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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OlVNER BUILDER DELCARATlON I h.ftsy .ffiro undcr F.alry or r.rjrry rh,r I m qcmpr ,rom rhc ConrracroN Licc!\. Lr* rDr rh. f{rbwii8 r.arn (sft 70:11.5 ausincss and Prorclsi.n Cddc): ny Cny or Coxnry which rcquirc\ u lrrmir b ( ifld. rkcr. tn8)v., dc,rel^h or rcprn any slruclurc. prior lo ns issuance..lso rcquncs rhc appli.rfl ld su.hrcnnirto fi|., siSncd ndcm rhal h.or she is li.en*d lDrsua ro rh. ptuvi\ion\ otlhc Cdnkackn \ l-ien\cd Uw (Chll)rcr 9. Gnnnrncins wirh Sccrt,n 70ql of Divi\nrn I or rhc Bu\in.r\ lnd Pmltsions Codc) or lh.r rE or shc h crcml rhcrurrom,kl rh. h*is nr th. rllcgcd cxcmFrion Any viol.rionolScclion 701r 5 ny lny ryplicanr rora pemir subj(ls rhe applicul b acivilpc.a[yol nol nmrdhnn five hundled nolh6 (3500) -1. !s nwncr of rhc pmp.dy. or my e'nploye. *irh wrgcs rs th.n sb conFtrs.tion. *ill do tlE work !d llE (Er@ i\ d, i'ncdrl orollcrcdlorek(SE7014.Blsinc$lndltolcssionsCnJc:rhcConrrrcroisl-iccn\cbwdocsnorJtplyt,dtrostrn.f rhc pn'Irn, who huilds or iq'mvts rh.rsn. md wh dâ‚¬s such wd. hnnsclfor hcrcltor rhrough hh.r hcr own cmlluyccs. pnrvid.d rhar \u.h iq)rohftnrs m hicndcn o. olTcffl lar sk lt howcvci rh. hrildirB or inpmv.mnr is sold wilhir' .n( rcar al on{hlion. lh. owocr Buir:Li $ill hovc lhc bodcn offmvir8lhjl hc or nE dil ml lruik or inlnow lhâ‚¬ pmpcn, tn rlt pxrFrp.r L r\osncr olrhcpopcnv.,ocxdu\ivrly(onlrx.rirg *ili li.utr\.(l..nrrr.ri$n,.on{ru.rrh. pmjccr(S.c 7l!.1. Buntus\ inl hrl":sir C.dc ThcContrttr's Licciic I-trw,n,c\ rorUt)lyk,0dwnn oltrot'c y who builds or ir.arovc\ rh.rcon. rtr,l *ho .onrrrcl\lbrsu.hpn,F.rs*irhrOr D.rrrrli.cnlcdltr uxnr brhc Conr.rcr{n-s l-iccnsc Ua). I ddcxemfl und.r S*ri6.-. B. & P C. tur lht @\on Drle ()*n.r: u0B5[BS3:O!lt[NliA[QN DECLATAIIAN I lucby rlnimundci pcMlry of p.rjury onc ofrhc following dNhhrnN Ihr\c and will ruinrrin r Cdificnrc of Con{nr tr ScllIn{rc tursorlc^ conFc s rtrn. r\ provdcd lor hySe..li(nr.llur.lrhc trlhor GxL. for rhc perlomuncc otthc sork ror shi.h rhc f.rnir n nsucd I hnrr rtrd willnri rin sorkcr( .onrr^-nslrion inruirn.c, n( Rquncd bySccriatr 3Tmollhc tihor Cod.. nn rhc pctlo unccof rhc *ork loruh{h rhhn .nrir y rukcr- comnctrslt ior rs canicr anl policy numhcr uc: .5 -lccnilyrhatinthcpcrfornun.eofrh.sorkrdwhichrhn,rhrir n t$cd- Ishullnor cmpl{,yanypcno ihany'nMn.r s asb ttsm subjccr ro rhc *orkB' .ump.ns,rion ldws orCslirornia. Md,8m rh0' ill slsuld tBonf, subFl to l,'c wolkcH .onp.ns&.ntmvisionsof S(riotr l7U)of rhc L'h/ G)dc. I shnll $ARNIN(; I: llLtrc h \cru'c \o'kc'\ (n\ri\rri,n' (trcrrlr A in l.)rr r. .'lnn l |Inilri.\ rDd civil turcs up ri) onc huDdrcd rhonsrM dolhr (Slu).ofi1). ir1 rion. dlnugc\ ^ niovidcd lnr rhc Scuion 1016olrhc htq Codc. inrclrJ Jtrd *,", -F-?*r/"^ I ltrrcbyrllir undcr pctrrlryofpcrjurr lh lm n) r.l ChrIrcr 9lcoNncNin! *irh Sc.riotr 7{l()) ol I)nni{r, ] r rh. Rtr.inr$ xtrrt t,,ori$irnn aoJ.. rn(l I h.rhv rllttrr und.r pcnrlry.ln rluryrhrrrhcr. i kndin8rgrn.y turrh.l.fDntund ofrhc $.rk lor{hichrhi\ pcnnir i{ nru.J (Sc. 10e7. Cir C ) ATTLIIINLIIEII.AAAUON I hslty alitr undcr pcn0lry ol !.rjury otrc of lhe lblh*irs de-^lrlri(nr\: Pcflnir! sh.{os Norific ionltdcrrl R.guhri$\(Iirl.l{, t'an6) rhc rid.'rl rcEUltrrnnN rcgJkli',9 rh{ I lxrvc rc.d rhisapllicd'on i ,h<;.oftNr la8le ro cotrlplywirh illCilyond Oniniy and srrrr ln$\ rchriryi) hu ivcs olrhh Cnl d Counry ro cnt.r trtx). rl.c nrnri,r.,l prcncny ior inspccri,,n I)pliunl or ^aâ‚¬tr| Sian.lu i(lil ,^,.,'Fq'/X Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Rool Sheathino 23.2,,tGL\ Shear Wall 17Framing \ lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat ltrlasonry Pool Fence T-Bar Handicap Req. Deputy Final Report En gineer Final Report Flood Zone Certif FINAL 4 il W.tr 9i/ Certificate ol Occu pancy I \ t-- Notes, Remarks, Etc : Subf loor/Vent/l nsulation ,ry- --T_------