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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Sel Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/Vent/l nsulation <br />Roof Sheathino <br />Shear Wall <br />Framing <br />lnsu lation/Enerqy <br />Drywall <br />Ext.i lnt. Lath <br />Brown Coat <br />lVlasonry <br />Pool Fence <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certil. <br />\t rOr <br />FINAL v\'tr1\'L\DAS{,rs1 <br />Certifacate of Occupancy <br />Notes, Remarks, Etc. <br />OWNER BUILDER DELCAR-ATION <br />I lEr.hy allno !' d Fmlry r)r Friury rh I am cxcmnr nom rh. Onrlra.hr Liccnsc ljw ntr rhc fdlowhs rcr$n (Scc.70.11 5 <br />Busi'i.\! dnl PtuLsRnr CGlcl: Any City or Connly which lcauncs r Fmir i{' co!{ocr. ,xci. inlrov.. drmlish or t.lr tny <br />srruururc. !.kr ro irs issurmc, also rcqniEsrhe applicanr li,r such Frnnr ro 6lc. s8.cd stltcmnt lh.l hcor shc i5li.cnr.d p!^uanr <br />k, rhc Jroltn'n! or rhc conkncttr'r Lt.nscd tr* (Ch,ptcr 9. cdmmtrcr8 rilh Selur ?0(& ol Diviri{,n .l orrh. a$,n$s and <br />Poi.ssions Cdc).rrhrl lforshc s cicn:rllhcrclioma lhe h.sn lor thc allcr.d cr.nqr'o.. A.yvidrtionofsetkn?031.5bylny <br />,0tl'e,nr Id, p.in subjeklltr,ml,carirroi.rvilp.nahyolnolmorcrhanlivchuoir,ldollm(.i500) <br />l. is owner of rhc Fopcdr, or dy cnployes virh sascs as rbcn sdb comr.ns.'ion. w l do Ih. vork $d lh. nBlur n nor <br />idcdel or oflircd for vlc (S( 7044, Busincs and Prof.s{n,Lr CdLr Th. conkrltr: Lkcns L.w d€. nol amly lo an owrcr ot <br />rh. llnlrny who hondr o qmrcs ilrDn. snd wtu ,lcs ssh u,rl hinscll or hcrrlt or rhough hn or hc. own.mJioy.$. <br />p(,vi!cd rhar \uLh imllrokmnk m fln inr.RlcJ or dltbdl tur elc. li lxrwq, rh. tulljnE or nqmwmnt is sol] *iinh one yc{ <br />ol.om*lbn. rh. Owncr Builcr will h.rc rhc l&{cn oi pmving lhar lE or shc did d hrilr or hl'ft)vc [E I,mFn, tu tlE pu{ns ol <br />_1, a!.wncrolrhc!io!.ny, rm.xclurvclyco mclr8 wxh lr.cn\cd co 1.n'n n) constru.llhc pr'hcr (SN.7X4, Bu\i',cs <br />xl hulcs\ nC c: Th. Crntrrl'tr's Li.cnsc Law docs not apply b owncrotp!,pcnyoh()hxius.rimflolcsthcrc.o, <br />rnJ who r.ntrucrs n)r surh p!)rcuh *irh a Co Bcrtrl, liccnscJ Nrsur n) ll[ cotrtr.lrtr s Licctr* Law). <br />I amcrcnrpr utrdcr Scct!,tJ & I'( litrrl,isrcrnr, <br />Dire:- Ow <br />WORKEfS' COIIPENSATION <br />IECIIISAIIO! <br />I hc,cby 0r'lrm undc, p.nalryol pc4ury onc oaU. n,fiNirr