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BUILDING- INSPECTOR RECORD
<br /> SITE-WORK DATE ID/SIG. COMMENTS 0wh..Budder Declaration
<br /> I hereby affirm under pmelry of p.jury in.,I am exempt fmn t1t<Cuntr¢to« uem,e L.w for the foilowmg..on(lcc'031 S Bmtn<„
<br /> Set Backs and Prof....Code) Any City or County which require.pmn.1 In mtutrvct,alien,tmprovq demolish or repar env,t cw,c,prio,to rt,
<br /> e,also«quire th,.pphcant formch P.nnn to Me..gne:rotemmd that he or he i,loaned vunuant tc,he p«nuo..1 me
<br /> Forms/Steel/Holdowns Contractor',Licarow law(aiii 9.Camwncing with Scott.pDot)of D(vblm s of the B.tne,and Prof on on,Cod.,or that he o,
<br /> ,he t,exmpt therefron and the bun for the alleged aempion Any violation of seedion'031 f Fy A-)apeh:en:rn a p<rrm.:,ub)ec,the
<br /> Erection Pads ...heam tto.'i'd pcn.lty of r.rtwra that five hundred dollm(51001
<br /> LIFER Ground _I,. awn.of the property,or my employe.with wage.in..,'cle compe.aden,will do the work and the,tmctwc b not mtnndcd
<br /> r offered for the(S.JOU,Bwine.and Prof..iem Code The Conma,or',Licm,e Law do.not apply to an owner of the n.11
<br /> SLABFloor who build or impov.thetogand who J.arum work himad(or hmdfathroughhit or her own employee,provided that,uch
<br /> improv<mmu m not iotert or offered for the If,however,the WIctng or improvament mold wl,hln one yea of conp!etton,tnc
<br /> SubfieorNent/Insul. " Owner-Build.will have the burdm of oving that he or he not bui Id or t th,.,for the D.r hire of,CcI
<br /> Roof Sheathing — I '- l 'f I,.owner of the pop ,,m exclmively, con uth,vv"'tl:cerucd oont.d,on m connmct the p,4cn 5,c 'Du,Buvne,end
<br /> P
<br /> Wall
<br /> mre..cr Code.The Contr¢tmY Licm.Law doe nix apply to an owner of property who buJN or tmPove;hereon and who
<br /> Shear all contracufor such prgc,uwnh,Contractxts)licen,ed punuent to the Contrector'a License Law)
<br /> Framing _I.ea.np,under Section ,B.At P C fonhutwo,
<br /> Insulation/Energy Date owner
<br /> Drywall WQR RS COSfPENSAIlON DECLA_a_ATION
<br /> I hereby aRtm under penalty.[perjury one of the following declaration,
<br /> Ext./Int. Lath Ih.v.and wdlmunuin.Corti nu«ofCon,m,m Self.instate fo,worker compan.uh,. c,,d,d for bySec,i-3'00of,he
<br /> Brown Coat Labor Code,for perfomunee of he work for which the perm,i.iuu.d
<br /> Masonry _I Mile and will mYnwn worlrm' compmuuon inurutce,u «qulrcd by Seen on T'tW of the Utter Code for the eft.^..nci,cr the
<br /> work for whir cft thi,permit i.I.ued My workm ii...on tn,urance cam er and Polity nunbcr arc
<br /> Pool Fence Carrier I i _
<br /> T-Bar Policy NumberExp,...
<br /> Handicap Req. (Thi,.alon need no,bfcomA ifnhffermi,u(on One Hundred dollm(SI(X)or leq
<br /> Deputy Final Report _ItmiF thnmtnc P+formance of Jr,work for which thi,perms innued,I'hall not employ any pmon l c ay rnamer,d.tc
<br /> becune mS en to the�wcrk '<omper ion Lw,of Uhfar.aH and•gr•'•that ifl hc,:d b<wm<wc ea m it,worker
<br /> Engineer Final Report Ceti, ��� /L n�' ti o °rtn. agwCofd a m thd9. lvwiththp,<C«.Minn,
<br /> J awl Xk/
<br /> m "P'eh
<br /> WARNING.Failure to ire workyr.'compem.uon coverega 1,unlawful,anC,hall,ubjen an empic>er to mmtnel p<mhie.,de-[
<br /> fm.up to one hundred thomand Oollm(SI W,OW),tn.ddi,ion m th<can of mmpmuuan.d.mages.prov:dcd fw th<Se<oon 3D'6 of
<br /> the Leber Code,tmm,t and enom<y,feu.
<br /> FINAL 2 1 LICENSEDlunoer CONTRACTORSDECLARATION
<br /> .Rm I hereby r under pmtl N ry of p.jury u am li t <maed do proviaon of CnaD,c 9 t mmmmdtng.vur.5ea:un':DO,t of Du mthn J of
<br /> Certificate of Occupancy the Buelnc.and Profe,io a Cade,and my It.nae inn full force and effect
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<br /> Notes, Remarks, Etc.
<br /> Dec, L j COMaC]pr l i l.� I. L L t
<br /> r
<br /> CONSTRUCTION LENDLNG AGENCY'
<br /> I berth)eRmt under penalty of perjury that this,u•comtrvaton I od,r,agency for the p,rf,,an ,of the uork for which this Gcnnu n
<br /> ,oed(Set.1097.Civ C)
<br /> Lender,N.ne
<br /> ..ended Addr.r
<br /> APPLICA.NT'S DECLARATION
<br /> Dcmebtion Permn.d.been Notification Federal Regulations(Tide e0,Pan 6)
<br /> Required Letter of Notification
<br /> 1 eenify,hn the fcdertl regubuom ,,ardih,.beao,«no..l are not applicable tc this pm;ea
<br /> I cmf,that I'nave read this.pDhcaoon and...a that the above information it wnr,, I.grec -mpg.. sat O,v.,I Co...
<br /> ordmanc.and S.I.law.nlatmg to uddmg coh.ci and hoebY.utnonxe[cpremu:n<,of tee C.p and Ccuno to en¢r upon:n,
<br /> above mentioned pmperty f ern Du
<br /> A Lcantor eh,u> �� b.�.
<br /> Peminee ovene(Ptnt) /� 17�L E�//A
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