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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNET BUIT,DER DEI,('ARATION <br />I hercb sft m undq paalry of pfjury thar I @ .rcmpt tum rhe ConlracloR Ltens. l i{ for Ihc folloNins r.Mn isc 70n l 5 <br />Busin6s ald Prolsion Codc)r Any City or County shich r.qut6 a p6mil ro consltucl, alrd. impm!., donolish or rcpu <br />'srtucrre prior b ns istra.c.. als. r.quir6 lhe applicut for such pcm lo tu. a sisned $ahdr rhd he or shc is licord p6udl <br />Io rhc prolisiom ol th. ( ontroctois LicetrFd Law (ahaprd 9. Commcnci.s wilh Scrion 7000 of Division I olrhc lrDsiflcss ad <br />hoiesio,s Codc) oi rhat h€ or she is.xdo rhscnoE dd the bs6 aor Ihc allcg.d .ranplion Anvliol.tioflofSc.li.o 70.1I 5 byMy <br />applicdr for a p.flnir subjr$ lh. aprlic rtoacivillndhyolnornuethmfivchundrcddoll s(5500). <br />l, 6 oNnd of lhe FoFny, o! my cmplorc Nith was6 6 I heir $le conpaqltJ.. will d. t. Nol{ md th. stMue is nol <br />intdd.d or ofiod for sl€ (58.7044, Bsi6 dd Poi6sF6 Cod.: Th. ( onrr.clois Lictrc tir do6 n l {rply ro d ownd of <br />rhcpropeny sho 6ril& or inprovB mn. dwhodcschM hnnsell or h6clror lhoush his or hd own anploye. <br />provid.d rhar su.h imprerdndrs @ nor imaded or orqcd (,r ele. I I h.sds, rh. bdildin* or inpmv.mml is sE wnhin on. )€r <br />orconpl€lion. rhl Ou6 Buildr \ill hai€ thc htrda orp(\ins lhd & or shc did not buil{ or imFovc rhe pmpoly fo, tie Dur!(le of <br />-I, <br />6 omr orthc p(Fry. an .xcl6i!.ly conarding *ih licdsed contBctoE kr onshld lhe p.oj4r (S€ 7044, B6ins <br />d PrDfesrion Cod.: Th. Conrrlcrois Licasc l,aw do6 nor.pplylo o ownd ofpropd, who buildsor nnprovcs lhsmn, <br />dd $ho conl]a.ts for such Fojds with. Coor6cto(s) li.d!.n porsMt to theComr.cloas l.i€se Liw). <br />I m.xmpt und.r Se on . a. & P.C.lo.lhi!,@n <br />D.t.: Onner <br />IABIiESTTAIIIEISAIIO!pncldBArro! <br />I hercby amrm utrdr p.nally of psjury o.e or r& lNrins d€lrario6, <br />-l <br />harc ud pill mainlain a C6likal. ofco6dl to Sclf-lNure ior work.rs conr!.nsalion. s pDvidcd for by Seclion .1700 oilhc <br />L.bor toia for lnc pdfoflrscc ofln€ M tor \'fiich lhe pgrnil is isued <br />Ul Mvc and trill mainlain wor[e6' coop€Balion iBurancc, 6 rqut.il h, sdrion 1700 of thc Labor Codc. lor lh. ,)<lomdc. of <br />rh. $rk lor which lhis Fnil is isEd. My wortsl .oot erio. i6oid.. cmid and policy .u,nbd e€ <br />qLt6?59 - t1 2-e <br />Jcniry rU u rlc paroflnanc. of rhe work for shich Ihis p€,nir is issucd. I shau nor dploy e, peBon in any mmncr <br />$ d to b.comc subjcl lo lhc Nrrk6r' conp€nelio. laws 6r( al'aonia dd asrt rhar if I shorld bdon. subi{t lo th. <br />\o.k6 conpl6ar bo povirions oas<tion 1700 olrhc bbor ( od..I shall. fonhvilh o,nply wiih thoe prcvtnhs <br />wARNlNc: Irrilur€ to su. rork6' comp€Nlion .ovnse is unlas'lul. 4d shall subj* d onplotc ro aininol pouhiB dd <br />civil fin6 op lo on. huodr.d lhous.d dollds ($100.000). in addixon lo lh. cosl orconlpcMrion, dma8es 6 ptovid.d ror th. <br />K"", <br />^.6-'.sraorlc innT6l ad alrd.r].r 46.Z.//-74 14 <br />I r(T\suD ( (rN t'lI ( ll)R <br />I)ll(.ldalrQ.N <br />I hercby nmm undq p.nalry of prjurr rhat I d licctuai undd povGio. ofch0pi6I (commdcins silh Seclion 7000) oaOirision l <br />or rh. ausin6s md PotsioG Codc. md my licnsc is in tull forc. ad cfid <br />D Qe:L967 <br />1/-Lo 49 -."*'- Bei< {carsmi:ff erl <br />COIiIBIIiIIOAIDNDINCSCEICI <br />I h.eby a,Im unda pdulry ol rejury rhd Os. is a .oBtrucrion LndinS a86cy tor ifi€ p6fom&cc ol lhc *oik for snich rhis poni G <br />issu.d(S{ 3097. Civ C ). <br />l-cnd.is Namc <br />AIELT{iANI.D&CBAAIPX <br />I ho dt amnn uidd p.nalrt olpcju.y on. ofrh. aollorvinB ddld,lions: <br />D.molition P.rmils-Asb6los Norillcarion F.{joal Rcsuldions [rirb 40. Pan6) <br />-Requted <br />l-ellq olNolifi calion <br />-l <br />cdirytha rh€ f.d€ral r.luldio6 r.rddrn[ 4bsrds rmovrl e. mr rpplicablc to this prcjEl <br />rvl .d rly rh, t h,\ . rad rhrs anph(arion md s olc rhd rh. abovc infoflnar nin is cotrc! I asrc lo codpl, wnh aI Cny .nd County <br />'ordimrB dd srare ti\s Ebr'nE 1o burldLnr coNrudion. ed hd€by aurhodrc rcp6drdiv6 oalhb ciry ed Counlyto ml6 upon lh. <br />aLa\ r nrnhoncd I)nl{ny li r irrlf,.totr fu'lxx.s <br />k,,n* <br />?er Ll-ln^^ <br />,,",", ll-zo-l( <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq zlultqfin <br />lnsulation/Energy I -t a <br />D rywall 4rflur lr 7-r) <br />Ext./lnt. Lath I <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar 4l9luQ,/>) <br />Handicap Req I {u- <br />Deputy Final Report <br />Engineer Final Report <br />I <br />FINAL *lzsll,q'i t<4llreA @ <br />Certificate of Occupancy ttul <br />Notes, Remarks, Etc. <br />L <br />Flood Zone Certif.tt