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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATrcN
<br />I hcrcb, lliirn undcr pcirlry ol Frlury rh l ont cxcnrlr lm'n lne Corkr.t,* Licctrs ljw hrrhc rollowiig rc.$tr (Scc.7r:ll5
<br />Bu\ircs\ md P(na$ioh Corlc): Any Ciry or Cou y which rqtncs I Fanir r(' conirucr. dlrcr. anlttrovc. .lc.mlth ot NI,rn rny
<br />{fl.rurd, Drh. to irs hsumcc. lho rcquncs rhc +rli.a0r forsu.h Pnnil t) filc, \i8n.d $arctrfnl rh0t hco! \hc h liccn{d purs0nt
<br />lo lhc pmvisn,n\ of rhc cotrrrr.tfft Liccnrc li* (ChaPlcr 9. Co rntn.inB wirh Scclion ?fiI, ol Divisn'n I olrhe Bu\incs rnd
<br />Profci\ionsCodc)dr rhnt hcorshc i\excmpr rhcrctro andrhchr\iiforrhcolh8cdexcn1ption try vrhtion ol S*rh. 70:l I 5hyrny
<br />lpllrrfl hr r Frnrir subjccrs rhc dtpli.ant t' a.ivilpcnallyolnor morcrhrn lilc hundrcd doll.n (Ss{xD
<br />I. {s owncr of rh. prcIany. or By cniPl.)t.s sith wr8cs rs thcn vtt conD.is .tr. wrll do rhc wot* ud rlt dtrrurc is mr
<br />i cdcd or olTercd nn srl. ( S.r 7(114. Ausincs ud Prdtsions Cod. Thc Corrrcroi s t iccnt liq iloes n.r lPply n, xn oqrcr .f
<br />rh.Fn,r. y wh. builds or iNnFvc\ rhcdnr, rkl wtk, oc\sx.hsr*hi.sclforhcnclforrhroxghhisorlrro*.d lrolcci
<br />Drovid.d rhrr\u.h irryroEDrnh r.R ir ctrdcd.roficrcJ hrelc ll ho*NU, rh. hildi4 or iqrc!.nrnr i\qrd sirh onc vlr
<br />ol (nrFtrirn. rlcOwnd auiEcr *illhr\t rhc t{nlcn olllnnint r&[ h( or sltr di trorhdildori' lr()vc rhclmlEry lor rh( pt,]x^col
<br />l.0sou'ncrolrhc propcny, r cr.lx{iv.lyconlmclin8 silh liccDsctl .onta.!,s b .onslrucr rh. pn,jc.r (SLt. ?(}4ll Br\i"'s
<br />rnd ltotusinr Codc: Thc ConI'cktr\ l-iccnsc Lasd..s tror rpflyro (no$Dcrolntu|rt t*hohnikkoti pr.r.s rhcrcon.
<br />itrd sho co nr tucr \ r'or \xch lmjd.r qirhiConrocto(s)liccnscdpur\lantrorhcco racloir l.iccn\. L.tr)
<br />I nuxcrr un.lcr Sccri(u
<br />Doler Owmr
<br />woRl(l'{\-contpFNsATroN
<br />D[qdnAu!.lN
<br />I hcrch, flttirm ondf lcflllyorlrrjuryonc otrhc i(nb*ii! d..lritiors:
<br />Ih,vcatuwillnuinlah!Ccninc,rc.rC.nscnrrosclf.ltrsurcLrworkc( codpcns.rtnr. !s lmvidcd ror hyScdion:1700ofrh.
<br />tjtxr Gdc, for rhc Ffonnoncc ollhc sorl t, *hich rh. p.rnrir h issucd.
<br />rlr. ('{k lnrhi.hrhi\ prnnir '\ n{d Niy{olkcN..nf!tr\rri,n,lnnnm.c.xtri.r npolicvnunrh.r .
