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SITE-WORK DATE ID/SIG.COMMENTS OWNDR BUILDER DEt,CAR,{TX)N
<br />I hc6by rffinn undcr Fnalry or p.rju.y rhar I im .k !, iio,n rhc (nnlmcros Liccns LlB for rhc followins rca$n ( sc. 70-l l 5
<br />Busincss aM Pr.i.ssi Codc) Any Cny o! Counly whi.h rcqutcs . pcrmn ro connrud- alrcr. iopr.v.. dc.rlnh or rcpff .ny
<br />srrucrwc. oiorro ns hsuoncc- aho requtcs rhc appltonr ior such pcrnir ro nle, sirned {arcftnr rh.r h.or shc n liccnsd pursu0nt
<br />ro rhc FovNnrns ordr conr..bls ticcosd Law (Ch,prcr 9, Conmrcncin8 uilh Sccrn,n ?OOO ol Divtion I orrhc ausa.css,nd
<br />Pmlcssiotrs Codc ) or lh hcor shc is cxcnDl rhcEfro'nond Ihcblsis r'o,lhcollcscd crcnrfln n Anyvn)hliotrofsdion703l5 hylny
<br />applicrnr li', ! tr.rnrir subrrch rhc smli.unr tD a.ivilrcmhyofmr mrrhrn llvd hundruddoll s(1500)
<br />IIOAtrE&T:g)IITENTAIIAN
<br />IEI;LASAIIO!
<br />I hcrcby rflnnrrndcr t[MlryolprrJu.yotrc ollhc tullowire dcchr.rions:
<br />-l
<br />h.v. n ld rill rDinriin r Ce(ificrrc of Constrr ro Sclll trsurc lor wo,ksa snl. erioi, ,r povid.d f.r bt SNtn'n 171x) oi rhc
<br />Latxtr Cdlc. r(,lh. p.rrorm,trNof$c trolk lor which lhc Frhrir is islcd.
<br />rh. *ork ntrFhi.h rhn Frnrir ir nruod Nlytrork.r\'.r rfcruriir nNtrr...{rricr i Eni.y trtr hrr xr.
<br />Exptcs
<br />I ccnrfrrhrr in rh.lxrfornhnccollh. work lor whichrhh pcnnit h irsucd,l strU nor cmpbyrnypcsotr in otry.ranncr
<br />$ u\ h trom \rbjcd t, rh. *.ikds .o,np.nsrdr hws or cnlirdn,,, .ntl J8Ec thnr il I shrula b.conr \ubFr r. rtE
<br />sorkds odpcnsdrion ,n,viio.s urSc.rion ll00.l lh. tih, C(ic.I shil.lonh*ilh compl, wirh rlos p$visions
<br />*ARNING F{ilurc lo *curc wo cr'conFnsalion olcmgc ir unh!tu|. Md shrll suhjcr a. cmPloyer lo oiminrlFnnlri:\ and
<br />.iril nncs un b ons hundrcd rh.usrnd dolla^ (iloo.O(x)). in addirion b rh. coi or.ompcnsrrion. dlm3cs x\ ptr,vidLrl r(r rl[
<br />SL\lion 1076 oirhc titxir C c,inlcrc$6ndark mysl K,",..710'rt
<br />I ICENSFD CoNTR,{CTOi
<br />DECI.ABAIION
<br />I hcrchy dttm undcr pctulryorperjurr rh,r I an lic.nkJ undcr pmvisioo ofChafls 9(commncins wirh Seti,n 7filo) orDivnion.l
<br />oI rhc Busincs rnd Pmiesn,ns Codc, and fry li.cnse i\ in anll roft ud cffccr.
<br />Licc.scCh$:-1'ta-tt x
<br />q)!$alsIIaNMDlNGrlliENlJ
<br />I hcrchyamrmundcrFnrllyofpcrluryrh i rhcrc nsLuFrrucii,,n L ihsr8ctrcyfo!rhetdhrlEnccoirhesorlforwhi.hrhkltrnltis
<br />k$cn (scc 10q7. Civ. C )
<br />Lf,rdclsAddnssr
<br />-
<br />l.r ilyrhrr rh.ltd.rrlrcSul.rion\ rcFddirB rshcno\ r.n$vdl {r. noi rpplicrhl. r. rhi\ pn+.r
<br />I ccniry rhar I hntr rMd rhn lmltatiotr a1d sratc thar thc ot-vr inlonMnD t cord Lge ro conply with all Cily rnd Coudy
<br />ordi.otrccs ind Slarc kws EIalinS ro l,uildinS construcrion. md ncrcby lurh,irr tspr.scnrdiv.s or'hh Ciryand Counryni cnrs nli,n rhc
<br />Lbvc nr.nrir)ncd Prcnc , rnr "z:..-
<br />Anpliunl or Agctrl Si[o!h'rc 4 CTOL -^.'
<br />7 - (ct't6
<br />, /Att /
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Ener gv
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/lasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />A
<br />FINAL y-2 s 9.t4.)U
<br />Certilicate of Occu -vpancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Shear Wall
<br />T-Bar
<br />I
<br />{r
<br />-1.
<br />!s owmr of thc DrcIEny. or nry emthr.€s wirh wr8cs as rhet slc odFnetio.. will rlo ltr wdk d trE slnrl@ is nor
<br />intc&rcd or orlcrcd fo, ek tsd 7044. B8incss and Ptufc$i.ns Codc: Thc contDdor's Liccns faw dms nor apply b rn owrcr o,
<br />lhc lrtcdy *ho builds or in{,roks th.mn. ,Jrl *h. dG skh wo* hifr\cl, or hcsclf o. rhmuah his tr lrcr o*n.mployccs,
<br />lrovidcd th0i such imfmwnls E ml i cnk m olicrn for ssk. t( how.wr thc t{ilding or in'Ieh6nr il slil winh onc }td
<br />ol compbrion. rtE O*kr Blildc. sjll har rhc tird.n oitmtng rhar h. or sh. did rcl huiu or inp6h UE pmtEly for thc p!ry)c ol
<br />L .s owmr of rhc !op.ny. aft cxclusivrly .onrN.(ing wnh liccds.d com6.ro6 to con(rucr rtc pmrcd (Sd 7044. Buqim$
<br />d Elfssion Codc: Thc Conlr$lu\ Liccn\c Law docs nor apply lo !n ownd or nroFrly *ho builds ot imJ,tovcs lhercoo.
<br />and who onr@( roi skh lroj.rs wnh a Co @lo(t liccn*d lu(Mtr! ro thc Conrracrois Liccnsc Llq)
<br />I an cxcmrrr u.dn Serio.- B. & P C for this rca$n.
<br />D.ter oPner:
<br />AIIIICIINLIIEIIABAUAU
<br />I tmby dlim undcr ncrally olpc,iury onc ofrhc ldlowinx de.lnrarion{l
<br />D.flblitiotr PcrnrirlAshcstos Norificorion Fcdcral RcE!llrions (Tnt,10. Pan6)
<br />-Rcquircd
<br />txlt.r of Notifi dlion
<br />I
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