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SITE-WORK DATE ID/SIG.COMMENTS Osn.rBuitdcr D..tdrarion <br />I h.r.hy !tl''rm und( p.ultyoa!€Duryrh I in.x.npr rorm rt. Contrc.lo6 trens.t w aor rh. lollo*ms rqson (t c 7011.5 Busn6s <br />rnd Profcssio.Cod.)r A., Cn, or ( ounly wfiich Gquir6a p.mil lo coGrtud. dr.r. impror..dcholnh orr.p.t My strucrur.. prior ro ir3 <br />issun.., also r.quii6rhc aDpllcanr fo!such pdnn ro fll.a lisn d3l'lmc lhal h.orshc is liccNd puEuMrrorh.prortionsorthc <br />ConrG.rois l.rc.ns.d lrp (Cltapra s. Cdmm.ncing w'lh S(rrcn 70Oo ofDrv6bn u oarh. B$'n.s.hd Protes'oN Cod.) o. rtut hc or <br />shc is .r.mpl lh.r.from rnd rh.bdis rorlh.rll.s.d crcmption.A.y violliion olSeriod 70ll 5 b) rnyrrphclnr for ! pEmil subj.cl3 rh. <br />q,pl'c!m roa.ivilp.nallyoaml mor.th.n fiv. hmdr.d doll&s (1500). <br />l. a5 oan( oalh. pNpdy. or ny .rpkry<s r irh s rg6 as ltcir sol. compcnsarion. q ill do rh. sork rnd rh. ntudur ir nol riod.d <br />or orT.r.d for sl.{ sd ?o44. BurnBsand P.oLsnonscod. Th.conrrcroisL'c.ns.Lawdo.snorrpntyro!now.dotrh.pordy <br />sho builds orinprov* rhrrcon. and*hodo6su.h work hims.lf o. h6.lf or rhiou3h his or h.r own .mploy..s, provid.d rhat such <br />improvcm.ms rr. nor inl.nd.d ororcrcd aor s6lc.It how.rq.lh. buildins or improv.m. tsoldqnhinon.r.&.rcoiplction.rh. <br />()*nd'Bu'ldcr{ill hlk lh. burd.n ofproviu rh,t h. or.hc.ol build or inprov. for Ihc purposc of3il.). <br />l. asoR..rolrh.prop.ny, i .xclusivlly conliaclinr sirh liccns.d contrsroB ro coGrtud rh. proj(r ( S.. 70,$. Buincss.nd <br />Prol.sionC6de Tfi. Conrado.s L'c..e.lrw do6 nor.pply ro rnown.r 6l prop.ny who bu'lds or rrprovE th.r{n, iid who <br />coht&G fdr3uch pror.ct * h r conrrdo(, lE.ns.d pu6u.nrro rh.conrdcrors L'c.n!. bw ) <br />I @ cr.npr udrrs<rion .B.&PC for rhi! r.aon <br />WORKf RS C(}IIITENSATION Df, CLARAIION <br />I h.r.by afim und.r r.nrlry of p.rjury onc ofrh. followins dcclaniioB: <br />I havcMdwill mai aina C.din.arcofConk lo S.ll.lnsu.€ lor *orl.rs' cohpehs on. as prov'ded for hy S.cl'on lToo olrh. <br />trbor Codc, ror rhc prrordaocc ofrh. work for Ehi.h rhc p.mn n issucd <br />At**o *u,.,^." *"rk.^ emp.Nr,on ,nsu,ic.. is ,.,ru .d bv S..hdn 1700 6irh.llborCod.. fo' rhe p.rlonun.. olth. <br />carici and rnhcy numb.r arcrhr p.rm B us!.d My *or[.*' c6frp..el'on rfturu..rck y',-C 10? | Expir.s <br />lThir s.clion nccd nor b.cohpl.l.d il$.pcmil is ro. O.c hundrcddollac {glool o!lcs) ,/ <br />lccn,fylhat i. lic psiorronc. of Ih. sor* for which thk pdnir is i$u.rt- I sh.llnor onplo <br />h€c,m.suhJ<rtorh.worleB conrp.nsrrcnbwsolCrl'lorn'a.ands-!r*rh,r <br />:1700.f rhc lnlor Code. I shall <br />{- <br />WARNINC F,lur.to scurewort€rs .omp.nsat'oncov.'agersunlawful.rndsh.llsu6r.cran.ai,ninrl p.nalrics and.ivil <br />ni.s up u on. hundr.d rhouknd dollr6 { S 100-0(x)).in addition Io th. cost ofcomp.nsdr <br />rh.libo, rod.. rnre,6r ind o of.J , te( <br />.s 6 prolidcd for ih. S.ction:1076 oa <br />LICENSED CONTRACTORS DECLARATION <br />I h.rcby rlftrn und.r p.mhy orpcrjury th3l I am liccnscd undcr pmvision ofChlpifi 9lcom.hcins wnh s.cron 7000) olOivnion 3 of <br />lh. Buiess ud Prof.sioG Cod...nd my lic.E. is in aull forc. and.[ccr <br />t{ <br />(t)Ns t Rt ( tl()\ t.uNDt:\i(; \(;t:\('\ <br />I hdcbyaiiirhxnd.rp..rhyor!6juiylhar thd. tacoretruclion l.ndinsascn y forrhe p.nbm,nc. <br />itsu.d(sec l0!7. Civ. C ) <br />Lcndd s N!m. <br />H:lhal thc f.dcra I r.8u lll ions rc8 dinB ab.nos rnnovrl ac..r aprlicahl. to lnis prej.cl <br />lhlt I har. r.ad lhn apphcalion inromdion iscoft.cr.l rlrdrocooply *nn illCityand Counry <br />ordinanc6 r.d Sr6r.l-rFs r.laring lo by rhorin r.pr6.nrarivc5 olthb Cily 6nd County to cnrdup.nth. <br />a b.\r m. nr ioncd prop.rr y for in <br />( <br />r.-i,."-..rr..,1' F fl */,2 <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsul <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 />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />FINAL otltvltc ?n^{A>) <br />Certificate of Occupancy \J\\-:r- <br />Notes, Remarks, Etc. <br />-Jq <br />MlWP51\Psrmrl-hspection Fo.ms\B!ilding-lnspecrlon R€cord.doc 03.31 06 <br />BUILDING- INSPECTOR RECORD <br />Erection Pads <br />T-Bar <br />44 f <br />AtrucaNr-tDt(t -84uo! <br />D.molnion P.rnits-Asb.stos Notifi ctrrion F.d.6l R.sul ions (Titl. 40. Pan 6) <br />R.quircd Lrtd ol Norificd ion <br />I