BUILDING. INSPECTOR RECORD }''
<br />SITE-WORK DATE lD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUlnsul.
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL I [, -t I i'c7
<br />Certificate of Occuda r{cy
<br />Notes, Remarks, Etc. v
<br />OB.rBuild.r DeL,.lion
<br />I h.r.by .fiirh undd p.Dlty of pdjrry rhrt I m s.hpt form dE ContoctoR Liccn$ tr* for lhc lollowin8 raon Ga.?031 5 Buinqt
<br />.id Pof.5lion Cod.): Any City o. