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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS O1lNER BUILDI]R DELCARATION
<br />I hcrcby rlfinn undcr pcmlry oI Frju.y lhlr , !n cxcmpl lmnr lhe Conr,rro6 t.kense l-as fttr rhr rollown'8 tuNr (s(.7t)11.5
<br />Bu{inc$ ,ftI Prulcsio. Cod.): Any Ciry or Counry which rcqoncs r Fmir b .otrNru.r. nl'cr. mD.ovc. denFli\h or rcnat oDy
<br />sflcrurc, l]rior ro ir\ issurirc. aho rcquircs lhc lptli.ad n such lf,mit ro litr a si8trcd sr cmnr rhlr hc or \h. h li.c.\cd N*urhr
<br />ro
<br />'hc
<br />pdvi\ins or rl* C.nrn d s l-icc.*d lrq lchrprcr 9. C.mnrn.in! wirh sc.rion 70u) or Division I oflhe Businc$ itrd
<br />Prna\sion! G)d.). har hc.rshc hcx.mpt rhcrcfion rM rlr hasis forthcallcScd cxcnrtlion AnyviolarionotSecridT(l,lltbrrny
<br />rmlicdl for rrcrmir subjcclsthc lprlic.nt lo acivil!cn.lryofnornnrcrhln five hundrcddoll \(S5(D)
<br />l. r{ owkr ofrhc ptufrdy, or trly.mplores wilh wr!.r $ Ihcir nnc.o rpcD\rli(in. willdo rlE kork r{l rlt ituim i\ n r
<br />n cqd or otilEd t, ele ( Sm.7044. Busincs r d t'nfc\si,nN Codc ]'hc C.rtrctr's t.icctrr ljw docs mr apply b m o* cr ot
<br />rhc F,Irny wlE tdilds or irynowr rh.mn. md wto dms smh *ork him\tlfor hesclfo. rhmu8h his or hcr osn rmPk,it.s,
<br />pmvidcd rhar skh niJmrcrftnh m Nr ir cndcd or DlImd nn slc. lt lFwcvcr. ltE ttr illing or in\mrtn.nr h old $irhin .m )ntr
<br />ol conr0hlhfl. lhe O*B Buillg rill hrt rhc l,udo ot pmvins lhd h. or shc diJ ior huiH ot inFntw rhc toFny tu rhc ,'urtrt ol
<br />I. arown.rofrhc fo!.ny..r.x.hsivclyc.nta.h! wirh ll.cnscd contradom lo con(rucr rhc nFFr (Sc. TOtl. Bunmrs
<br />!.n h.icsbn Code: Thc Conrrrctn s l-icensc l-iw docs nor lPplyft, rnown.r otnturcdy who builds or i'nfnvcs rhrcon.
<br />rnd *ho conrDcrs Lr su.h prcF.rs wirlr a crotrttukd\, li.cnscd nusuonl torhcCo mdusLicnscLjs)
<br />I r.xcnu undcr SccLotr
<br />trca&:&::t(]llEiNrAIl0
<br />DICLATAIIQ!
<br />I lrrcbv rlin nnd.r pcMlry ol n rjury om of rhc fdbwn! dcclr!^r nnx:
<br />lharrnndsilltrrinrri,raCcnlfic.lcofCorsctrrtuSclf"lrsurcl{rwnrkcr'.-rlFnsrlion.arFrvidcdirbySc.rtrlTtx)olrhc
<br />hlrx C{nI.. lff rhc pcrfornrncc.f rh. work for whi.h lh. p.nnir t hsucd
<br />-l
<br />harc and will manrhin wortefi cohpdnsarion inslrancc, !r rcqlircd b! sc.rion r7m or rhc tihor L'odc. for lh€ ncrfomrcc ol
<br />rhc Noi& forwhichrhn pemi is hsucd M, w6rkcB' .onpcns ion insxrdN. cadi., nnd Inlay Nmbq sc
<br />CBricr:
<br />xtccniryrh ir rhc jrrlor mrrcc ol llrc wort litr wh ich lhis pcntrir i\ istr.d.I \hrll or. rdoy,try,c6.n in onynrmNr
<br />Nt,hcco'tusuhl.rrbrhcwork..onrp.nsdrn hw( of Calin,nM. antt .ercc rh rll should hccom sbjcd hihc
<br />workc's' d,n1p.nsrrioi prolnnrns of Sc.r i.n 17(x) of rhc tjt{tr C.d.. I sttrll. Ionhsirh $nrply $irh I hos polnnnr
<br />WARNING I'rihrc lo scnrc Norkcrs'conDensllion corcmac is u hwtul- ud \h3ll subjKr 6 e lp!,,ttr k' ain nlFn.ti.r rtrd
<br />.ivil fin.r trn io. . htrndi(.d rhou{nd dollar rsl(xr(xx ondirion ro rhc con oI compcnsarn r. dinuScs as pnrridcd ri)r rhc
<br />scrtr,r ror(,n rll: Lxlu C, c. inlc .n inilxir fruf,J;.>1/]-o/d cloh_
<br />Ur!l!l:!-M]}
<br />IncrchyalfirmtrndcrpcnolryorFrjoryrhdIrnli.tna{und.rpn,visiotrolCh,Uqe(co.rEn(ir8*ilhS..!ion70}))orDivisnrl
<br />.l rhc Busims s Pdc$iorN ordc. d myliccn{ n in lulllotu! rll?6lrcci
<br />f)i.lrl
<br />z/.zc / rd
<br />AITLII;ANI.DECLAAAIXIN
<br />I h.r.by rfiim undc. renalr, o, Frjury om or rhc rdbwine d*hrn!ionl
<br />Dcmlilio. Pcirnils'Asbcslos Nolificalio. Fede.ul RcB!hrions lTnh.()- Pd6)
<br />Rcquircd t licr of NorifEolion
<br />ltdillrir rhc icddrrlrrgtrhii{,n\ rcgr di'rI n\br(o\ r.n$ xL ]n or i )li.ihlc n, this nn,itrr
<br />rorrlrc!h.tcnriornuri{,!is.oner Irgr.{b.omplyuithallCiryan,lCotriry
<br />r tnl ul h.rchy ur}xnnc rcflceNarnc\ ol thk Cny ind Cotmy b e rcr uBr rh.
<br />I.cnni rh.r I ha\r rcad rhnlntltcolioniodnlrcrt
<br />.nlnrtur. rtul srxrr Lxtr\ rct. inarcr6uit,tinsf, Ntu.r
<br />JL\c,,ri,r,nr,r rrnlrny htr n,,f - *:>__,
<br />\ptttiunt or
<br />^Arnt
<br />sirniirc t / .',zaaL:
<br />Pemi,enanre,pnnil: 1 Ytq-L< g<
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall /A
<br />Framing a-)olr X.\I/JU,
<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 />Flood Zone Certif .
<br />/\
<br />FINAL K*1o-lK X.ltLJr;)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />D<.,o' ?,-ga\<)
<br />CONJiIBUqII0NIINDNIj.ACENII
<br />I hcrcby i6iinundcr pcmlryolr..ju!yrhur lhsc h a consltucrion lendios trsency Lr rh. p.rformRc oflhc *ort lor whi.h rhk F.mn (
<br />nsucd (Scc. 1097. civ C.).
<br />I cnd.r'. Nrm.
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