|
SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq 7-25-t{X.Ws+)
<br />lnsu lation/Eneroy
<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 />//\
<br />FINAL K-t>-t t K,W!T
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />OWNER BUI!,DER DET-CARATION
<br />I fierchy arfinn undcr pcnllry ot pdjury rh l dcrc'npr rr.'n rbc Conta.tos Liccosc tnw lor rhc n,ll,*ins icde,tr (S..70115
<br />Ausincs r,xl Pn,fcsbn Cdlc)r Any Ciry or Counry whi.h r.quiNs r Fnrir lo co.(ocr. alr6. inllrovq &mlish or rcl8i rtry
<br />nrudurc. prior ro ls i$uone- aho rcquncslhc amlicol t,r such pcmrir b fiL, si8.cd n.rc'mnr rhd hcorshe n li&.scd pnrflor
<br />ro rhc rrovhhns or rrr conlra.lo.s Liccnsd Law (Cha0rcr 9. Gmmncins wirh Sccrbn TllOO of Divisnr I .rlh. Businc$ ud
<br />Pmtcsiotrs Codc) or lhll hc or shc n qctrlllr rhcrcrrom snd rh. hlsh ror rhc dlcgcJ.x.mPrion Any vidalionolSc.rioi T0ll.5 hyai,
<br />trPplicairiurFmirsubjccrsrh.,pplic.nrron.ivilpcn.kyornornmrcrhanrilchunnrcddolla^(5500).
<br />-1.asoqrerolthcDnDcny.orarycnrplo)rcsNilhulscsasrhrnv,h.onra.ns
<br />on. *ill do thc wo,k d rhc nddr i\ nul
<br />icnlcd orollcrcd itr eh lsd 7044. Bnsiftsmd P fcsstrFCodcrTh.Cont!.roisl-kcnsctiwdocsiorrDrlyro!nowncror
<br />rhc non ny who huilds or imDrevc\ rltmn, i *lr) dds ch ()rk hinsell or hcrsll or thnrugh his or hcr own cnDloyccs
<br />F)rnbd rharskh imp(,vc' *eEn inrendol orollcEJ hr$L ll ho{recr, rh. hildirB ot nqrmrcnrnr n sU *irhin onc ,tr
<br />oiconDbrnnr rhc O,ncr Buiklcr willhr\r rhc bunLn orpn,ling rhd hc or sh. dn m hild or inDmlc rhc poFny for lh. pui?osc ol
<br />l.rsowncrofrhcpn)p.nt,i rcx.lunvclycontrrlirE *irh li.cn*d.onrraclqs ro con{ncr rh. I,n)i.{t (Scc 7(}1,1. Busir'.\\
<br />rnd Alfssi,n Codcr'Ihc Cotrlrerois l-iccns.l-as d{E nor arply b an o*mr.ltrut'cdy $h. builds.r imprrt\ rhcrcotr.
<br />mJ slD conrrr(for su.h pn,ic{ls wirh r Cltrtm.rr(s) ltctr*d pur{rlr rolicConrra.kn \ l-iccns.lrw)
<br />I ancr.nnr unJcrsdron .B &PC irthNr'..,
<br />Ds(€ O*ns
<br />wonxnqs' ioruprNs,\rxtil
<br />DEII.ABAII!}N
<br />I h.r.hy rflnm undclrn.lryof|xrjuryonc ofrhc followirs declffariors:
<br />Ihrv.a*lwilltuinunr0CtnificrlcolConscnrloSellltrsurcntr*orkcn.otr1t*.rion,istmvidcdf.rblSecrion.lTmolrhc
<br />Lf, txr Codc. fn rh. pcrbtu c orthc aork lor which rhc,crnir i1 issued
<br />I h.vc .trd will nrn 3in qorkers conrpcnsariotr insunncc. !s rcqlircd b, Scr ttn lTUl of rhc bbor Code, aor lhc Prrorfr m .r
<br />rh. wnrk h $hhh rh.s n.m rs hsucd Mt $nrlch cnmNn.arion in\u'Jncrcarr JJld Fnq nuf,bcr Nc
<br />c".,", \ tx-a*ql.
<br />_Ernncs:
<br />-
<br />_l ccnily lhar in rhc pcrfo"fun.c ofdr w.rk nn whi.h rhh pcfln[ is hsucd. I \holl nor cnfk,y any [lc$.0 in any nranncr
<br />kr rsbh..o r subjc.rro rhc"ortcrs conrpcnsllion hwsofcrliromia. lndaEft.(hrl rll sh,uld hc.o'rc suhFcl lorhc
<br />wor*.r{ .o f.nsarior prolhmtrs oI Scd ion 3700 oi rhc Lltg C(xlc. I \hrll lnnheith onlt)ly silh rhoc t'ovniotr\
<br />IvARNIN(;r I.i[]rc ri scnrc *o'k. r.n\xn\rrir)n co\r'r k unr,srul. rtrd sholl sub,crl rn cmpk,)tr kJ oinrinnl lEnilrics lnd
<br />.iril firc1 un b om hundr.d rhou\rtrd dollrrs ($l(Xl,(XX)diridr nr tlE .o( o, comFnsrrion. drnq8cs rs t"ovidcd tnr rhc
<br />::.?fr;tr{
<br />t)t.( I \R \ lI)\
<br />I hcrbynftrd und.r n MllyorF.jury lhol t a lircnRlutrdcrprovnionolChapr.r9l.onnncncirBwilhScclhn7rx)0)orDlvnion:l
<br />o, rhc Alsinc$and Pnrcssioi\ Codd, and nry li.cnsc i\ in fulltura alld.ffar
<br />i)lorqt1F(]oNSTRIICTION I TNDIN(; A(;l,NCY
<br />t hcruhyaffir rndcrfnnlryofpcrjffyrh rhcrcisrotrltrucli)ntndin8agcn.tfitrrh.r.nnrrr.colrhcworktor$hichrhi\Fnniris
<br />is\uci (Scc .l(n?. Civ C )
<br />Lcndci. \Jmc
<br />-
<br />ATTUCANIDEEIAXADA!
<br />I hab, nlUnn x.d. r ,cnnlty ofFrjury onc olrh. follo*i.B d(l,r!lionv
<br />DcB'liion Permirr Ashc*r N.rifi.,rn'n I'L'ncfu l RcSuhrn'ns {Tirlc,l0. Pra6)
<br />-Rquircd
<br />t.rl€r of Norificllion
<br />l..nilirh rh. rc cirlrcsuhrnrtrrESflling ash((osrcmo!rlrrc nolxnplic hlcfu I
<br />-l
<br />ccnifylhxr I htrc rcrdrhi a oi dd rrdc rhnnhcrtri( rarm& n i\conc.r I
<br />fftlinrn..\r Srrr.In{\.c
<br />ulrrc mcnrnnEd p&r.ny nn i
<br />A pplk.nl or ,\,+nl SiAnol ," L+(
<br />.f,d Counry kr cnrcr upotr rhc
<br />7/2/1i
<br />Formsi Steel/Holdowns
<br />Flood Zone Certif .
<br />/
<br />L
<br />=
|