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SITE-WORK DATE ID/SIG.COMMENTS OWNDR BUIT,DER DELCA TTA'TION <br />I h€reby amnn unds rE alry oa pdjury rh.r I ab .rmpr aro,n thc Conttcrom' Lic.nse ljw lor lhc tollorvDg t@n (s€ TGll s <br />BNin€ss dd Prof*ion code): Any Cny or Counly which @qut6 a p6nit lo construcl. ah6 improvc, &nolish or rerat v <br />stlclue, prior ro irs iso4ce. also r€qun6lhc applicen aor su.h Fnit ro filc a sisncd sr.r@or that h. or $c is lica&n !6uer <br />ro rhe FoviioB oath. Conlrlcloas l,iccnsd t3q (Chapt6 9, Comfrencing {ith Salion 7000 oaDirision I otth€ O6in6s dd <br />Proa.sions Code) or thal h. or shc is deofl tbq.tom dd th. bsir lor $c allesdj crdnprion Ant viol.lio.ofs.crio' 70.1I 5 byany <br />applicanr lbr 0 pmir sub.jrrs lhc applic&t lo . civil poaliy of nol Dor. lhd 6!. hundred dollds ($500). <br />-1. <br />d oMd olfie pmpoly. or nry emplo)G Nirh $ ass s rh.t el. coflrp.tration. $ll do $c sort ad rh. slruclG 6 ft{ <br />inlqd.d orofts.d aor el€ (56.70.14, BEine d Pmlssions Codc: 'ttu contactol s LicdM Lw dod not apply ro m ownd of <br />rhe Flfdy who buil& or Lnprcv6lh6o.. ed who d(6 such ra'l hitu.la or h.Mllor lfinugh his or ho oM .mrloy6. <br />p,ovid€d thd su.h inpmvdEds ft nor intmd.d o oltddl aor slc. It ho$ds. thc hiidi.r or inprovffit is $U Nnhin on )a <br />ofcompldiotr lhe OM6 Builds will hav. th. hn&n of previns fid hc or sh. dd nor b{ild or nnp.ov. the popsly aor lhr plrF)e oI <br />I. s ownq of lhc pmpdy, an erclusi!.lt contadins rvilh licm*d contradoE rd cocrtud thc Frcjd (S* 7044. BNms <br />oftl hofdi.. codcr Thc Conlraclois l,icens.l..v do6 nor apply ro do{nd ofprcrBly rho builds or nnprovcs lhsmn. <br />aod wh. conl8ds for su.h F.jeds {nh a contado4s) licmsid pu6uanl o th. Conlraclois Licdsc Law). <br />I merdm unddsdo. .B & P.C.forthts'don <br />D.tr: Owner <br />IIaBSESSICOIIIEIIA]IA! <br />D!C!ASAr!A! <br />I h6eby am.m und€r penahy oapgjrry o.. of the follo$ ing d6l{alio6: <br />-l <br />have ad will nainrain a cdlificat€ of Co6dl lo Self- l6u,e lor trork.c conu,ensl 'o., 6 Fo\ id.n for b, SEI ion 3 700 orlh€ <br />Labor Code,lor rhcFrom&cc ofrh.{o lorshich the p6mil it is\ucd <br />-l <br />h0v. a.d will nrinlain wotkft compeBarion iBur.nc.,6 requted by Serion l7({ ofrh€ Labor Cod.. ior lh. p6fonmc. of <br />rlE {o.h for which lhis D.mit is bucd. My wo*dr omDosrion insur cc cdnd ad policy nunbd ee <br />3 \"rte aJY-Q€.5,^\{i. / ^sq.q,@ I--d <br />qt319r5-(?1/.t /r <br />I cenify rhal io lhepdtur@c. oarhe worl aor \vni.n riis p.rmil is issucd. I shallnol mploy any p6o. i. anv mtunc <br />$ as $ bccoi. subjdt to rh.$o*os comptrarn,n hws ofcalifomia. &d asre lhat ifl shorld b..od'e srt €cl lo the <br />workd' lonpsariod prcvisiom ot Sdion 1700 oflh. llbr (\d.. I shdl. lonhsilh comply reirh rho* provisions <br />WARNINC: raihtr to sur€ workqa N,nptuarion covdaSc ir unla\rful. d sh.ll subjc.t u oployrlo ohinal lEn hi6.nd <br />.ivil line 0p lo on€ hundr.d lhousd <br />Sfirion 1076 o[th. tibo! Code inltr61 <br />ffi, -Tllze/z>A <br />), in oddilion to lhc cos oacomp.6alion, donasd a pravided for fic <br />kin q <br />DI'( I \R\IX)N <br />I hcrcSy am.mundr p.nahy olpajury lhar I m! licos.d ufld6 FovBionoachap(d 9 (commocinr *nh S€rion 7000) ofDivision 3 <br />ot rhc Busins aad Prel6sio6 Codc, and ny licG. is in luu forc€ od.,T{r. <br />a+6 7.:.-3 {a6 <br />,r",", l/2 .'t?St,,,r.,..1 <br />'1 <br />Ss\*< Te.t, /-- <br />caxsrBuclloal,llilDllclclN(I <br />I h@hy am.n udd penalr, of pajury rhal rh6€ B 6 cttriroclion Lndin8 asqcy tor th. Florlmc. oirh. "ork for s'hi.h rhi Fni t <br />issu€d (S( 309?, Civ C.) <br />A.ITLICANLIICIASAIIO! <br />I hd.by afiinn undtr p.nally ofpojury onc oflh€ lollowi.s d6lealions: <br />Dcmolirion PdmG-Asb6ros Noti6calion !€dsal Resuldrions (Tnl..t0, Pan6) <br />R.qrtcd klld oa Nolilicalion <br />-l <br />c€nily Ihar lte fc{ral icgtrld ioG Egtrdins 6b6tos roo\ al arc nor ippl[abl. 1o this proj<t <br />I cdif (h{ I havcruJthls applicalion od srarcrlral th. ab.ve inlomalion is cor€c1. I alrdto..mPly sith all Cirya.d Cornrl <br />ordma c6 6d Srarc riNs ro b{ildins conslrucriotr ed hd.b, aurhorn. Epr6alariv6 oalnis Cny md Counly lo 6ta upon lh. <br />alFve mmlioned prop€ny for <br />.\DDlicntrt or \Bcnr Sisnnru,r <br />S^|"s. -Tn"h /n--9.t.tu..lle <br />rt /zc/e <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsulation <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 />Flood Zone Certif <br />FINAL I tflqld 'rl}t 4*f"&., <br />Certificate of Occupancy U\ <br />Notes, Remarks, Etc. <br />BUILDING. INSPECTOR RECORD <br />e