|
BUILDING. INSPECTOR RECOHD
<br />SITE-WORK DATE ID/SIG.COMt\hENTS oII NT:I{ BI II,DI]R I)I'I,("\R,\ I('N
<br />I hcreby lllnn undcr t--nalry,,t rrJury rhir I i'n.xd rfl rn,nr rhc (onrNhn Liccnsc l-rw fu rhc f{,llo*i s rcN,n (sc(7r:ll5
<br />Busnr\s !ft1 llotNion Codc): ry Ciry or Coutrry ehi.h r.qtrnc\ | F.nir r. con(rucr. rlr.r. imprulc. dc'fr,Ii\h or kpr, rtry
<br />nrucrurc. rntr b irr issuamc. llso rcqunc\rhc lmlic{nr lor such ncmi o l'rlc a si8ncd \rdcmc rhri h. oi shc is li.cDscd pur{rnr
<br />b rhr pn'{sn{s or $. Co.trrcrols Licctr{cd kw (Chiprs 9. Com rcncing wiih S.crion ?O(I) of Divirbn 3 ofrhc a!\irrc\s and
<br />l\oltsiqN Cone) or rhrl tE or\hc i\crcnlIrrrh.rdnnnrrkl rhc hr\is lor rhc.llcEL{cxcmpti.n. Any viohrionofScc!i,n 70.11.5 hy rny
<br />rrplic,nr rorr Fnnir suhjcrl rhc t'Ppli.o.i h a.ivilpc axtoinor m.rc rhnn lvc hundrcddoll(s($51x))
<br />l. asotrncrolrhc |x,Nny. aflrcxch'\nelyconrrrcrins *irI licctrscd.otrttrcitrs k, roiifl.r rhc nro]c.l lScc. ?0,1-1. l]u{nc$
<br />rfll lblssi,n Codc: 'l hc Conkrkn\ I-i.cn\d Lrtr doc( nor rt)tlv ro no$nciofproD.nytrho huildsor in,plMsrhcrcon.
<br />lnd wh...nh.lstorsu.ht,ojcchwirhxConxrcrr)n\)liccnscdl,u,suanrt,rhcC(nnrn(n\l-'.chch$)
<br />-lrnrcxcmpl
<br />undcrsccrion .B &Pc lnrrhi\r.n* r
<br />Dal€ lhner:
<br />wonKFks' colrPFNaAfloN
<br />DECLASAIION
<br />I hcrcby rllirtrr utrdcr NrrllyolFrjury onc olrhc nnlo*inr dcchrartnt:
<br />_l havc 0tr1 uill nu inuin a Ccnilicarr .r Con\.nr b s.ltl$trrc rd workcn c.nlcns.lion. !s [ovidcd for l,y SNl tun ]7Ln ur ihc
<br />Lahtr Codc. fd lhc p.rfnmh-'c olrhe work lor $hich rhc lcmi h nsucd
<br />_lhtrvcrnd*illtrui'niin{orkcrf.orrctr\rrionNurr.c. s '.quncd hyS..rion.r7rx).Irhc lrh{rCoJc. f{n rhc Fnornr..coi
<br />rhc$orktntrhi.h(hi\pcrnirisi*u.{.M,w.rk$\.oil|tnsriioi surM.cconicrorlroli.you,b.rr.
<br />-l
<br />ccniii rhlr ir rhe Fcrfomrmc otrhc sork n, shich rhG p.i,nn i\ nsrcd. I shrll nol cnrloy rny pc^on in rny nri f
<br />$ r\t,lr.otusuhtccrk,lhcrorkcr(co rlEn{lionlrqsolCnlituirir.rndalrccrl ifl\lr'tld h-.oitluhjcclIolhc
<br />*okdi .o llcn\rrn,n tiovni,,is ol Scdion :]700 ol lhc tihx C.dc. I \hrll. ftf h* irh (nntly $irh rlkR !tuvisio.s.
