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BUILDING. INSPEGTOR RECORD <br />SITE.WORK DATE ID/SIG.COMIUENTS <r\- <br />- <br />Ow-BuildcrDclrnrb! ' - . <br />I hgcby aflum uadq pcrhy of pajury thet I u aup fom ttc Cofircor' ikre bw for & OlUowing m! (e7ct t . 5 Buir6r <br />ud Prcfssion Coda): ADy City or Coutrty which rcquirc a pamit to connruc! rls, inprcve, dmlbh or nrpair &y ttsuctug Fior to itt <br />Lrurncc' abo rcquirc tbc rpplisd for sudr Fmit to filc r rigtEd natm! rher hp or rlE it liadod purlun b lt! prcviriou of tho <br />Conrrcior'sLisn$dL.w(Clupts9, Coffiing wO Scctbo 7000ofDivirion3 of thoBuim ud Profariot!Codc)orth.thctr <br />rbc ir mp ttac&on ud rhc b.rit for ttc dlcgcd ffiptbn .Ary vbhtba of Scctioa 7031.5 by uy rgpliear for r panil rubjccrr tto <br />ryplioDt to r civil pcrlty of not mrc rhrn fwc hudrd dollu (Ssm). <br />-I, <br />u ow of thc prcpqty, ot my mploya with rnge u thcir mlo mmpcartb4 will do thc worL ud thc atute b Dt iiladld <br />or offctcd for rb ( S€.1X4, BuiEs trd Profcriou Codc: Thc Coilrrdor's Licffi hw dc tDt rpply ro a ow of thc prcpsty <br />wlE buildt or improE th@n, ud who do6 srrl mrk hirelf or hcrclfor tkougb hir or ha m cmpbyccl providcd tbrt ruch <br />inprovcmou re m htadcd or ofiacd for rb, If, how, thc buildhg or impromcat ir rold wirtia orc ya of oEp!.tbq thc <br />Ow-Builda will hrw thc burdcn of proving ther hc or shc rct build or inprcrc for tho purpos of nlc). <br />Busincss and <br />, end who <br />_I rm excmpt undcr Section _ .B.for <br />I hereby affirm under pcnalty of perjury ono <br />_IhrvcmdwilluiilriorCqrifErcofcoEotbSclf-IEucbrmrta'6np6rtbllu FwidldfosbyScioa3?00oftts <br />bbor Codq for th€ pqfo@ of thc w* for which ttc pcmh ir i$ucd. <br />-I <br />hrvc ud will oitlrh mrld' ompciltion iunrcq s rcquircd by Sc.rion 37@ of tlo Irbor Codg br $a parfomncc of dr <br />mrk for wtilh ttir pmh ir inuod. My rcrka' ompmrion inrume mlr rod policy nuba uc <br />any in any manner so aE !o <br />worke$' <br />WARIING: Failure to secure workers' compemation coverage is and shall subject an employer !o ponalti$ and civil <br />fines up to onc hundred thousand dollars ($100,000),in addition <br />the t.abor Code, intcrest urd attorney's fe6. <br />cost of compcru&tior1 damagcs ss providcd for thc Soction 3076 of <br />LrcENSDD CONTXACTOIS DDCIJTNATION <br />I tscby rffum undq padty of pajury ttrt I u limcd undc Amvirba of Clupa 9 (oming wih Scabn 7@0) ofDivbbn 3 of <br />tho Buirc and Prcftuior Code, rnd my lirc ir in firll ftre ud cficct <br />Licerse Number <br />Dato: Contnrclor: <br />CONSIRUCTTON LENDIITG AGENCY <br />I lrcrdy rfum undq polty of pcrjurythrt tlEc ir r ostuction lcoding rgacy br ttc pcr&macc of rhc wt br wihhthir pcmit ir <br />LnEd (Sa 3(ylr, Civ. C.). <br />Iads'rNrm: <br />Lcnder'r Addreg: <br />APPLICAI\TT'S DECI. ^ ITATION <br />Dcrnolition Pcrmits.fubcstos Notifrcation Foderal Rcgulrrionr Cmh 40, Plrt 6) <br />_ Rcquir d I'cnrr of Notifi carion <br />_-*I cortify that the fedcral rquhtions regsding asbertos <br />lrcertiry that I heve read this spplicEtion and ststc that <br />remo\ial are not applicsblc to this projcct <br />the above information is correct I all City and County <br />ordinances End Stste [-swr relating to b,uilding and <br />abovc mcntioned propcrty for <br />Applicant or sgent I <br />Permittee name <br />o <br />to <br />md County to erter upon the <br />Set Backs <br />Forms/Steel/Holdowns tJ/,I <br />Erection Pads (n ^W)UI I <br />UFER Ground I #t<\ L \ <br />SIAB Floor I -\. <br />Subfloorruenulnsul I ,'t0,D3 ll$/qq) <br />Roof Sheathing ,ftwil <br />Shear Wall 9,'!rtt \-/ <br />Framing t\w4 ) <br />lnsulation/Energy /h/r{4,4\K -,{ff (v'( <br />Drywall ([ 0 tv' f.-''r/fr,v/0trl MD <br />Ext./lnt. Lath tofr7v,; <br />Brown Coat I <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />t/.*A <br />FINAL mr%tvtw <br />Ge{lficate of Occupancy t <br />Etc. <br />I <br />' f ttAlu,U ,UA4url- l-tkt- <br />to construct <br />oontracts for such projocB with a Contrador(s) liccnsed pursuant to the <br />,nr wnc(: <br />( <br />I <br />Vta)0/A <br />I <br />a <br />UIDfr c€ <br />a <br />I