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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNDR AUII,DT:R DI:I,CA R^'TION LEEby alfrm !nd.r plndry of p.rjlry (b I m .x.mpr t n rhd Conhro6' Ljc.o$ Law fo. rL follo*in! rcae. 15...7011.5 Busincs and Pr.Ic$ion C.J.)r Any Cirt or Cornry qhich rcquncs . Foir ro connrucl alrc( irprot, d.mlish or ftpan .n) nruduE. prirr ro irs isumcc. lho EquiE rh. .ppli.sr for su.h n flri b fil a sigrEd sr'r.mnr ihtrr lE o. 3h. is lic. al pum&nt ro rhc 0mvi\ions oI rlE Contactoas l-iccnEd law lchaprcr 9, CommcncinS qirh Sc.ri..7000 .lDivisio.I .lrhc Bosires and P(rtsionsCodc)orrhrrhcorshcNerdhpirh€renohdddDb*irhrrlElllq.deremprion..{nyviohiionofSecrionT0ll.5bylny applicrnrforaDcmirsubl.carh.0pplicr rorcivilp.nrhyotnormr.rnunfivehundrcddoll0n(t5{X)). ,s ownc. . r rhc p.oNny. o ny cmplnyrcs *irh wag.s as rhcn k . !$'rycnsari.i, *il, do rh. wo* and rhc sMrE n mr inr.'rlal or orLEd for slc (Se 704-4. Busin.ss rnd Prolaaiotu Cod.: In. Codhdol! Licene Lrw dB nor apply ro rn.M.r oI rh. pNn ny wlF hoild! or inpDws rlr.@c llld wtu dB such mlt biru.lf or hec.lf or rhtu!3h his ot h$ own .r{loyes. pr.vidc'l rhar su.h iryowmdi e mr id.'i.n m o,Ied for eL lli hNcv.i r hriBins or inpmEmnr is sld wihr oE Fa oi.onfhhn. rrE Owftr Buili]., wil n E tlE boln.n ot pFvirs lld ,E or dE diJ dt erix or in{ow rh. pmFdy lot $. p!'pe of _1,dsown.rofrh.psp.dy,.m.rclusiv.ly.onkd.rin8wnhli.ctr*!co rurouro !!!No.r lh. pdj.cr (Scc.70i4, Busin.sr lnd PbL\sinr c.d€: Th. Conrrrol s Lic..s. Low d@s nor arply ro !n o*ne. of propedl *hd builds or impior.r rh.ron. and who contads tor such pDjccN wnh a Conk&!r(.) liccnEd pusud ro rh. conra.roar Licctr{ hw) lrn(r.n' trn c' Sccrtrl llr!!4-ts-a-I1!]} I hcr.hy linmundcr pcnaxyofpcrluryonc.l rhc blloein8 dccl& ions _l hrv. rrl wrll nEinrain. C.nifcd.oIC.nscnr !o s.lfJNuE tor sorli.r'ronlxmario!.3s previd.d for bys..rioi 1700 ofrh. Ijh.r Codc. lor rhc perlirturce oI rhc rort lor {hich 'h. p..6n is isstr.d. _lhuv.rtrdwillmainrdnso.h.onp.nsrrnrnn$rMc.,arrquir.dbySecrion3T00olrh.LlhorQ)J.,ti,rrh.rcdodB eof rh. worlln. wlrch rhh l).mit is is$.n. My workcc coqrcosrrion Bure. cnri$ Mi policy nuf,hq uc: -l ccnityrhar iofic Frlor@rc ofth! *o* for *hich rhis pc,nir is iisu.d.l $!ll hn.hploy yFsrinlny'DEr e 3\ h li.$ft subl.cr ro rhc rortch oqfnsiion lr?s of c.litom8. and asec rhd if I shnuld hccoN subjcct r. rtE *o*.h (oq'.nsarion poisios ot Sdlion 3700 of rh. Labor Codc. I slEll. fonhwirh .omply wilh rlEe pDvilioc WAINNC Failur. to sk work.r' compcmdion corcaE. is lnlastu| lnd shdl subjccr ro .ivil fioe{ ul) ro nne hu r.l rhous , 'lollm (Sl s..!.n :1076 or rh. rrhor (roJ. i'n.r.{ ann atu !E!!f-81!t1\ I h.ft5y.finm und.r pcn.hy of pcrjurr rhar I im lietrr'd unde. prc!$i.n of Ctuprs , lcommncing wnhScdbi 7000) ofDivhhn 3 oi rhc BusiNs ard Pmtcsiotu CoJ.. ad my ltc.* is in tull toE drl clfccr. l-iccorc Clasr_Lia.s. Numb€.: Conlro.ror- eoNglrllqrloNLrlllllli-lcEl.cf ilsu.d is.. 1017 cn c ) AT8IICNIDECI,ASATON I ffiy&ffmtondd p€nrk, of p.rjury on. of rhc follrwinadelc.nons: D.nrliriotr Pcmih-Asb.nos Norili*rion F.d.ril R.gul,i.ns (Tirl..l0, Pdn6) R.quir.d ldrd of Norinqiion _l..nilyrhar ih. f.d.ftl Esulariotrs EBrdi'U asb.sos Emvll!rc nor amlicabL b rhis pmiar. dxt im. rh.r rh. !bo!. infomriotr i\cor*r.I ig'e h.lmply Qirh allciry inl coo.ry aJn h.Ehy aurt fla EoEenrarives ol rhis C y lnd Cnudy ro ..16 up.n rL trtr,Yc mnrn)tuJ F^rr.ny tnt 2-2 rlrt Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Sublloor/VenVlnsulation Roof Sheathino Shear Wall Framinq lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat [/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif. /1-</t/7-t / n-hYlt,,) Certilicate ol Occu Notes, Remarks, Etc Rev.0B.07-2015 ,./-- ?- I L,../ Drt.:- tJtrdcf. Nxnc Lldcat Addss - FINAL