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BUILDING. INSPECTOR REGORD <br />t- <br />SITE.WORK DATE ID/SIG COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />S u bfl oorA/e nUl ns u lation t' <br />Roof Sheathing )-r" 0 tt 't1l -, lofiq lnq n&lq U <br />Shear Wall I <br />Framing <br />Insulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Requirements <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certificate <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />//)//rt,t , <br />( <br />i)d.--)l .,,-/O <br />r <br />Ihcrcby affim un&rPadty ofFjurylhil mqoFfmthcCammcro'Lire Lm fcrhcfollwiryl!a6 (H.?03t.5 BulFsr <br />od Profaio Codc): Any Oty a Coug ?hidr rcquic r Frdt to cdmuc4 dta, irprcvc damtirh * rtpeir my stucte, Fitr to itrimcc'drorcqliBthcTpliotfcndpamiitofilcrrigncdrtdaMt thdhcathcirlimrcd prrrmtoorcpoviriqsofthc <br />Cnre'tLicadIr (Chrpta9, Cormdng with Scrim 70{nof Divi:im 3 of thcBuino md Prcfaim Codc) arh*hcc <br />lhc it qmB 6@fmr rd rhc bqtit fa lhc dlcgcd cmptio .Any viol*io of Serio ?03 l 5 by [y lppli@t fa r pqmit lubjeE rhc <br />+plimtto rcivil pqdty of ndrnrcdm fiw hu&cd dolhn (3500). <br />-1, <br />I ma of th. FoPqty, c my arylcy€ with wrgc a thcir rclo snFserio, will do rhc wort ud thc lruaw it nor iiladcdc ofiacd fc rdc ( 38.704{, BuiE Dd Profaim Codc Thc Cqrtoctq'r Liw lrw dc oca rpply to o w of rhc propagr <br />who buildr cimprcu lhm, mdwhodm rwh wqt hirelf c hf,clf athugh hircham orploya, prcvirtcdth*nchimprcmlr e not inta6rd a ofrfrd fa nlc. lf, hw, thc building c impmmt i, rold within mc ya of cornplaim, rhc <br />Owna-Buil&r will hrw thc hrdcn of proving thd hc tr rhc not build c imprcvc fc rhc pupoc of ntc). <br />-1, <br />u mr of thc piopaty, m acluircly wrtrcliag with limrd mfrrs ro cdutnrct thc Fqj6-t ( SE. ?Oa,t, Buina udProfaio Code Thc Cqrtnao/r Ucre Iry du not rpply o o m6 of Fopaty rho buil& a improu thffi , md who <br />cfilac{r fc tuct prcjcE with . CoErts(r) lisucd pumt to thc CooE ctfi'r Ucru Lsw.). <br />lmacmprundrSc-tim .8. &P.C. fathirm. <br />Date: <br />WORKERII COMPENSATION DECIJ\RATION <br />I hatby afEm udrpcodty of pajury mc of thc follwiry dclmtimr: <br />I hlw md will mhtrin r Ccrtificrrc of Cmt o Sclf-hre fq wq'k6' mFildio, a prcvidcd ftr by Serim 3?OO of lllc <br />fq thc perfqmancc of thc work for which the permit is issued <br />-I hlw md will mintain wqto' olrpaultim irorrue, u rcquircd by Scri@ 37OO of thc Lrbor Codq fc rhc pcrfme of thcwct fq which lhir pstnir ir irruod My wolsa' mpouatim ime mia ud policy numba rc: <br />Policy <br />(This scction not is for Onc hundred dollan ($100) or lcss) <br />this is issue4 I <br />agree that <br />shall not anploy in any manner so as to <br />thc wqkcrs'1 <br />I$or Codc, I <br />WARNING: Failure to securc coveragc is unlawful, and shalt subject an crnploycr to criminat penalties ana ciril <br />addition to thc coot of compcrrsatiqr, damagcs as providcd for the Scction 3076 of <br />the l-abor Codc, intcrest urd anorney's fees. <br />LICENSED CONTRACNORS DECI.ARATION <br />I hmby afiim undcr padty of pcrjuty $at I m limcd uda prcvilim of Chaptg 9 (cmcing with Scctim Tooo) of Divisim 3 of <br />thc Buinq ud Prcfsim Cldc, udmy limc ir in full fm mdcffet. <br />License <br />Date: <br />I hatty rftim m&r padty of FjEy thd **ffi of thc wqk fa which rhis pcrmir ir <br />issued 3097,Civ. C.). <br />APPLICANT'S DECI.ARATION <br />Demolition Pqmits-Asbcstos Notification Fderd Regulations (Title 40, Part 6) <br />_ Required Lctter of Notification <br />I certi$ that the fcdcral regulations regarding asbcstos rcmoval arc not applicable to this project. <br />read this applicuion and stile that the above information with all City urd County <br />and County to cnter upon thc <br />above mcntioncd property for <br />or agcnt <br />(print): <br />Rr.rv: 1-:10-04 <br />-/ /7v <br />7-5ou bL/g.l/€/u5 ,1.//