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13 31^rC 0Z,eS 6LllPllnB <br />,nB ? 6uluueld <br />IC:IUUOC <br />.ioN <br />BUILDING- INSPECTOR RECORD <br />SITE-WORK COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />U FER Ground <br />OWNER AUILDER DELCA&4TION <br />I hd.bt .fim undo penahy ol prjurr thot I an er'npr fio'r rhc Contraclou' l,rcensc La{ lor rh. lollosirS reMn (Ss.7031.5 <br />ausinss ad Prol6rn Codc): Aiy Ciry or Counrr rhich rBtun6 r p6nh lo onslru.1. altd. nnpolc. domlish or Epat t <br />srucrue pno, to ils isuM.e. also rcqutc rh. applicd for sr.h po n to fil€ a sisncd slaod lhar Ir o. she is licmscd pu6u t <br />ro rhe polisioc ollh. Conhctoas Licensd Lsw (Chapicr ,. Comm.ncins wilh Sdtion ?000 olDivision :r oflhc B6i..ss 4nd <br />Ptulsio ns Codc) or rhd h. or shc is .xmpl lfi6c6om rd thc barD ror rh. .ll.!.rl .xdnprior. Any \ iolalion ol sd ion 701 1 5 b, a.y <br />applicanl 6, a pmnil subjcds rhc applic r ro o civilpcnahyofnor nDrelhao fiv. hundr.d dollars ($500) <br />-1. <br />s oN.r olrhc prcpe1y. o ny onployc $ irh *ag6 * lhct $1. compsel ion. sill do lh. s!ll( and t sruclre is no! <br />imdded oro,Ie,ed lorsl€(se 7014, Businssdd ProIBioB Code 'lhe contr,crois Li.m. t w do4 nol a$iy ro M orvnd ({ <br />rh.rmp€ny $ho tuilds or i,nF.v6 rh@n. ed rvno do6 sch sorl hi'nslf .r h6clro. rhrculh his or hs otrT.nploys. <br />provid€d rhar such in[mr€ndrs R nor irhdcd or olTdrd for Fle tf. hos--d, rh. hiildin8 or inlprcvoml B $ld eihin one )s <br />ofcoDplelion. rhe OvnE Buildd will ha!. th. budd olprcvins ld h€ or she did n r boild or nnprole lh. pmpqq ror rhc l)triF.e of <br />l,6orv.{oflhc pmp€ny. m .ic lusivel, .onlia.r in! {nh licmed c()IllrsctoB to coistuct rh. Ploid (S€c 7044. B6'ns <br />and PFfssio. Cod.: The Conlra.loa! Lic6s€ L3v do6 nol apply to d o{nd o f propsly \rho builds ot inprov.s lhdsn, <br />and who conkds for strh p.oj&l t licds.d p!6uer lo lhccodtrcror's Li.@ tiw). <br />oEc-t4-84ft0r <br />I he eby nmrnr rnder p€nahy orrsiuryoncoa'hc aolnrvins de.ldalnu: <br />I have dd \v ill nuinlain . Cdi6c.t. of coBdr io Sell-l6urc for sork.6 conrPenerion. s provided lor by Sdtion lT00 ofrh. <br />L.b.r C.dc. lor th.prlomdcc olthc $ol1{ lor $hich Ihc pmil is issued <br />-lhavernd\rillmainrainNorters'comp.ns <br />ioninsulancc.a\.equtdbrsdion3T00oflhcl2b.rCodcforlhcPsionneccof <br />thc rork tor $ hi.h this parnil 6 issu.d My {or ke4 con,peNtion iNtrrmce c.nid dpolicynlmbqde: <br />-l <br />.dliiy rhat in the ptrformanccoalhc work lor whi.h rhii prmil is issuen. I shall nol dpk'y any pcr$o in anymdner <br />e 6lo be.ome subjd ro rh. $oA6' compcB0rion laws olcalitomia, dd ald thd ifl should b€comc subje o 'h.\vorts colDenexonDrevisioN ols.crion 1700 ollhe ta&tr Code.l sh.tl fonh*nh conll,ly withlhoseDrevBiods <br />WARNING: Failrr. ro KU€ uorlGs' conDsdnrn .ovdarc is Mla\ful. and shall subj{t m mplord to dirninsl p.nahi6 a.d <br />.ivil fr.s up to onc nundEd thoMd <br />sNrion :\116 oarhc tibor code inrddr <br />in addnion ro rhc cosr llcodp.Mrio.. dm.s6 6 providql aor lh. <br />I hd.b, amm und6 p€.ah} ofpojury rhd I on licdE d ondd provisioo olchaptd 9 (cormmcinB wnn S€clion 7000) ofDivisio.l <br />ol rhc lrsins ed Prol6sio6 Cod., and ny li.mc is in loll lorc. od ciI*t <br />l,iccN€ Cl6s:-Licc6€ NuDbs: <br />- <br />caNiraucuoNlE![llctcENlr <br />I hncby sftim und6 p.6hy ol pdjory that lhft is a constrction lmdin! asdcy foi rhc pElomuce ot the rvor[ aor $hich this Ponn b <br />kucd (Se.1097. Ci!. C ) <br />Affuc NfDfcuaArlg! <br />I @ afam, undo pdahy olpdjury on€ oflhe tollowi.s d(luations' <br />Dmolirion Pmils-Asb6ros Norincar ion F.d...l R.sulations ( l'ille 40. lan6 ) <br />-Requncd <br />L€lt6 o I Noli66non <br />-l <br />rdify rhd rhe f.d6al r.gulatioG reg{dins 6b6los Enov.l ar. not applicable to this prejrt <br />l.oriayrldlh.veEadlhisapphcalionddstalelharthcatnlci fonn.lion is corecl I asr< lo comPl, wirh all Ciiy and Counly <br />ordinincs ind Skte LaNs cllling 0urlDlizc rcpr6enrariv6 ! I liis cn! <br />abov. henrion.d p'oped, aor <br />ApplicNnl or Ag.nl Sigm <br />^;i/;;ft- <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Enerqy <br />Drpvall <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 />FINAL / //e //q /\ <br />Certificate of Occupancy //=-r 't'-/ <br />Notes, Remarks, Etc <br />M4 <br />;:.Li:l 21 tYtt <br />--------r------