vnh S€clion 7000 oiDivision I oflh. Busin.ss Md <br />Proacsions Codc) orIhal hc or sh. is crdtrpl thscnom d lhc bd!i! aar rhc allcs.d e\ed0ion nY viol.lionofs.dnrn?0115 bvanv <br />applicanr lorapcmi subj.cls th€ applicanttoacivilp.nalryofnotmorethufivchu.dr.ddollffs($500) <br />l. s osrr of rhc Fo!.Yly. ot my mployB wnh Nae6 s rh.ar $le conp€t$lt n. sill do fi. ttll ud lh. srrucid. i\ nor <br />i.rodar or olldal lor el€ (56.?044, a8ins od Pmfsio6 Code l i. contrlclor's Lictuc 12w do6 not a?plv ro d oMn of <br />lhc plpsly rvho buil.ts or iinpm!6 th6on. trd who dG tuch \@* himscll ot hficllor rhoush his or hs oM .nplorcc. <br />pmvid.d rh.i sucn iFpmvmb m not idrdderl or ofic ed tor ele lr, ho$6d. rhe h{ildins or inpmrddr is $ld within on. rd <br />ofcoopldio[ rh. O$rd Bui$s vill hav. lh budd oaFovins rlul hc ot shc did .ol ttuild or iflEor€ rh propalv for lh. plrPo* oa <br />-t. <br />s osnd oarh. prop.n!. m d.lu$v€ly contacri.! \irh lic.6.! conlrado6 ro co61tucl th€ projrt (S(. 70'1{. &6ine <br />and hlfstn Codc:'rh. Conrracrois l-ic.ns. La* do6 nor aPplyto..osn6 otprot ny \rho builds or idprov.s {hden. <br />md sho conlmcls lor such poj..6\nha Contado(r ltc6.d pu^udt iorh. Conrra.rois Licd. k*) <br />I dnexmpt unrlcr Sdlio <br />Drt. Olner <br />woRl(iRs' ('oItPENs^TloN <br />lrDcLaSAMN <br />I hd.hy ail]flD undd peaaltyofpquryon.ofthc tollorvinB drluatioN: <br />-I <br />h.!. and Rill mainlain d Cdincal. o I CoNmt lo Self-Insu,.6rworkcs conD.nlaro,r, s polid€d for bv Serio' 1700 orrh€ <br />r4or Code lor lh. pdfor:Mcc of lh. oik lor wnich fi€ ponil it sued <br />I havc ond will naiotain work.B @mpc6.lion i6u6nc.,6 r.rlut.d bys(rion l?00 oarnc kbor Codc iot th. Pafommc. of <br />the ryork tur whi.h rli! pnrit is isued My $uter!ion iNurmc.@id d policy nu!trb.r e.: <br />o <br />l( u t ).-/? <br />-l.cnirylhat <br />in rhc psaormancc orlhc *ork ior shich rhis Pcrmir is $ucd.l sh.ll nol mplovanv pcM. in anv munn <br />$ s 1o b€o,ne subjtrl lo lhc sod(6' comPensl ion laws or Caliiomi., and rl iilshntrtllEon,c $hrecr t) rlic <br />Norlm' compnsrio.povisioNof S.clionlT00oflhc bborcod€. I rodhsnh.omply $ ilh thoepovisiom. <br />\VARNINC: F0ilurc lo su. workd' comp.Nrio. cormgc is I subiet d mplols io aimi..l p.ehi6 od <br />civil fincs up to oic hu drcd llDusod dollas ($100.000)ofcompcns ion. ddasd N provid.{ (,r rhc <br />Secrion1076ofrh.llboi(ode.int66ldd,tidrncy s <br />I heby amr und. pmtlly of p6jury fial I d lic.ned u.dd Fovisioi .achaprd I (conwtrins wirh salion ?000) olDivirn:i <br />of th.trusinsed Ptuf*ioBCodc. ud my licos isin inll turce md eildl <br />ol (,L L 8ascl( <br />l/-2s- t 7 c-, <br />( (rNsl Rll(1IOI\l l,I.lNl)lN(; ,\(il N( \ <br />t hs€by amrm undd Ftr.lly of psjury n4l lh6. i! d conslruclion ktdins agm.y iot lhe pdlorr@.. of <br />isucd (Ss. .1097. Civ C.). <br />sork for whi.h this p€mn is <br />L€nde'-r$me <br />- <br />Lend0 t Addrs <br />- <br />AIA,fCANLDLCLABAUA! <br />I Hy aIIm und< p.nalt, of ptrjury ooe ol Oc aollo$ i.8 del&.iions <br />omohion Pmils-Asbelos Noli6cal ioo F.daal Resulal ioB (Titlc 40. Pan6) <br />-R.qut€d <br />LellcrolNolifi caion <br />I cdiay thd rh. Ldral rcsulalio$ ESddinB stdos renoval de nor applicablc lo lhis tftid <br />! .srify lhar I halc red tn6 appl infonnaln,n $.onNr I arrelo confly \vhn allCilyflnd Cotrni, <br />ordinancG.nd Starc ln\$ ELtihs ro build hdcby oulhoriz€ rq,Mrari\ 6 ollhis Cily dd Counly lo dl6 uFn dt <br />alx,le rnMiio.cd pnrpeny fo! <br />,lpllicnnr or,lgr r Signatrrr <br />L <br />/-L1-/g <br />UFER Ground <br />Flood Zone Certif. <br />D^,", //-2q-/ f <br />4 <br />Framing <br />--T <br />= <br />.TI