deldarn,nr] <br />_l hlvc !n will tuinrain a C.diltarc.rconrd ro Scl nsu( lor mrkdr .omFnsalion. as ,,ruvilc, lor by Sern,n -uU) oa rh. <br />tilx)r Colc. to. rh. Fraolm.. ot rh. srk ror whih rhc p.mi is nsucd <br />/havc {i will @,flaii work.rs .omFns.lion insuraNc, .s r.tutr d by sdl!,n J?00 ol thc rlbor Lodc, ior rh. l,crrolmBc or <br />tne vork ror vhdh fiis lxmil Ll irN.d. My workdi cohFns.lion insuEncc cmi6 .,n Fky nunhq ml <br />?- .r.t,,)'?- 1 , <br />pori.yNlnrbs:.,r1\rd?aao zz o? Er!trcs b',L- L I <br />_l cn,li rhrl ir! llrc |t,liJ ninrcorrhcworklirwhichlhisFrnririsNricn.Ishrlltr.r.nnk,y.nyr.rnn',r'anymnnncr <br />$ .sto b.cooE s$ic.r k,lhc*orkcrluompcnsali{nrl,wsot Caulnrnir,, ,!r.c rlrril I sriNlJ hcom lrhjccr lolh. <br />wo*cn.omlEn\lri,rF,vi\ion\olSc.ri,,n.lT0OolrhdlrtirC,)tlc,lshdl.,i)rlhuirlcomnlywilhrh{xepn,vi\bn\ <br />WARNING: !i 'c b \c.dr w( (n (,mp.trsarnr cov.rdB. ,s tr l.wlnl. .trJ slrlll suhj(t ,', .'.ploy.r nr diminal !.nahisl'ft] <br />rn'l lnr\ Ii'.trdl, JrJ rhotr\xiJ Joll.n ($llxl,txr0l, r,{l!ln!r r) rh. (.n]n.n\rrnrn, 'imrgcs r\ fnr'JcJ n, rh. <br />L-ta-L( <br />!2E!rz!-8!L!.()! <br />I hcrchy 0li,n u n,ls rcorlrr ol rcritry rhd I 3n li(n$d und.r l,t)vino. ol ch,t'lc! e (..nrmnuinB * h Suii,n 7(xlo) of DivN.n .l <br />ol rh. lnsix\s an t Pof.$n)ns C( c. dil ny liccnsc is ir full Ltrcc .nd cller <br />-t ?rr SS-s-5- <br />CONSTRTICTION t ENDING AGENCY <br />I h.rcby rinnukl.r lEnuhyo, Frjury rhar lhcrc is a.oldtuction hnilins ascncy tut rhc Idroinun c ollhc qolk lnr *hiuh rhis rrnit it <br />ilsxcd (S.c lLq?, Civ. C.) <br />APPLICANT DECLAXATION <br />I lErl'y alrm rndcr Fnahy or Frjury onc or rhc lollowib! JelaRt ions <br />Dcmririon PcrnnB-Asbcslo\ Nolrllculn r l;edclal RcE! kl Nrs lTnL .r0, Pd6) <br />Rcquncd L.rr.r ol Nori,Eari,n <br />l..n'lirhri rhc l.!l. lrrSu[rtr,n\ r.!rdng r\bc{os rcm,vr I d. n!( inn]rrhlc r) rh'\ pr,tc.r <br />_I .cnili rld I hnvc rc l thn {dicattun uxl srarc ih.r rhc lbvc intumn tr r cor.cr Llrd Io comtly wilh all Cny rDd Counly <br />ordinrN.s anl Stur.l-uwsftl&n8 b hulldxr! .onslru.non, .nJ hcrcby rhis Cxy,'d Cou,ty lo.nt6 upo, tlr <br />o.t,2-19-L\ <br />rhx. nrtrri(,ul pn,pany li,r dsJf,.tro <br />Aldi.lnr or axot six .h,.r.o,t P t.J 7-t <br />UFER Ground <br />T-Bar <br />Sccton 11116 o, rh. tllrtrGxl., idc'rn nnd iuorncy\ <br />o,r., Z-r 3-z I .."n*^,,\lr 7 t0t-z- (,* ocrttr it ,,'c .