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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS Omq-Buildcr Dclantion <br />I hacby rfrirm unda pculty of pqjury tlut I rm acmpt form thc Conrraor' Lieuc hw for thc following ruon (ro.7031.5 Buincs <br />and Profesion Codc): Any City or County which rcquir6 a pqmit to orotrue, altc, improvc, dcmliih or reprir uy rmmc, prior to its <br />bsun@, also rcqutB thc applient for ruch p.rmit to filq r sigocd st tmeil thst hc or shc ir liceroed pursunt to thc provisioB of thc <br />Contraaor'r Lierocd Law (Cheptcr 9, Commcrcing with Scrtion 7000 of Divilion 3 of th! Buin6 rnd Profgrios Codc) or thlt hc or <br />shc is acmpt thacfrom ud thc brsi! for tho rllcgcd qcmption .Any viohtion of Setion 7031.5 by uy applieot for. pemit rubj4t! thc <br />appliqnt lo r civil pemhy ofnot more tlun fwc hundrcd dolh6 (S500). <br />_I, s oM6 of th€ propsty, or my cmployB with Eg6 $ their solc 6mpcetion, will do thc wo* ard tho rtru.tuc k rct intfidcd <br />or offacd for ulc ( 58.7044, Bwins md ProfssioN Codc: Thc CooErctor'! Li@Ec hw do6 rct rpply to e ous of tlE prcpqty <br />who buildr or improvc tlE@q rnd who dc lwh work hirelf or hmlf or through hir or ha om cmploya, providcd that ruch <br />improvemcnr arc not intcndcd or offqcd for sl€. If, howcv6, thc building or improrcmcnt is sld within onc yw of omplaioq thc <br />Omq.Buildcr will hevc thc burdcn of proving Out hc or rh€ not build or improvc for thc purpolc ofnlc). <br />_I, r ow of thc propqty, rm qclurivaly antEcting with li@ad @nt rctoB to @NEucf thr Fojr(, ( Sc. 7O44, Bwinsr rnd <br />Profsion Codc: Thc Contrrdor'r Lierc lrw doe not apply to m ome of propcty who buil& or improu tlson , ud who <br />@ntrlcts fo! ruch proicds with r Coturclor(s) limed purrum o the Conhctor's LieEc bw.). <br />_l am cxcmpt undq Section .8. & P.C. for thir rren. <br />Datcl <br />I hacby rffrm unda **n, o, *;* o*ffi <br />_I hsvc rnd will ruinuin r Catifiqtc of Coen! b S.lf.IEurc for rcrko' ompcutioq u providcd for by Soeiotr 3700 of the <br />hlor Codq for the paformre of thc rcrk for wtrich thc pamit ir irucd <br />'f,f.rc -a *itt roirtrh rcrto' @mpcutbn irnncq u rcquirod by Sc€tbn 3?OO of thc bbor Codc, for tllc paforc of tlrc <br />H:*:jT"[.:IT-"ry *"fl:'r"'T' <br />Policy <br />] zlo -- r-o q <br />(Thir s€tion nacd not bc if thc pcmit i5 for Onc hundrcd dollrr (Sl0O) or 16) <br />_I catiry dut in thc pqforrc of thc worl for which this pamh ir irsucd, I rhall rct mploy any panon ia rny tmq rc u to <br />bcsmc tubjcd to thc rcrko ' ompruuioa bm of Crlifomir, md lge thEt if I thould bc!@ rubjcd to thc workq' <br />@mp€ution provisioro of Scdiotr l70O of the hbor Codg I shrll, fonlryith @mply with tholc prcvilioN.. <br />WARNING: Fsilurc b sarc wrkc' ompcution ovogc ir ulrwful rnd rhrll rubjcct u employs to cimiul peuhis rod civil <br />Iinc up to onc hundrcd thowd dolhs ($100,0@),in lddition ro tho ost of ompcutior\ drmg6 s provllcd for thc S61ioo 3075 of <br />thc hbor Code, intacr ud ruomey'! fG. <br />LICENSED COI{TRACTORS DECLARATION <br />I haeby rffirm uoda pcmtty of pcrjury dut I em lierocd unde prcvirbn of Chapta 9 (omcncing with Scaion 7000) of Diviliotr 3 of <br />thc Bwincss and Profqrioro Codg ud my li@M is in full for€ ud cfrE( <br />LieNc e -a1 Li@nsc 1" ro 5$ <br />Date: <br />CONSTRUCTION LENDING AGET{CY <br />I hacby afrim unda pcrlty of pqjury thlt thac ir r @rotru(ibtr lcrdinS rgqEy for thc pqfomre of dE wott for <br />irsucd (Se. 3097, Civ. C.). <br />L.nda't Nmc: <br />thir permn ir <br />L€ndcr't Addrsl <br />Dcmolirioo pmit -Arbcror Notifiqtion Fcdqrl ffiB* <br />_ R.quircd Lltta ofNotifiotion <br />I stiry dEt thc &dnl rcgulrrtbu rcgrrdbg ab€tor lumnl re mt rppliablo to thir proic.t <br />>! *,tt, *,, t e rad thir rppliation !d irt! dlr tIE rboE inbmtioo ir @rc(,. t rg16 to @mply with rU Cty rDd County <br />ordiBncg rnd Shtc Iau rabtirg to of thir City rad Couty to atc upon thc <br />rbovc mcntioncd propcrty <br />Appliont or rScnt <br />Pcrmitte umc (print): <br />rnd becby euthorizr <br />a <br />1 <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />SubfloorA/enulnsul. <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <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 \\-o^b-oi gt.t.? <br />Gertificate of Occupancy <br />Notes, Remarks, Etc.