<br />WARNINC hilurc b ccurc sorlcri.o rt$$rion corcrr8. i\ utrhshrl, rnd shtll suhi.{l arr cmplor"cr t, rtiminrl |cMlra\ d
<br />.i!il ftrcs uJ, lo onc hundBd lhou$nd dollrrs isloo-(xl(
<br />Sccri.n 1076 rlrhc l-alu Co(|.. i'rrcrc{ mdnrktrruy \ L.s
<br />ion. da a8cs ss ti(,vid.d lar rhc
<br />DECIA8AIION
<br />I hcrcby !mr6x.d$ p.Mlry or pcrjury th0t l,n licctrwl undcr provhion olChlprcr 9(con'ftn.inB wirr Sehn 70tD) oIDilhion l
<br />ol thc Busincssond Profcssn,ns Codc. dnd myli.cn$ i1 in rull ror.c d ctfccr.
<br />-Liccnse
<br />Nlnrh.r
<br />"*{t -S:ksl3 -*-*.,,\P? tsric{LC4lJfd-\}-}"lA
<br />!]ANIIBIJCIIANIINDI!!,;IIiIN(I
<br />I hrrcby alltnt undcr lrnslry.ip.rjuryrlkr rh.rc h dd,h{tu.ri5n hndi.8 4cncy l'o. rhc lcrlomBmc ofrhc $ork foi *hrh rhis rctnrl h
<br />issued (Sc.. 1097. Civ. C )
<br />LcMcr'\ Addrcss _
<br />dITLIIANLDIiILAAAIION
<br />I hcrcbyiltinnn.dcrpcnrllyoipcrjuryonc otrhc n,lk,wi',gdcclanrn,ns:
<br />Dcnnniriru Pcrnrirs Ast so\ Nor Iicariotr F.deral Rcsuhrn,n\ ('l'ir1.40. Pdn6)
<br />Rcquncd Gttci ol NolifEuiinr
<br />I ccnilirhat rhc,idcralrcsxLno \ togMlnr! r\h.noi r.ix,Ml arc mr$flic{hlcr,, rhi\tnl.cr
<br />l.cnifrrhrr I luvc rci rlrs:ll)pli.{ri{nr d nrrc rhd rlt f)vc irtfnx1i(t, i\.ot.r I rA'ccr,.ornnlyBirhjllCiryrnd Counry
<br />ordiMn.cs rnd Sr.rc bsrEbri.Ero huikliry consrrucrioo. u.l hc nurl.i'i7c r.Jrn\cirnrnc( orrIr\ Ciir rnn Counrr r) cirrr uFn r]f,
<br />rh,!r ,. rirtrrd nrpc'Lt l!r i\1,.!r
<br />/\Dplicnnl0r,\sr l Sir lun -*6:5:zc{s
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<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 />FINAL +/?/15 sb<\
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />UFER Ground
<br />Subf loor/Vent/l nsulation
<br />Ext./lnt. Lath
<br />l-$oqrcroirhcI'lrpcrly.o.nryempbycc\tirhNrscsusrhcne,t..rfcisrL.tr.silldolhc$!r[udlhcntulFisnor
<br />im.ndcd orontrcdr'orslc(Sr70{J.Busnr\\andPnnc\sn,nCod.:ThcC.iknroirLiccnscL,wioc\noramlyhi owi$ol
<br />lhc |m)ncny wlnt^rild\or iu)rn$rh.($n. s'rl wh,doc\strchwo* hi scllorhc'\cllorrhn)ughhi\.rhcrowncnlr]qccl
<br />nn,vidcd rhrr \uch ia1P(rdrd6 ito frn i.rctrdcd o oficrcd Lr\aL lthoqcvcrthcldildingorinryoyc'nmissndsiihin,tr'rttr
<br />ofcomplrion-thcO*ncrBrildssillhavcrhrhnrdctrof!$!irEttuih.orshc klto hdiki or impovc rhc porcny litr rhc puqxM.f
<br />o,,",t L.'' €' ?tzlL
|