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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDER DEI,C NATI('N <br />I h.r.bytrrfitr xnd.rI).nalrt.r p.rjxry rhr, I m.xcnpr rn,n rh. cotrh!.ron Lkctrs tiv for thc followins rcrson (Scc?oll5 <br />lrusinc$ {nd PmL$n Codc) Any Cily or County whi.h rcquncs r Frmil lo onllrucl. alrcr improlc, d.molish o. tPnnny <br />srrucrulc. IIio. ro irs issuancc. als,cqliEilhe aprlicanr aor slchFmir ro fil.rrtn.d ndonm rhd hcor shc is licc.scd putru,trr <br />h rhc pbvisions ofrh. Co.krcroas Liccn\cd bw lchrfl$ 9. ConumNir,c wirh Sccriotr 7(XrO oi Divilii :l ofrhc Bu\in.$ rid <br />PmtsnnN Codc ) or rhol hcorshc kcrcmfl thcrclionr!trd lhc bnsn lorlhclllcscdrxcnuion Anyvid,ri.nofs(rion70ll5hyany <br />applicant lbra pcrnrir subjech Ihc lpplic{nr k, rcivilI)cnalryotnornr&rho fivc hxndrcd dollrs($500) <br />I. N .wnfi or rh. ptuFdy. or $y carplo}tcs wirh saecs ds rhcir sol. c.nDen{r ion. sill do lhc *ort lrn rhe {ftrm t nur <br />inr. cd or oflcrcd lor elc ( Ss ?(lr4. Busincs\ a!'l ttotsn,ns Codc 'I he Conkktr'\ Li.cns. Ltrw dds not .pdy lo an owncr ol <br />rhe ptulEny wlD builds or nnpnrrcs rlL]mn. r.l wtk, dtu\ {ch *ort hi,nscllor hcrsllor rhnulh his or hcr o*n cnfloyccs, <br />,rclidcd rlur such in,r*obmnh m noi inr. cdoroncRllor$lc ll h.\c{r, rh. huiUing or iftfrortmnr i\ sld qirhinoR ycnt <br />olconlplcrion-rhcOwner Buitr.a w havc lhc norlcn ofproving rh!] hcor\hcdid mr hikloriqx'h inc rhJlry for rtE puq$e ol <br />l.a\oNncroirhcnopcny,rBerclo\ivcly.ontacringwirhlic.nscdc.nh.nmbon{ddrh.nnlc.t(Scc70€.Bu\inc$ <br />rDd nrfc$hn Cod.: Th. contrdo.s Liccnr L.* docs n.rdl)ply r. !n o$n( ol'potcny $ho hild\ or in,F,v.\ rhcrcotr. <br />rnd {ho contrcrsfor\uchrojccrwnhaC{ m.t'nr licctrscd rrrsund hrh.Ctnrra.xn's Lrcnsc t,ow). <br />Ln cr.nlpr uM.r Sc.r ion , B. & P.C. ,or rhis rcN)n <br />u()atr[&s:.couflrN$llaN <br />DIiCIAXAIIIJ! <br />Ihcrchyafll nu cr p.trikyol p.rturyo.c ofthc li)llotring dc.lrnlion{ <br />lhrred' will Dnnai'\ rccrlifr.r. olCoi*n o sclf lisurc fd *orkc6 conrpcns.rion. as pmridcdlorbysccrion.lTff)otrh. <br />Lltxtr Cdc. fitr lh. perlornune oarhc *ork fitr which rhc pcnnil i\ ilsucd <br />Ihnhrd*illnninrtrirlworkis.omp.trsdrioninsuran.c.asrcqDncdhySccti 3?(x)oflhcLohorCode,fotrh.!.rf.nturccof <br />rhc work ror which rhis p&nrir is issucd. Myworlcm c.mr..sarion insur.mc cMi.r and Fnicynumbcr&. <br />Policy Nunrb$ <br />-[xl'irc\ <br />-lccdiiy <br />rh{i in thc pcrforromc oirhc sork ior *hich rhis permir is n\ucd. I shrll ior cnlroy rny Jl.N)n ir.ny manrcr <br />$ .s ro h..onr suhi! Io lhc *orkcc conr!.nsaiion lrws orcrlfornii,..d asre lhar ill sh,uld ttc.'m \ubjer t, rh <br />*orkcr( conrpcns n,n Dr.vhions ofScdinn 37(xloirhc litnr <br />11ARNIN(;: Flltrrd t, {ru'c \o'kcr! .o rl)cD\rridr.o\c <br />rtril lni.\ ut b oic huidrcd rhoufurd doll c (11(xr.(X()) <br />T, <br />i crcnrnd ormy's fccs q <br />IIICIABAIION <br />! hcahy ltltm undq pcnahyofpcrjury rhd I am lic.trEd undc! IR*ni.n.fCh.prci 9 (.oNrtrcirB wilh Scdiotr 7000) ofDilisi{,n:l <br />of <br />'hc <br />aurftss and Pofcssn,nsCodc. dd nrylicctr* is in iull lorcc md cficcl <br />?-( <br />calislaucuoNrENllNclli[!.Er <br />I hcrby rftrm undd Fnrlry or p.ijury rhar thcrc is tr con{ru.rion kndins agcrcr lor lh€ FrlonEkc orrh. w.rk ltr ahichlhir Pcnnir is <br />hsucd (Scc 1097. Civ C.) <br />AITLIIANLII&;LABAIION <br />I tf,rchy nnnuilcr p.nalry ofFrjurt otu.f rh. foll,,wi'rg dc.larnlnnN <br />Dcn,lilnrn Pcmils Albcsror Norificarim FcderrlRcEthrn,n\ (Tirlt 40, P.a6) <br />-,{.qun <br />d lf,rlcr.f Norificari,n <br />I ccdity thar fi( lcdc{lrcsuldio.s rr8 <br />-l.cniiyrhrr <br />I lBE rcMihl\ +rlicrrn,n bc.mply wirh lllCiryrtrd counry <br />orllnxncri rnJ Srrl.ljs.r.Lii',! ki hdiltl <br />'o!c rmnlioncd proFny for insF{rn,n <br /> DPlicntrl o. A*enl StDaluru:tonJo "'?l)'-i'a-" <br />Set Backs <br />Forms/Steel/Holdowns <br />Ereclion Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsu lation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />.-'7--) <br />f2-b1 . * ?1 Y'5'18 z 7l?7-.t-\z-2 )7,t'tb t 'En- <br />Certif icate of Occu pancy <br />Notes, Remarks, Etc <br />Pool Fence <br />Flood Zone Certif . <br />FINAL <br />lxftler\ Addrcs: <br />tAQ--CA <br />-----T---- <br />------t----- <br />I