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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/lnsulation <br />Rool Sheathing fl2Jln hn*/.>)) <br />Shear Wall dl <br />Framinq <br />lnsu lation/Enerqy <br />Drywall <br />Brown Coat <br />It/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />itxt,?-,1'FINAL E fr-> <br />Certif icate ot Occupancy U\ <br />Notes, Remarks, Etc. <br />OWNER BUII,DER DTII,CARATX)N <br />I h..chy ?llrlr nnd.r pcnxlry {'l Frjury rhri I m cxcn,,, fntrn rhc C.itr.t i Licctrsc Law lor rhc iolknvirg r.r{,n (Sc..70115 <br />Busirc\s n,kl Pn tssior C.dc): Any Ciry or Courry whici rcqunc\ r pcnnir ro .onsrDcr. rlrcr. imp('!d. dcnDlrh or -){ir ..y <br />shrluc. friorto ns h$rncc.akorcqutc\lhcrpplicrtrlr'orsuchocrnrirloriler\igtrcd{reti(rhrh.or$cnliccoscd!trlu{nr <br />t) rhc novisi,,n\ of rhc Conrrrctr'\ I-i.ciscit Lrs iChrlrcr 9. Comtrrkirg wirh Sccliotr 7LXlo ol Division :l .t rhc Buint.s rtra <br />appli.rflr lor ! rnnir nrbjarr thc .prrliqtrl ro a civil pcM lly .l ml nnrc rhrn fild htrndrc dollr^ (s5m) <br />l. \owmrofrhcpn,lrc'rv.ornryc\rolesqirhwigc( (rhcns'!ccomp.r{rior.willd.rh.$.rkxnJthcnnidu.c$ or <br />inlcnd.d or ollcr.d lor sle lSE T0ll.llu\i'rs and ltolt$i{n,\ (ixlc 'lhc C()n!r .nx \ Li..i* tns d.cs ml atply lo rn osmr.I <br />rh.fh|)cny !h. buikh., i'nloksrhc'd,,. inlBhod..\ R'.h \!* h txcllorhcr\cllorrh'oulh hi\ rrlu owrci'd.y.cs. <br />olc.'nplcri,r rhl O\rD.r Buiklcr *illhxr rhuhurdcn.flR^i'rgrld hcornr did nor bui or inprorc rhc t[)Ir ny lar ilt Nrtx,lc ol <br />rid \ho ronrn.trntrsr.hlvoic.rsirIiGnr&kr(s)h.crrcdtursurnlr.rh.Cqrrrdoilli.cnsclr() <br />I rnc\rn'Ji dn(lI ScItri ll & P( l0 rhn rcr{.f <br />uaBtrD&L(autlNs rlotuict a-84llo! <br />I horehyilltarufdcrpctrrhyof prturyotuof rh.blbsi'rg c.lxnri(nr\: <br />Ljtff Conc. hr lhc Nrlomuncc oi rhc {o'l f{x which rhc pcnnir is i$u.d <br />Iluv.rdtill ri' dirt $orkcrs' .on|cnrilnr lnar.Nc..s rqtireabySccrion.lTll0ofrhelxh.rCodc.tarrhcpcriinnrnccol' <br />rhc q.rk tur *hich rhis Firnir is isuLn. My $orkc^' conrp.nsrli(r lnu.rEc crtrirr xlpoiicyiun$crdrc: <br />l.cn i-vrhrr in rhc nc'nmknc.orrhc w.'k hr *hichrhh ncnnir i\ i\\ucJ. I \hrlltrol c rdoyn yrcr$r irrny nrnD.r <br />{, rsft, hccornc sulrjr_r rorhc sorkcri (nnndn\dnin hq\ of Crlir(nnin. 3 d rgrcihil il l slmuld ticc rc {'hJ.d t'rh. <br />w.rkcs comtcnsrri{in pn,visii,ns ofSccrnr lTmofrhc Lnb.r Codc.ln,xll. tudhwilh conrdy *irh 1l}rr !ft,vi\i{trs <br />Sc.ri,,,.1076.irhc l1lh0rCod.. inrcrei xidrtrncy s f.c\ <br />ItcEri,rEtrcoNr&lgta <br />DA:I,AXAIION <br />ol lhc Busirlcssmd Pror.$iorrs Codc. {ln my liccn\c h ir lnllf .c,trd.r,icr <br />raNflrlcraNr[lDtlc-atiENcr <br />Ihcrci,y {nhrutrdcr F-nrllyolpeljur} rlur irtrc iracon( crion L i'rs rScrty lor rhc Pcrl.iln cc of lhe work n,r qhi(h rhi\ lrr trrit is <br />is\ucd (Sc..:1097. aiv C.). <br />A}ILICANfIEIIABAIION <br />I hcrcby oftnnr undcr lcnrlly o{faiu'y otrc.frhc follotr ing d.chrrrions: <br />Dc nlirol Pci,nir*Asbc(os Norilic{riotr ltdcrrlResuhrhns ('lirl.40. t n6) <br />Rcquncd Lcncr ol Nolifi .arion <br />I conilr rhrr Il[ f.dc,aLrcAul.rhrs rcgrd$! rshc{.s rnF\nlrc nor ip0li.rhlc h rhis pi{iccr <br />l.cdirylh lhrvcrcrdlhN al'tlirrior arkl slnr.th ltu rhrrc inririuli{D is cof.r l rFro ro.orll)ry s]rh rll Ciry 0d Coliry <br />odimnccs. nlShrc l-iqs rcl.rins ro building connru.lior. md hcrchylultxtri7c rcprcanhrivc\ ol rhn Ciiy ind Orunry t, cdrcr ulDi dtr <br />ftorc nrctrrion.d l)n)Itny r(n inspl!-rtrrt tiurr.scs. <br />Applicnnl orAgcnlsitMlore DAie: <br />P.mrilce Dnre (pn nr ): <br />EIIPEIR <br />Ext./lnt. Lath