<br />Foli.tNun$d-
<br />l.c ily lhol h rhc pcrronmn.c.lthc $ork for {hich rhn lcrn,ir i\ n$cn.l shlll nor cdPloy .ny P.r$n in lnv manrcr
<br />r !\ b bc(nt suhj.{ tu rhc qorkcs' comf.nsalion lnw\ orcdhrornir, ind lsnc rhi irl should b.com bicliothc
<br />work..o'npctrs.iio.provisionsofscdn,n.lT00ofrhchbrcodc,lsMll.trnhwirhcrmPlrsirhrho{pmvistrts.
<br />WAININC] tilil!rc n, rduE workc6'.onDensrrio drycmac ii unhwtul. !trl shall \uhjer an cnlplolcr ro.,iminrlrcMlrics ond
<br />civil ,inc\ !p ro otrr hxndicd rhousmd dollm (5100.0u)r, i'r addirion ro rhc co\r or.onfc.sation. danuscs x\ nmvid"l r''r rh'
<br />Sccrnrn 3076 ofrhc ljhtr codc. irrlcrcn Md atrormy s re\
<br />D.lr: Appli@l:
<br />LICENSED CONTR (]TOR
<br />IIECI.ABAITON
<br />Ih.eby!fltNundqpcnlliyorp*juryrhorIrfllienEnuoderFrvisionofChoPt$9(drm!tuni.8qithSNlion70m)'roivhn:1
<br />of rhc Busincss ond Pmacssions Cod.. rnl my li.cnsc k in full nrcc rid.lTct.
<br />Controclo.
<br />CoNSTRUCTI(IN I.I'NDIN(; A(iENCI
<br />I hcrcby 0flirm un.lcr rafulryol Frurylhar rhcrc is a cor(dcrbn LndmS ascncy f{{ rh. Frbnnincc ofrhc *ork ror shnh rhi( Pcrnrir i\
<br />is\ucd (Sc.. 1097. Civ. C ).
<br />ATTLISANfIECI,ABAIIO!
<br />I hsr+)y Imru.dn pcnrllyofpcrjrryon. orrhc rollowirS dcclamrion.:
<br />Dcfiolirion Pcrmirs AstEsos Norincdio. fcdcal R.gul.r ioff (Titlc 40. Pan6)
<br />Rcqun.d ktlcr of Nolifi catbi
<br />I ccnilyrhlr rhc t d.rsl rc-pul io.s r.suding aslEsos rcno\al irc nol utli.ahlc ro lhh ptolccl.
<br />-l
<br />c.niryrhar I h,vc ruadihis it'dicarionud srarcrhar rhc ft,v. inlorm ion i\.6r.cl l 0BrN lo orylv * irh all Cilr and Counrv
<br />.dinanccslnd Sr e tiws rchlin8 lo buiklina consrd.ri.n. ut hcrc$y iurhore r.prcscnlatilci orrht Cn, sd cou.lvlo cntt !f-. rtr
<br />rh.v. nEnriored prcpcny rd instclior p!,t'oscs.
<br />,\pDli.nnt d. ABenl Si8nclurr
<br />Ir.n lrt n,t(rrinl)i
<br />Set Backs
<br />Forms/Steel/Holdowns /aiU.
<br />a-
<br />UFER Ground -nf\
<br />SLAB Floor t\\
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq tt t/rq,'lUKl/+4t 7Lryl
<br />Shear Wall ((*-A)
<br />Framinq l 2)t itQ reA-.L-'2,\ )
<br />ln su lation/E nerqy 4 7{hh.<,@
<br />Drywall I tl4 fi,!,rvlira ED
<br />'Etytnr. Larh l,y"]\*)o
<br />Frown Coat L 7;14**)^'(pl)
<br />lvlasonry I 0t
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />4".e*hd",2-7 -l cl Vtw*t"/,Oll/
<br />FINAL a.1-t4 a Att,^Zz7-?D)
<br />Certif icate ol Occupancy JI
<br />Notes, Remarks, Etc.
<br />Erection Pads
<br />I'
<br />'l>'
<br />I 14
<br />,,1
<br />itL lz4
<br />\l'
<br />Flood Zone Certif .
<br />I i i,1 . \J,1,,. _
<br />I As.$Y
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