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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG o\1Nt,R OUII,DER D}]t,(-,\I{\l tON <br />I hdcby oil,n und6 p€nahy of pgjury rhar I d dcmpr ton lh. Co racbrc' Lic.ns. riw for lhc followi.s r@n (S.c 70ll.s <br />Busins and Profeion Codc): Any Cily or Cotrlny which lequirs r p6oit Io .odtucr. altq. inprole &tnoltsh or E at ey <br />srtu.ldc. rior ro iri i$rec., also requtelh. applical ior such psni lo 6le a siB.ed st"t ot $d h. or sh. k lictr.d Puuuel <br />ro th. provisio6 ofrh. Conl,acrors Lic€ns.d b* (Chaprd 9. Comm.ncins virh sfrion 70OO oa Dilision I of rn BGi.s ind <br />PDf€$io.s Codc) or Oar h. or sh€ is .x.npl thdcfrom and lhc bnss for rh. all.led .x.oplio.. any violarion ofsclion 70115 bt a.v <br />applicanltor0p.milsubjdslheapplicamroacivilp.nahyofnolDor.lh66v.hoddr.ddollds($500) <br />1.6 orwcrolrhefiorEny. orny cnplors Nhh w,s6 6 th.ir sl€ codpc.qtio.. {'illdo ihe no* d lh. srdrc is not <br />inrddat orofer.d lor sl.ts(.7044. D6ifls ud l}orsioE Corl.:'ft. conlracroas l-i.mc Ltrv do6 not applvro m oN.d ol <br />rlE prepsly sho buil& or imtrovs rh6o.. ard \rho dc such so]l( hnNcli or hc6ell or threugh hh or h.r orr €{Plov6 <br />provid.d $ar such LnprevoMls e nol inlod.d q ofldqi lor sk lL ho\Bs. lh€ bnildi4 or i,nProvmat is $ld wihin on. ts <br />ofcompl.lioq rhc Oh6 Buitdd will h,r. thc bud€n of proving lh3l lE or the did nol b{ild or imPlor€ lh€ l,opdy ft)r L\€ ptrFs of <br />I. 6 ovnr oflhe propdy, an crclusiv.ly cont.cl inB snh lic.nsd contndou ro co6lnrd I h€ projd (se 7044. DNrns <br />and Psftsb. aod. Ih.Conlractaas t-ic€ns€ tr* dod nor applyro o\vnq ofp(p.n, $ho builds or improvcs lhoNn. <br />and \vio coolEds lor suci l'oj.11s \rnh a Co6hdorl9 licNd puBudl lo lhe Conlmclois Liccnse l-a*J. <br />-l <br />mer.npl rtrdd Sdlion-- B &P( aor this te6on <br />\!ORKTRt' COMPf, NSATION <br />DECLAAAIO! <br />I hd.by artr,n tod6 psEhy olpejury o.e oarh. follovinA daldalioB: <br />I h.v. d \vill mainrain a Cdincar. o t CoNor b Scll-l6ur. fo. wotkdt olD€nslion, s provided aor b, S..lion 3 700 oflhe <br />Labor Codc ior lhe pEfomtrc. o hh€ Mlt fo. *hich rh. pdnn is issu€d. <br />I havc aml NilL daxn,r wo*.rs comp.Bariotr i6urmcc. s Gqnnca by s(r ion 3 700 orlh. llb.r Code. lor thc psaonm.. of <br />Ihc rvorl ror shi.h Ois p.f,nir is isu.d My u.rkers co'np@rion i8ur .e cris od poli.l nnmL{r 6e: <br />PolicyNunba:-ErPtel <br />I ccdiryrhal i. rhc pdlonmc. oalhe rvorl aor rvhich lh6psrni * Gsued.l shallnol d]ploy nny pd$n inanvnrorcr <br />$ s lo b.(ome subjet to lhc sork6 co'tpc@iion laws of ( alilomi.. ond arc that if I should bronrc subjdl ro lh. <br />mrld' o,npenslion provisiom ol Setion 1700 oarh. hbor ('od€. I shall. ronh*nh .omPly wilh lhos previrnrN <br />\IARNINC: f'ailure lo sur. *o.l.u' co,np.nsolion covms€ is ulla$aul. dd sh.ll slbjct dplor6 to anninol Fulli6 dd <br />civil fincs up 10 one hundrcd rhoused doll6 ($100.000). m addilnrn o $..osl olcomp€nsrio.. dm4* s provid.d lor th. <br />Strli.n 1076 ofrh.l?ktr C.de. int.r.x edlnorB\ lG. <br />L[ragrD-cqNr&rflaa <br />DECLdAAIIO! <br />I hftby rmnn undd p.n.ny ol psjury rha I @ li.cn*d undd pmvision ofChapls 9 (.onrmacina Nilh S€clion 7000)orDnision 1 <br />of the Busin* dd Prolsiore aod€. dd ,ny licqsc is in full lore and .llct. <br />LenJer . <br />^Jdr6" <br />- <br /> PPLICANT DECLA'TA11ON <br />I lEtb afim undd I,mally olpsjuy on. oalhe aollowin8 delMtio.s <br />tremoliion P.nnneAsb6ros Nolificalion Fcdsal R.Auldions ( rnL 40, Pd6) <br />Rcqukn ldrd olNotifration <br />I cdliay rhat the t dsalreguhrtuG EgirdinB 6b€tos rcmoval ae oot aPplicablc to lhis p,oi<I. <br />-l <br />calit lhar I har. Md Ois applicalion ud sralclhdl lh. abolc infommrion is cotrci1 l,srftto complv wilh allCnvand Countv <br />od,nanc6 dd sllte bws r€lalins lo buildins co.sru<lio( od hdcby aurhorn. qrcsrdiv6 o f this Cnv dd Co@tv ro dls upon lh. <br />abovc 'nolioord <br />prop.ny for iBpa]lion pwpos <br />A0llicr r or AA.ntSigonhtr.. <br />l,€mhe nrne(prinO: <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Enerqy <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 />Engineer Final Report <br />FINAL rr\rA \\ulll $, <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />COMMENTS <br />Subf loor/VenVlnsulation <br />Flood Zone Certif. <br />cQxsrBucrloN-u;lluNcJcllg <br />I hqcby amrm under p.mhy o f pdjurl lhal thse is s coNlruclion Lndhs a8€.c, for thc psfomd.. ol the sod( tor whi.h lhis p.f,nn is <br />issued(S(. 1097. Civ C.). <br />t--+--