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SITE-WORK DATE IDiSIG.COMMENTS OWNER BUI LDI]R DEI,(' IIATION I h&o, afinn und6 p6ahy oa pdjdry rhar Ln crmpr rrefr rh. Coniradou Lic.lsc La\r for lh. follotrins rcsn (5(.7011.5 Dusinss and ftolsion Codc) Any Cily or Counly shich rcqunB a psnil lo conshrcl. alt6. ilnprov.. d@olih r reF'i ey .rruclud too. to irs isDmcc. also ,cqui6 rhc applic t for such Fmir lo 61. a ssncd sralmdr rhd h. o. sh. b lics.d pusu.4 ro the pmvisioB of fi. Conracbis l-icensed Law (Chaprd 9. Corun.ncinA qilh Sdion 7(100 of Division I oalh. Busin6s dd Profcssioos Code)orthal heorshc isexsryr lhsctom md lhe b€sis lo' rh.allered cronflio. Anyriolario.ofsdion?011.5bt4., .ppli.adlorap.nnnsobtersrhcappli.mrrorcivil!.n.hyofn.tmor.rheliv.hxndEddollds($500) -1. 6 own€r oirhc pmpaly. or ny cnployc6 B nh var6 a lhcn el. codp.aarion. *ill do thc sqk ..d tn. nnaie is noi i 6xled or olI6€d aor sL (Se.7044. Buine ed ftofsioB cod€: Tnc (omrdcror'r l.ic.e ljs' &6 nor ,pply ro m oma ol rh. prnFiy who t{il& o. inFov6 ih66n. rd who do6 su.n *oil hims.l, or h6.lt or lhmugh his or hr oun .mploy6, Drovided rhat such imD.oEmts e Dor stsd.d oroE6.d tur eL. li bowB6. rh. hrildi.g or ihprovffil is $H wilhin one )w ofcomplaion. th. O$ro &il&r w have th. h{dar oaFovi.g tha h.or slEdil.or hild or improvc th. poFly for lh. pIrpoeof l. N owns of rh. liopsly, m €xclusiv€ly contradinS with lic.6.d contmcloE lo conslrud th€ prcj.ct (Sd ?o44. &6ms and PlolBi- Codc: Thecontrctols LiccN.l-aw do6.ol apply to rn ownd oapopdy trho brilds or imp.ov6lhs@n. a.d sho conl,acts aorsuch projdc wirh a Conrmdo(s) liccBcd pureu t lorhc cohrra.lors t,icmr Law). I m .x.mpi und6 Selion , a. & P.C. for this r.Mn Dtt€: Orr€r: )!486!8S-.C9!!TENSATIO! DECI.ASAIIOX I t.r€by amno undd p.nolly olpsjury ooc ofthc lollo$iru ddlsalioG: I ha!. ed will mainrain a Cdific.t. of CoBol ro S.lll6ur. fo! sork.B' cohD.nerion, 6 proridcd tor by sdlion 1700 ofrh. kbor ('od., for th. pofomoc. of lh. {o for which ih. pmn is iqso.d I have.ndwillinrintainworke.i co'npensalion rhc Lahor Code. lor rh€ pdfonnmce ol p€nnir is issu.n. My $or[c( ,1 7 I cdilyrh i. dE pafontrmc. oI th. work for {hi.h rhis p.mn is issrcd.I shall nol cmploy any pq$n in anyBdnd e N to b..omc subjdt lo lhc qo 6' comp€Nlioo lsws oacaliaomi0. ud asre lhal if I should b..o,n subld' to th. uorl6 compemation provisiofls of SEtion l?00 oflfi.litor Co{q l slEll. ronh$ilh conplr *ith rhos previiions WARNINC: Failur€ to sur. sorl.6' conpq6dio. $v.6sc is u.lavtul. ed shall subjei & enploF lo qiniial p@hi6 dd .ivil nncs uf to on hundr.d rhousd doll6 ($100.000), nr addir lo rh. cos ol coflrp.Nt daa86 5 p( idcd aor rhc Gdq inlsd and rro.n y\ I hd€by afiim undd tdall, of lsjury lh.l I m lica*d und6 l,mlision ofchapls 9 (comftocinB snh Se.rion 7000) ol Dirisio. l oa th. Busi.6s a.d PrcfBioB Conc, md ny lic@ ir in full lor.. and .firr. /o 3t Vbr"f AITII(ANLDECIdSAIIO! I rEdry Eitnn und.r pdally oapcrjury onc ofrhc follovins dcl&aliom: De,nolirion Pmirs-Ash6los Notifi carion Fcd€ral R€sulahons (Tirk 40. Pan6) -Rcqut€d Lell6 of Norili.attun I cerlily rh!] I havc r.!d rhis applicatnrn udsiarcrhal rhc above inrom on s.dnd.I alrelo.ompl,wnhallCilyandCounly o mrDcsntrd Srarrln\s rcLlr,n! ro I'ldinBconsrn'cfon.aurhori2.r.r,.srdiv6oarhis Cily dCounl abovc nmlion€d propdy for insp<l ,\pIlic.nl or AAenl Sifn.turc /9 Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Roof Sheathino Shear Wall Framing Vk//\i\fix ln s u lation/Energ y Drywall I /?/t,l a\<x/ Ext./lnt. Lath Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL '4 rltt1 .{udo Certificate of Occu pancy Notes, Remarks, Etc BUILDING- INSPECTOR RECORD Subf loor/VenVl nsulation Brown Coat I I hd.by anm ud6 p.naly ol rqjlr, rl'ri th6. is , codrucrnn l.din! a86cy for lh. pdlommc. of the vork for whtn lh$ psnn i issu€d (Ss.309?, Civ. C.). L.n.ler'" N!me I.ndd r Ad&s - -l cdiay ln.r rh. acddol r+ularions rcs{din3 ab6rx ramvd arc nor applicabl. ro rhis por<r. l,rirnike,n,c(I,'n,t): I =