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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsulation ,=\ <br />Roof Sheathing V.zs.t*4.-r. <br />Shear Wall <br />Framing <br />ln s u lation/E nerq y <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />It/asonry <br />Pool Fence <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL cglz-/ rj '1fl,99) <br />Certif icate of Occupancy <br />Notes Remarks, Etc. <br />OWNER BUILDIIR DOLCARATIoN <br />I heEhy.alnm utrdcr p.nrlry of pcrjury rhat I !m cxcmpr fiom thc ConrracroF l-icense ljw n, rir Lllo*in! rcavnr (se 70115 <br />Businc\\ s'xt Proac\sion Gxlc) Any Ciry ur Cou y which rcqunc\ s Fnnir n) .on{n.t. ahd. inl|)rovc, dcnFlth or rcPat lny <br />(ructurr. priorto irs nsu,trcc, .ho rcqunes rnc n,)tlicad tur su.h Nnnir ro filc r sisncd srorcnEnr rhor hc or shc i1 li.cn\cd punudnr <br />k, rh. pi,vtions of rlI Conkcror\ l-i..nsrd tr* (Chlprcr 9. G,mnrking sirh Sc.ln{ 7000 or Dilision I oi th. ausincs lnd <br />Pmf.sions Codc) or rhrt rr or sh. is crchUl <br />'hcnflom.rd <br />lh. bn\is r.r rh- dllcSd crcnubn Any viohlionorScdi{,n70115 hyany <br />ltllicrtrl id rtciinil subjccts lhc aprlicnnl lo r.ivilpcnrxy.rnol nmrc lhnn fivc hundlcd dollm ($500). <br />I. r\ owrcr olrhc pmlEny. or nry c'npbrlTs wirh *agcs a\ rhcir yrlc c.nwn\rri.n. silld. tlx wnrl ard rhc srtu:luE i! nol <br />inlc.dcn oroficr.dlorslc(Se7044.Businc$andPmf.sionsCodcThcC.nrrcrolsl-icc.scLoqdocsnorlpplyromovncrof <br />rhc pmrcly sho l,uilds or in{'mvcs rhcrmn, rnd wtx, dms such wo hnnsclforhcr*lfurrhrt Ah hh or hrr owtr ctrrdoy.cs. <br />[ovnbd rh.r such irnpmrcNnrrm n inlefrlsl n ofcrcd lorsh lt h)*crcr. IIE hiLlin! or improlcmnr n $h wihnr oN ]ur <br />ol.oml,ldion. rhc Orn.r auit]d sillhnvc rhc bodcn oftftllin! rhd hc or \hc di] tror build or impmr lhc pmFny krlhc porlo{ of <br />-1. <br />ar owEr of rhc lnoJ',!iy. rm cx.lusivcly conrncrine wirh liccnrd .onracron ro onnrud rh. ,rojccr ( S.c 70{.,r. Bu\itu.l <br />uxl Pm[L\siri Codc: Thc Contackn s l-ions. t-aw dtrs noi rppl, h ri owftr of trop.dy who huilds or inr[ovcs thcrcotr. <br />od wh. conhcts for such proF-^rs wirh a Conhcror(, liccn*d pnrsuanr lo rhc Coor&cktr s Liccis I -rw ) <br />-l <br />Mrcxcnrpt undcr$clnn'-. B & P.C. forlht rc0son <br />]la.Bx,t:8r]r!)[lf!!rAllaN <br />I,IIILAAAUAN <br />I ltrchyrlfirmtrndcrpcorhyoltsjrryoncolrhcftrk)*ir8dcchrrrnr\ <br />-lhr{clndwillmiarainaCcnificarcoaConrc.rtrSclltlsu,ctursukcsLrnnn.sarion,Npn'vidcdlorhyS.crion.lT(DoflncL$orOnc. for lhc p.,fonnnEc ofthc work for which lhc lcirni is nsEd <br />I htr(rnd lill trrirrain tro*cri .onrp.trsari{D insurrmc. rs rcquircdhySccri,r:17(X)ofrhdhhorC(d..lorrhc!.rliinu'nccof <br />ln. *o.k lor $hich lhispcmil is nsEd M, sortcr' comncn\irion i$urrnce c]nis ud F,li.y .!nl,.r m: <br />Pol'ct Nu'nbs- Frrr.. <br />l.cnify rh,r in rhc pcrtui,utr.. ofrhc work tu which rhi\ Frn,ir n i!\ucd. I shrll nor ctrlFloya.y pcrson in lny mrnrcr <br />s, as ro hccom iubi{' ro <br />'hc <br />workss. conrp.nsari(,n l.ss otcalifoarir, rnd r8rcc rhal itl should lf,coN suhFd t, rl'. <br />(orkd\ .onrNf\dinptuv\bn!olScdonlT(x)ol'rhc tnlu Codc. I \hrll. lhal!$irh .oardy *irh rho{ pn'visi(,,: <br />stull subj.rr an c'ntloycr ro dminll pcmhic\ rtrd <br />srrdr. d.nn8es !\ pnxi c{l f{n rh. <br />lLr t.tRll I ()N <br />Nnolryoiperjury rhd I onr lie.cd undcr Itrl vi\ior oiChnprcr s (conn*hcnrs sirh serid 70({)) oI Division:l <br />of lhc ausin ssrtrd PBLssi.trsCodc. and nryliccnr h in nrllior.c mn cr'lccf <br />CONSIII]qIII,)NIENDING.ACIIN.CI <br />I hcrcb, nrlinn und$ Nn0llyotrerjury rhtrr rhc.c i\ ! consrructior lcndins l8cncy ftr rhc pcrronnim. oirhc work nr *hich lhn pcnnir h <br />issucd (Se. l097.Civ. C.) <br />AIPIICAIfD}iIIJAAIIAN <br />I hmt'y xllnn u nds pcnrlly.fpcrjury onc orrhc nrllowins dcclrrarion\: <br />Dcmliii()n PcnnnrA\hcslos Notif'.lrtu Fslcnl Rcsulrlion\ llille Jo. l'!n6r <br />-Rc! <br />ncd lxrlcr iNollricdtnr <br />I cotlirhrr rh. fidrrrl,.Etrh.oi\ rrg ll g r\hn.\rr tr)lrlJr n.ttll.rhl. r. rh^ pr.,lccr <br />orJnricc\xtr Srrr.I xq\ rclt inA <br />Jbv. nEnriqEd pnr.nyin <br />Erection Pads <br />T-Bar <br />Liccfl* Class: . <br />L nJi.'. N r, <br />I