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BUILDING. INSPECTOR RECOHD <br />SITE.WOHK ID/SIG.COMMENTS OWNER BUILDTN DELCARA1ION <br />I h.ichy riiln undcr pcmlry (,t pcrjlry rhal I !m cxcnrfl tunr rh. Conrracl.F Liccnsc Lre ri,r rhc tirllowinE lcasn (SE 70.115 <br />Busirrc\s i,il Prorc*i(,n C(xl.) Any Ciry oi G)unr, $hi.h rcquirc\ r Fnir ro con(tud- rlrcl improve. dcnnni\h or mpan any <br />{tocrurc. lrhrto ir\ isurNc.0ko requtcs rhc.tDli.ml fir \uch |tnnn h fit r silncd qdtrftnr rhdr hcor sh. is li.cns.d pursurnr <br />I. ihc fmvisionr of rlf c(n mcror's Li.cnad lf,* (Chtrntrr 9. Connncn.inA wirh Scction ?00O of Divirion :l of rhc Br\i'rcss trnd <br />I\ofcsionsCodc) orrhrr lEorshc iscxcmpl rhcrclionrnd rhcbi\h fdrhc rllc8L{ cxcnllotr AtryviolnriotrofSccrionl0ll5byrtry <br />imlicdt li)ru pcrmir \uhjccr\rh. rpplicanrrorcivill]cnrhyofnolnmlhrnnvchundrcddolrns(ts00) <br />-l-$osNrol'lhcproncny.o.mycmployccsqithwrlcsa\rhcir\n.otrfcns <br />ion. willdo rh wdk tud rh. nduE ir mr <br />inldrdcd.roftcrcdt)relclsc..T&l4.Bu\inc$trndPrntsionscdclhconnctoisl,iccnscL{r'dmstu'l!!plyr)ano*n.rol <br />rhc Impcny who builds o! irtl)roKs rhcNn- and who docs such wo* hnni.lfor hcN.lfor rhrcuBh ht or hcr o*ncmfloyccs. <br />piovidL{ rh{ such inrovcmnrs m n r inrcnddl or ollcrd for vb li nowcvcr. rnc huiLiins or ilrlmvcmnr is $k *irtin nnc )rrrof.oinLrir. rhc Osmr Bri[cr willhnw rhc l,urdcnoiprovin8 rll lE or shc dii dn huik] or in{'mE dE pmlMy lor rhc lruil!$ of <br />1.,\.witrorrhcI,flreny,ancr.lusivclyco rrclin8 rnn liccnscd co a.tor\ to construcr l hc prorccl (S( TOaa- B6ins\ <br />rfrl P)lic$i Codc: lhc Conrri(tr \ l-i.ctr$Lnsdoc\N n) rn o$nrr,'lImp.dy slr buinls <br />and *ho conlmclr rbr such pn]cd \ wirh rCo <br />DECIdBAIIAN <br />I h.r.by rmrd under Fnahyolpcrjuryone otrhc followiry d(loi ions: <br />I hnvc ud * ill ruinrain ! Ccnilrcarc ot Conscnr h Scll.rnsurc r BorkcN compcnsariotr. I ,mvidcd rbr hy Ssrion .l?u) ol rhc <br />lrnr Aft. t r rh. pcrfonmncc of rhc work tor which rhc ncrnrir is nsucd. <br />l hnvc rid slll nrinhh qork*J onlllc \rrn,n in\uEncc. rs r.qut.d 6r" Sc(r i{)n l7{x) of rh. l jhor Codr, nn rh p.rtuflmn( ol <br />rhc w.rk lor whi.hrln\ pcnnn s s\uLrl Jllysorl.rf co ,Ixd\ari,n, nxtrrrn( crtr'dr r d tinicy nuhh.r rc <br />-l.cnilyrh3r <br />nr r[c trrloirDrccol lhc sork lnr qhi.hthi( tNmr i\ i*u.d.l shrllnor corDloy y Frn{r in rnynrdnncr <br />\) ,\ t, nltoN sulrl..rk,rhcsorkcn coNncn\di,,n hw\ oi(rlinrnii. a ignc rhll ill \hounl hcc.nE subJ.rr hrhc <br />\dk.*'.otr1|rci\ri{n,nmvi\tr)'sofSc.riml?({)olrh.l,rtrn(irlc.l\hrll.trnh$lrhrcnrly*irhrtxr{pnrri\n,n\ <br />IVARNING: l:rilrc ro arur. $or(.r' ..n,F.nsrlion <br />c'!il fincs up l{, om htrndrci rn.u\r dolh^ (llu) <br />Blnl. rnn nrl {'n}.r rn cnrtlo)!r r. .'l'nirrl F-mlr['\ ] <br />dr rEcs x\ |nrntrJ rnr rh. <br />Codc. inlcrc{ rntlarhrmy s <br />30 I <br />I hcrclry rnim utulcr pcnrlry.fFrjuryrhd I rliccn{Ju crprovi\ionoiChrprr9lc.n,mn.in!virhS.cri,n7(Xn)ofDnnn)nl <br />or rhc llu\ims rnd Pnfcs\ioosCodc. ud my liccn{ i\ in hlllorcc Mncllicr <br />CI}ISIBI]gIIANIENDIdIj.AGENCT <br />I hcrcby rlltm undcr pcnrlryortcrjuryth.t rhsc is r sniru.ii)n Lnding agcky 6rrh. pcnomuncc orlh. Bort tor which rhh lcrmil h <br />ksu.d (S.. ,1097, Cir. C ). <br />AIPIIgANLOEIAAAIIAN <br />Ilrnhy Imundcrp.nrhy.f pcturyoncurrhclalk,wii8decl dions: <br />Dcfrolin,n Pcrn,irs A\tc{osNorifictrrn,nFcdcrrl Rc3uhtionsl-litlc.l0, Prn6) <br />R.qutcd I.nc..l Ndif*,rion <br />-l <br />ccnilyrhar rhc fL{cmllc8ul0lions rc80din8.+r(os r.mrrlarc tut ltltlicrbh ro rhis pmtccl <br />I r.difyrhl ltuvc ftrd rhi\rt1lli.rr rJ nrr.rhrrrhd xh\c i,xSrN kr.. lrlly wirh rll ciryand coufly <br />Ddinrn.cs and Strrc Ir$rlxlingu <br />sti'lc mnrioncd l)ropcnylor inspccr <br />rcp.c\cnrrrivc\ ofrh'\ (-irt rnd couiry t) cfrrr utx rhr <br />Applifttrlor Ag.trl Siamlure <br />A 3-ANN <br />5 3a r{ <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Rool Sheathing <br />Shear Wall l4 <br />Framinq uhilB t\c/at- <br />lnsulation/Enerqy <br />Qlyrryall I <br />EMnt. Lath (/1,6[B apr&k <br />Brown Coat ll <br />Masonry <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Cenif . <br />FINAL 1/2,l lrP.-{,/z n ) <br />Certilicate ot Occupancy <br />Notes, Remarks, Etc. <br />DATE <br />Erection Pads <br />Pool Fence <br />L$ <br />Lxnds r Ad&e* <br />- <br />- <br />-T------i-