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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorfuenVlnsul
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />I I /t
<br />FINAL \2Jto/o, t
<br />Gertificate of Occupancy
<br />Notes, Remarks, Etc
<br />os.rBuild.r D.cl@rion
<br />I h,cby rirm und.r pmdry of pdjury fia! I m .r.mpt fm th. Conrr&loa Licdsc Lew lor th. iollowinS r.don (r.c.70., 1 s Buin*
<br />ad Profqsio Co<L) Any Ciry m C@nty vhich Equi6 a p@it lo colttu t, ah.r, improv., dmolish or rcpan dy struclrr., pnor ro itt
<br />i3sud.., aho Equi..s rh! applicd fd such pmit ro filc a signcd st!&hdt rhar hc or shc is lic.is.d puBuMr ro rhc povirioa of$.
<br />conEErd 5 Lims.d Las (ch!rl.r 9, c()mocins *iln s.crio ?00o of Divirim I oa rhc Burin6s sd lmfdio.r Cod.) or $r h. or
<br />sh. is cxmpl thdcfrcm ed lhc bak fd lhc lllc8cd cxoptiM A.y violdion of Sction 701 I J by ay appli@l fd . !.mil subj.cG rh.
<br />appliMt io ! civil pcialty ot ro{ mc dd fiv. hundrcd doll6 (t500)
<br />I, 6 ow.cr oi dc pr6pcn), o. my .mploy.6 wid w.86 6 th.t sol. cmposation, will do lhc work ad lh. $rucrlr. is nor inldd.d
<br />d ofr.r.d for s.lc ( sd 7044, Buingr dd Prcferffi cod. Th. Co.trctu's Li@!5. La* docs nor apply to u own.r of dc prop.ny
<br />who buil& m imFovd rcrcon, &d vho do4 luch vo* hirelf or h6.lf d rhrcugh hi5 d h.r own dploy6, pmvid.d thar suh
<br />impiovmdE dc iot iit nd.d or olr.Ed for 3.1. Il how.vd, dE buildi,g or imprcvmai is sold *ilhin onc y@ of conpl.rid, lhc
<br />Ovn6-Buil<tcr will havc d. burda of provi4 d.r h. 6 sh. no! build or imprcv. fq ln. pu'p6r of sal.)
<br />_1, 6 osd olthc FoFry, m.xcluiv.ly conb..rinS wn t li6sd mudoB ro consI'ud thc prcjat ( Scc 704.1, Bsin6s ed
<br />Prcfeion Cod. Th. conr&b't Li6.. bw d@ mr.pply b e omd oaprcp..ty vho builds d imFoy6 rhd@n . dwho
<br />conE&b for such proj.cts with a ConE&to(, lic.n!.d p6@l ro rh. Conradoar Liccns L!* )
<br />_l u qmpt udd scctio _,8 &PC l* thir.e.
<br />WORKERS COMPEIISATION DECLANATION
<br />I h@by aflim md.r pdalry olF ury oD. of !n. foUNins d4lDti@r:
<br />_l hav. udwill h.iDllii 5 Cd{fical. olcoihr rosdflis@ 16qorl(c6 cmpdsa o,6 piovid.d fdb, S.cdon 1700 olthc
<br />I$d qod., aor tn. p.nroa oa!h. worr fq whid lhc Fmn it iEu.d.
<br />\/l h!v. Md*rllrorEn *at6 @mpdsauq rn$M€, B rcquiad b, Seid 3100 of t\c Lald Cod.. fd d. pd{otrfue of thc
<br />T ir issucd My wortcE' comp.nsdion rnsuBc. cui. 6d policy lumb.ra.rt) \s
<br />Vtoc A CL\(toY z -3\-Ol
<br />lrt ,. *a.n *.a4i t i*pra.a ir rL. p'.Ji hundr.d dollm lt l oo ) or L.$)
<br />I c.ni8 thar r! drc p€rtomdcc ol6c work loruhrch d6 pcmir E tsu.d,l shall nor.hpl.l d, pdson in My hMn.' so 6 ro
<br />b.cM. subj61 10 tt. wo*6 ' .ep461id l.w! ot Glifdis, ed asrcc lh.t ii I should beomc rubjd 6 $c
<br />(omp.ni.rion provirio! ofS.crion l?m ofth.
<br />,.,. t'l -? [- c I
<br />Iy vith fior{ prcvisFn!.KY:
<br />WARNING Fdlw to r.cu. wo.*m' comp.nsation ;;;;;;;;;;;;x,d p.nak!.s ud c !,
<br />fin6 up ro o.. hundr.d lhoGed dollu (t I00,000),in lddtion ro th. 6r of corposarion. dzma86 6 ptovided fG lh. Selior 10?6 of
<br />l])c Labd Cod., i.rc6t &d anomcr! fds
<br />LICENSED CONTRACTORS DECI-ARATION
<br />I hacby aflim undo p.n!1ry ofp.dury th.r I m lidscd u.dd pioviiioi ofCtapra 9 kommdcinS will] S.crion 7000) ofoivision 3 of
<br />th. Buins dd Prcf6ion5 Cod., dd hy liccN. ir in full fca ad .ft cl
<br />,-n-*.,*'{ -B
<br />F\.
<br />Y 1"slq
<br />"",.
<br />q-Q\-o I
<br />CONSTRUCfl ON LENDING AGENCY
<br />t h6.b, .mm ud.r !.n.lry of pcrlury th.r th@ i! . c@tudid l@dinB l8acy fc rh. Ff(mec. of th. wdt as rhich thn Fmn i.
<br />isu.d (56. 3097, Cie. C.).
<br />AEIIEANIIDECL4!{I,IA!
<br />Dmol,rion Pm'Ls Asb.n6 Nori6carion F.d.r.l R.gularionr (Tid. 40, Pd 6)
<br />_ R.q!ir.d L.nd of Notiicdion
<br />i/}!/inify rh.t I halc r.ad tlri applic.tion
<br />ordindcB ed Statc Laws rclali4 tobuildi
<br />ed sl!rc thar d. abov. info@don is con ci I U... ro comply wnh .ll City Md Counr,
<br />"""c]-a l*c/
<br />trtzra
<br />SITE-WORK
<br />)
<br />L.nd.r's Add€i: _
<br />_l c.tii9 th.t Uc f.d.Bl Egulatid Esddiis ab6rs r.notal uc.ohrplhabl. ro rhis Fojcct
<br />auttdizc rcprcs.nrdivB of lhis Cily &d County !o mr.r upon th.
<br />ffi
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