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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNI]I{ BI'II-DI'JII DIT-CARATION
<br />I heEby itfirm und.! p.mlry of p.qury rhut I rm.rcmpt iDm rh. co'rr&ro^ l-ic.ns. Liw fo. th. folloei,l8 r.r$n (s.c.703l5
<br />Itusin.s ind Prolesb! Cndc): Any Ciry nr Coudy ehth rcquiE\ a F.mit ro ondrucr, .lrcr. i'.!mrc, d.mlish or Ellt !.y
<br />nBcfue, priu b ih nsu!E!. b Equt s rtE appli.anr fo. such p.m to fiL a sigmd srd.tunr ibDr h. o, sh. 6li..nei pD6u!.!
<br />r. rh. pmvisions.lrh. Conkr.ror'r l-ienscd lf,w (Ch.,icr 9, Conrmi.in8 *nh Seri.n 7(Xx) of Divnnn I ol rh. Busims and
<br />Prolern'tu Code) or rhrr h. or she B ur.nnr rbsnom.nd rlr hris for rhc ullq.d .xemflF . AryviolarionolSecrionT0ll.5by,ny
<br />lpplic.m fo, i p.nN subj.di rhc npolic.nr ro rcivilpenrlryottror 'm.c rh!tr liv. htrndred dolliA ($500).
<br />_1. r\ ownciof rh. potEny, or 'nyenplor.cs wnh vrEA as rh. $k comp.nsarinn. qilld. rt* 9trk ad rlE slduc is mr
<br />inr.lrlal or olTcBl fn slc (se.'7o44, Bunrc$ ald Pmfcr{oN ccL: Th. c..tr dols Lic.nE lrw Jfts nor +ply tD an oM.r of
<br />rlt r'()p.ny who buildt or nrymrs rF.E( rnd *h. dcs s(n w)rl hims.ll or lEnrll.r rlK'u3h hh or h.r oB .mdoy*s,
<br />providcd rh.r such inprMrn( e frn irkndcd or oltoftd attr sL. Ili ho*cd, r bdilding or ihqrovcftd h sold qirhio orc r
<br />oa conrpl.rir rtl Ov's Build.i *ill lrE th. buid.. of povi.g rld lr or sh. di'l mr blild or iorIFE rh. I,Epdy lo rlE purpo* of
<br />L a\own.iorrh.potEdy, !n.rclusir.ly.ont!.rin! wirh lr.n*d.ontd.hd r. !!r(ocl rlE pmj.d (Sec ?Ot4, Brsin.s
<br />ar l,ll,r8\n'!Codcr l hc Colhdols l,iQnB Llv de\ nor lPplyro anown.r ofprcp.nywho buildr or i.lnn,vcs rhd.otr.
<br />r wh. .onrdch fo. {ch prdjr.a wirh ! C.mdcb(r liccn*d pu^um r, th. C..r&rols Lienso bw).
<br />I anr demtr u'rdd S{ri,
<br />Ivor-[Etsr.t!]ru!rira!!0!lrtl -84rlt)!
<br />I h.rrhy rilnmund.r p.nilryolpcrjurv.n! olrhd rnlbsins drrl&{n^:
<br />I hav. ord wrll roinrli, a C.dricat. DfCoMnt to S.lllo$E tor *orl6s $op.NdioD, a\ provid.n nx by SKrion 1700 of rlE
<br />Litx)i Cod., lor rhc !.rfor rcc oI rtu *od rM *hkh thc ,.rmir ir issu.d,/'y'h"*,*,1"rll*. s,*ork. rquired by s.drim rT()O of rhc Laho. CGle, Io' rh. I)trfirMre d
<br />'r-ctr.,rr.rqhrh9!f,mints++r!"rlrmc,mFr,.ibninru,d..!.mindir,rrnr.umh{,dc1tql,- [ql 4-lt ^za
<br />_l cdify rhd i. th( Frfortuncc of rhc work for which rlis lcinir t Lssuci, t shall not cmploy any p.'$. in any 'rurcr$ 6 b hcN'x suhJcd ro rhc,o.Ien conpcNarion lawrofcrliiomir, and [grc. (hi ifl shouH b...m subjccr r.rh.
<br />*odi.h coqEnilrion pruvsionsofssriutr lT00ofrh.ljbor codc.l slull, ronhwirh$mply wirhrtbs provaions.
<br />WARNING FailuE ro *cur. uorkcs cnort6Ii ..vca8c is lnlr,tul. aod shall subjcci e .mploy.r ro cim@l p.dha and
<br />.'ul lnr.r up b on. htr rt'd rh.usrtrd J. rA (Slrxr.lrr)) 1 {ro. ro rhc co{ oI co $nsrion, da'Ng.s ar provid.d lor Ih.
<br />s.crn :!076 ofrhr l-'hrLixlc, idrcrcraRta ufty
<br />I heahyannmunder pcnolryofp€rjtrry rhlt I am lielsdundcr pnvtion ol Ch4r.r 9 (co'nmncin8 *irhScc(6.7000).tDivhion 3
<br />of ihc Businc$lnd Ptuli$io.s C.xle aftl my licens s in llll hre and clli.r.
<br />CO o L'/3,"
<br />n .n r'l r'l con,(.r
<br />I h.Eby !r lirnr undd p.Dlry of p.rjury rh, rhse is ! .ol(rud 'o! LoJuB ax.my for rh. p.rfom,*. of rh. PUlk lor shj.h rld! !.mrir s
<br />nsu.d lScc .ll19?,Cir. C ).
<br />A8ELII3NLIEILAIAIION
<br />I trrbv nffirn under renrlrv.iD.tury onc olrhc fdlowiDg Jr.ldhrion!:
<br />DdmolirioD Permi! /rsbcnos Norifi.art,n F.dcnl R4ul.rioDs (Tirl. t0. Prd6l
<br />-R.{un.d
<br />I.!er oi Noti6.dri.n
<br />-l..nil!rhd
<br />rlE ltJeBl r.BULrio'L\ r.grd'ry rh.sros Rmlrlr. troi Jnplicrbl. ro rltis poj.cr
<br />,l.nit ,r', r r,-" -",r,r,^ ".4*,-',,"rfiliorrc,'on,r srun rr*. rct rrni i. t',,raug,
<br />{dd(hrrrhcrlbrc i',lohhriotrn.oiicd IiErd(ocomplywirhJllairyudcounry
<br />irrl h.Ehyaurl iz. r.pr.rniar ivcs of r tus C y rM Cirunry to .nrr ulton rlE
<br />xho\a nf,nr on.d prolr dy rar
<br />At, itanr or As.nt SiSnlr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation l^
<br />Roof Sheathinq )- //il"n).-?y4 ''L/ )
<br />Shear Wall L/
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext.i lnt. Lalh
<br />Brown Coat
<br />lrilaso n ry
<br />T-Bar
<br />Handicap Req
<br />Deputv Final Report
<br />Enqineer Final Beport
<br />Flood Zone Certif .
<br />I
<br />FINAL 42tlzo DA-r\4 n,fr 8'/
<br />Certificate of Occupancy \Jl
<br />Notes, Bemarks, Etc.
<br />I ^DAnoa sl *?tr
<br />Rev.0B'07-2015
<br />Pool Fence
<br />I endcrs Namc'-
<br />,,", L41-4
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