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BUILDING- INSPEGTOR REGORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set
<br />F S
<br />UFER Ground
<br />Floor
<br />lation
<br />Shear I
<br />D il
<br />Ext./lnt. Lath
<br />ason
<br />Fence
<br />f
<br />H irements
<br />Final
<br />ineer Final
<br />Certlflcate of O
<br />Notes, Remarks, Etc.
<br />I h6oby rf,lrn uodrr patdq of ,([rory th.t I an crqnF fona lhc Cofier' Llcau. hr for thc followln3 reofi ($0,70, t .5 Budnqt
<br />rod tt^oforrlo Codc): Ary CltycCoumy rhlch Equlnt rplarll o ootruc$ rftcr,lnrFovq doolLh anpdrly tuan, prloro lu
<br />lsueoqdroEqulllrlt rgpllcrlrfrrtu.tFmh!orll..dfn dra.Lm.lt lhnhc(rh.lrlioau.d Fl.nmt!o0r.Fwllonrofrhc
<br />Conrraor'r tlmrd Lr' (Ouplr 9. Cocmach3 rlli Scalar 7000 olDlvfilm ! of lhc Burincrr md D,ofdridn Codc) or rh|t ha a
<br />tho lr acmpt thaoftotn rd lh. tdt la 0E dlcpd cmpdm ,tuy vlol.dm of S.adoo ?0! I .5 by uy epllmt for r p.nnit ub,er ih.
<br />@lisil to.clvll pot.yof icrnqttts fiw lno&rd dollu (t500),
<br />-I,ar
<br />olrE?oflh.Dmpany,anryrrrlCr.orl$m|r l,tdrrobcolpcncrdOrllldorhcrodcmdthcrtilctu!bnotlmdrdcd
<br />c otfcttd fc rrlc ( Scc.Zx.l, Ell.lftrt !d hofrslonr Codc Ifro Co8rncd, L,lc.ru3 L? doar lld .prly !o ]l orltar oltto lmDrfywhotoll&chFrott.tlaa;rd*todortu.[xf,tlilmllrt r.ltattrorthhiroah.rmsrployr.r,Fpeld.drhdreh
<br />lnFrrv.nrru.$c mt lor.n&d aolr.sad ftrrda l(, horcvrr,thc tdldlnt orirpllvlindltlr rold rlthln arcycrof conplalooi $c
<br />Orncr€uilda wlll hrw{rhrdar of ptwvint 6a h. arhr rcr buildclmpmw fcttr glrpu of nlc).
<br />-I,
<br />rr omcr of 6c Fopctty, un .Edullll, cqltnctlrf ?hh llcaBod orulrcto,r to con uucr rh. Drcjccr ( Scc. ?01,t Sujngr rnd
<br />hofcuion Cods ThcCotr.rdtUcaucLlrdocrnoa4ply 6eo*rrcrof froptyrtobull& c ftn?rcru tlr.ilcoo.rd vho
<br />cdlmcr for rsch Fqrci. rirt r Coltr.io(r) llcaued prmrnt lo lhc C.olttLlo?rt Ucqu. Lw.).
<br />_I m Gxcmpt
<br />,n, l3--&VQs owncr:
<br />I hereby rfllrm underponrlty of paJury oro
<br />-lhrvttrrdrlllrdalllneCortltlorofCfi06r!oSclGl8nlr.farroatlrr'coolpoutidr,ll
<br />povldrdfcbyS.Gdoor?ooof0a
<br />Lrbor &do, for rho p.rfsilnco of rh. !vo.t fc?hlclr tto Flri|lr b lxr$4
<br />-lhrwrdrillmiilrlnrslsr'comparti{ftrlrrrlrc.,., roqdrldbrSccdorST00ofth.L.borCod.,forrlropcrfonnrnccof6c
<br />wrk foc which thir pcnit lr bruod. My w*a' cqcnrdion luumcc crrlor rnd pollcy nunbcr rrc:
<br />PollcyNumbg: _ ,. . , Expltrr:
<br />(Thlr rccdon nccd not trq complacd if thc pctmlt h for orrc hun&od dollrn (S100) or lcr)
<br />-I
<br />certlfl thrt ln tho pcformmco of thc work for whlch thlr pennit ir irucd, I rhdl not cmploy uty pertm in rny muncr ro r to
<br />became rubjcct to tho wqkon ' compcrurtlon hwr of Crllfcnir, rnd r3rlc thrt lf I rhould bccomo rubjcct to thc workcn'
<br />,
<br />(acompcnmtion povklorr of Scction 3700 of thc Labor Codc, I
<br />a-
<br />WARNINC: Frituro to rccuro workcn'compcnntion
<br />(tl0o,ooo),in
<br />cov6rtt0 rhrll rubjcct m cmploycr to crimlnd pcarlder rnd clvil
<br />rddition to tho damrga u p,rovidod for thc Soction 3076 of
<br />thc lrbor Code, interert urd rnorncytl fecr.
<br />IhctcbyrlIirmundcr*.,,,o,,oi**nfficin3withSccrion?00o)ofDivirion!of
<br />fic Burinsr md Prcfsior Codc, ud ny llcquc ir h full forc. md cficl
<br />Liccnro Llcenro Numbcr
<br />Dlto: Connactor_ , . - . ,
<br />CoDISTRUC'nON LENpnYq A GnNqI'
<br />I hcrcby rflirm undcr pcndty of perjury thrt there il r conrtnrction lcndin3 sgsacy for itiipcrformencc of thc work for which rhir permit il
<br />isrued (Sec. 3097, Civ.c.).
<br />Lsnder'r Nrmc:
<br />Lcnder'r Ad&err:
<br />APpr rc^N?'s 4ECI/I8ATI9N
<br />Dcmolition Permlr-Arbcrtol Notiflcrdm Fcdonl Ro3ulrtionr (Titlc 40, Prrr 6)
<br />_ Rcquircd Lcttcr of Notificrtion
<br />-I
<br />certifr thrt the fedent rcaulrtiorr re3uding ubcror rcrnoval .rc nor rppllcrblc to rhlr proJccr.
<br />with rll Clty rnd County
<br />rnd County lo cntcr upon rhc
<br />Applicant or sgcnt
<br />Pcrmincc nrmc (rint):
<br />fl)r..,. 4 'r(\ nl
<br />rbove
<br />thrt tho
<br />t-
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