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BUILDING- INSPECTOR RECORD <br />SITE.WORK ID/SIG.COMMENTS O\INER BUILDER DEL(]AR-{TIoN <br />I hs.ty amnn unds pmally olpslury rhd I m csnpt nom the (olnradoR Licosc l.as for rh. folloNinA iea$. (S(70r15 <br />InrsnKs and Pof6ion (id.) An, airy or Counr! $hi.h Eqrn6 a p6'nn to coBrrucr. alts. impmvc. dcmoli.sh or rerEir r <br />snlduG l,iorlo ns isuaNe. aho requi!6 the flpplica aor such p.nnit r) fiI. rsilned n.temol rhd hcor sht is li..N.d puutrrnl <br />ro rhe pmrhnJns ol $. Contra.r.rt l,iccnsed L.\ (Ch.U.r 9, Con'n.n inr \irh Sstion 70Co or Division I oi rh. Businsr tud <br />Pn,r6sions Code) or rhar nc or sh. ir crmpl rhq.,ion and rhe bsis fo. rhc 0ll.8.d e\dnprion Aiy \iohrbn.fSdioi 7O:l I 5 bt ony <br />aptlicanl ld a pmnit subjdsthe applicanl ro..i!ilpcnalryolnol m.relhan fiv. htrndrcd dollam (S500) <br />Laso\nnoirhcrroFnr.ormydnploy$\ h s ar6 s lhrir sn. conrF$lio.. sill do rhc \ or* &d rhc srru.ruc <br />'s <br />not <br />intmdel or ofrer.d for sl. (s( 70.14. Busin6s afld PrefNions Cod{ the conuocrors Li.c6e L.rv do6 nor.pplyro ano(no ol <br />rlE pmrrnt \rtx, trilds or i'nlrov6 the@n. od \vfio do6 srrh \o,t nnns.ltor n.6.llor rhrorrh his.rh.r o$n..Dloyc6. <br />,r.vidql rhal su.h imprc\ dndts e nor inrn:&tl or oltu.n ror ek lt h.\ sq, lh€ hrilding or mlmymot is sld Nithm 'ne \t <br />ofcomFlelion. lh. (Nn.r Btrildo sill havdhebuldmofprcvn[ Ild heorshc n nol hild or nntror. rhc !$lf,ry lor rh. poqDsol <br />i. as.\idorrherorel\. a'n e\cbsn eD contmcr iry \irh liccnscn conha.rorsro.onsh'.r rh. Foj.n (s( 7044, Rusinds <br />indItresirnCodc:lhc(onlracloasl-i..ns.l-aNdoesDotappllkrano\ncrofprop.rlyNhohoildsorirproveslhson. <br />aftl $ho conrhft lor su.h pD.jcdr Niih a Conlraclo(, licosed pnEmnlo rh. Conra.kn s t.i.ss t-r$). <br />Ii'n c\.triprn lu S(rirlr <br />Drlr: Osner <br />\!o Rt(E[s. coNt PF,\s,rl toN <br />DFCLAIIATION <br />I her.by aalim undq p.nally o t pGjury one ofrh.follo*inr d&laatioB: <br />lhav€runlNillrnainraiflaccnlfic.r.olc.ns.nrLrselrl6urcfo,Lrolkgs'&nrpcnsarion,aspn'vide<ito!hySdiotr.1700ofthc <br />Labor ('odc. fo. nE p{fonnan.. ofih. Nort for rvhich lh. pqnil is issued <br />r1r \orl ld$hi!hlhispenn( is tn€d Mysor[Lrs conrFrsarhni,Ntr'aL.crfti.rin,]rll.ynumb.ra,e <br />I cenial rhat nr rh. !€rfornan.c ofrl!. $o* ror shich this ps,nil is Gsucd, I shall.or onploy any pdson in anr matrnd <br />oastob€comcsuhjellolhc$ork6'comptrsarb.l.Nsdf(.lir'omi..andasr€.lhaliflshouldb€coli€s'hj(tl.lhe <br />\0116 co'npasal ion prorGions of Sdion lTm ofrlrc l.atn Code. l shill, aonh\ irh c. rply rvilh those pl o\ isioN <br />IV RNINC: Faihre ro kur. work6 conp.nrarion covqru€ is u.la$ful. and shrll s,bld .n cnplotd to ainrinal pdahi6.nd <br />.ivil lincs ur lo orc htr.dred lhousand d.llars l$100.000). in addlb. ro Ihc cosl of compcNolion. ddnas€s s provid€d lor lhc <br />sdnrn 3076 oathe ribor (bdc, inl6d and allomy's fe6 <br />t tcllsEtlcgNu rIaa <br />DEC LA&{'TION <br />I h6€hy.mnn und6 p.nallt o f pdjury rld I er licc.ki und( Fovnnrn ofChaDln 9 (co'nmocins \rith S.dion 7000) oaDivish 1 <br />ol th. ausinN and Pml€ssions Code. and nry licdc is in frnl fora and eil(r. <br />calllalrllaN.LElDtlc_acEllr <br />I h@by afllm und.r p€ralry of gerru' r- I h.l th6. is. com'flrlion lddinB,g.n.r for rh. pGLman . ofrh. *ork aor $hi.h rhis r6mir i5 <br />rssued (S( lor7. Cn, (.). <br />AISLICA.NfDICLIBAUqT <br />I hct r. man undn poEhyofp.rjury on.orrh€ rollo$inB d(lalaln ns <br />D.,nohion P.mire^sb6los Norilicario. Fcdgal Rcsulaiions ( rnt 40. Pan6) <br />Rcqrir.J ldrd ol Notifi.athn <br />Icln'ryrhar the fed€r.l r.8ulatioN lqedins 6b6ros ro$.1rc nor apdicahL ro rhN poj.rl <br />I cdiiayrlEr I ha\rr.adrhkappliclrionardsllr€rhatdrcotrv€ inloamrlon is.oad I.Creto.omplywilh0llcityand(olntt <br />ordinanc€ dd Srare t,arvs Ellrins ro btrildins coBrnrcrion. rnd hd.hraulhoriz. r.prsrari\6 ofrhis Cilydd Coumt lo enro uNn rlr <br />ab\€mo'ioaed prcpcly for iNpdian prirss <br />l\ppli$tr1 o' ,\gcnl Sipnahrrc <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsulation <br />Shear Wall <br />Ext./lnt. Lath <br />Brown Coat <br />lt4aso n ry <br />Pool Fence <br />T-Bar <br />De u Final Re ort <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL 6 41-d lLL<n )ei8< q,r7 <br />Certificate of Qccupancy <br />DATE <br />Set Backs <br />Roof Sheathinq <br />Framinq <br />lnsulatio n/E ne rq y <br />Drywall <br />Handicap Req. <br />Notes, Remarks, Etc.