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BUILDING- INSPECTOR RECORD <br />COMMENTSSITE-WORK DATE ID/SIG. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/lnsu lation <br />Rool Sheathinq <br />Shear Wall <br />v,Framinq 7-(6 -B_lleSoI& <br />lnsu lation/Enerqy \ <br />7-/b-E--J laSa{o ?)Drywall <br />Ext./lnt. Lath <br />ltlasonry <br />Pool Fence <br />T-Bar 7-40 q6.l,l4*114/ <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certil. <br />qqFINALg4t4s-lr.Sb-to <br />Certif icate ol Occupancy <br />Notes, Remarks, Etc. <br />OWNER AUILD!:IT DELCAI{ TIoN <br />t hcrcby JIIrm un{t.r ptn"lry of Friury lhlr I nm cicnPr fnm lhc aonrrnrF t-icdnsc t-rq ior lhc follo*ids rcaq rs{ 7ori r <br />llusincss lnd PR,Lsion Cdc): Aoy Ciry or Clrniy whi.h tolutcs a pcrnir t, .utrslrud. alrct. inDtuv.. dcnnnkh or rcPn 8ny <br />nru.tur, rior ro irs tsuan(. d$ r.quircs rhc 0PP,ic l li,r snch Pcmr ro filc I sisned sdctunr lhal lE or shc n li.cn*d purunnl <br />ro rhc pn,visi{'n\ ofrlr Cotrrructois Liccn{d llw (Chaprcr q. Conrdcmi.! wirh Scdion TlXl) of Oivision.l ollhc Burin.*.nd <br />Porcs\n,s codc) or lh{l hcorshc ncxc.rpr rhcrcliom{nd lhchnsi\ rq rhc.llcScd cx.mpli('n Anyviol{lionofSNrion?0ll.sbvrnv <br />rptli.a turapcnnir subjccr\rht .rfli.an[. a civilpcnllirornor nx,crhrn li!. hundr.d doll8tr (5500) <br />-1. <br />a\ owncr.frh. pmtEny, or my emrloy*s lirh w{8cs as thcn s,h .lrnrcnsarioD. vill do rtE sork rnd th. {r-ra k n <br />i'ncid.d or.Bcrcd for elc lsd.?ol4. ausinc$.nd Profesions Codc Tlr Conlracktr s Lic.nsc tjw drcs nor aprlv ro ano*ncr ol <br />rhcpnFny lho boilds.r irrymrsrh.en, vi wh. dc trh sll hinsclf ot hcrtlf or rhtuuBh his or icr o*n cnrbvccs. <br />providcd lhBr such inrpmvcnrnrs m ml inrcndcd or olTcnrl ror eh. ll k'wcv5. ih. buildins or inllmvc rnr is $tl wilhin nnl,td <br />;f conplcri,,r tr OBncr Builder will h,h $. b{rdcn o, Pmvin-q lhll h. oi shc did not build or in9rort l]Ic PnFalv r. k lutlnE of <br />-l..sow"cr <br />oirhc pblcny. nncrclusivclyco rtrinB wirh lrccoscd conrracron b constru.r rlE ptujcd (Se. 7I)44. Bu.ifts <br />DM PDrssion Codc: Tnc Co.ktrcror's Li.cnsc liw dm\ nor apply ro.6ownct.rProP.n, *ho builds or ihprovcs rhcrcon <br />rnd who comtu k lor rch,mjcch *irh r cunhfurls) ltc.sd Pu6uun! ro <br />'h. <br />Conlraclois Liensc Lrw) <br />I rm.rdtrrnr un,l$ Sc.r <br />Dsl..-_ O*ner wotxrts' cou Porslridn= <br />DECIAMIIAN <br />I hcEby arnrh !ndc! FnrlryofDcrjuryo.e oflh. rollowing dccl*alio.s <br />-l <br />har Nod will roirtain a Ccnif(arc otCotr{d ro Sclalnsurc fu ftrkds o,nP.trstion.!s Ptuvidcd for bvSari.n:1700 ofrhc <br />ht r Codc. for Ihc pcrfortun.. of fic wo* Iot qhich rhc ptrnr is hsucd <br />-l <br />havc Md will mai ain wortcc codpt.srtn'n insur0rcc. !s rcquicd by sNrion 1700 ofrhc bbor Cod€. forlhc pdtunDn'c or <br />rhc Bo,k tu which fiis D.rmn is isodd. My workcrs omp€nsation insurarcc clricr and ,oli.Y numbcr uc: <br />Policy Nun,hcr <br />-[xP <br />I..nify thal h rh. !.dortui.c ofrlE work ior qhich rhk P.rnir is issucd. I shall ndr cnrPlov anv P.6on in,trv manncr <br />so as ro bccotu subic.r lo rhc woi(cr' conpc.s{tun Irws ol Crlifunia, d d8rcc rhlrift slDuld b..onf, subjd ft'rtr <br />io. provhi.ns or S..tion l?u) of thc Llktr Gxr.. l \hrll. lonhwirh omply wnh Ihos pDliin r <br />\IARNINC liilurc r. *.urc Norkc.i co n ..v.ag. is unlawlnl rnd shdll subict an cnpl.)t. ro niminal r^-nrlris nd <br />.ivi! ftrs up lo onc hudrcd rhousrnd dollor (15 ).lXX)r. in Mrlirion ni rhc con (n conrPcn! ri{nr, darrgc\ r\ nroridcd tur rhc <br />sr.rion :11r76 0l rhc lltxn coJc. id$c{ <br />6-- SF- /y <br />^zz <br />IhcrcbytrlnrnunddlEnrlryoio.riurylhdIa'nlietrs.dundc!fovhionofChaplc!9(.oorcicingwirhSatiotr7fiX,orDivis;'tr'l <br />ol rhc lusinc$ lnd Ptur.srnsCollc. ud nrrli.cnsc ir ir iull hrcc a&l cll.r' <br />4 ly'il/J'Z <br />{.2 4n- <br />I hcr.by rrhnnutrdcr Fnahyorp.rjutyrlDr rhcrc <br />i{su.d rScc :10S7. Civ. C.) <br />aconsrocrk,nlcndinEllcncyaorih.pcrforunccolih.w.rklhrwiichrhi\pcrmiris <br />APPLTCANT DF(]I,ARATION <br />I hcd,y lmm undc. rcnllty ofpcrjury.nc ofrlr followin8 d(larurio.i: <br />Dcmkbn Pclnns Aibeqkx Noiificalion FedcBl Rceuhrions (Tnt 40.lnn6) <br />_Rcq!tcd krr$.f Notifi calion <br />fedcral rcgulnrio.s rcgrdnE ashc{o\rc mvnl,rc n.r rmli.$l.h rhis pmjcd <br />md rhh applic,rion,Jrl i,rc th,t rhc 4hovc inturnftotr n corecr.I rsrti t,..nllvNirh allcirv,nd Counr, <br />ljw!rldinalohuildinscoii.rio.ituhcrciy!drh.ri7.r.trc{nlllnc\orrhrcryrndCoonrlrocnrduP'D <br />/4/'2- <br />a/,L Z Abzzru:e44 <br />Brown Coat <br />L.ndo \ Ad.lE\ <br />- <br />I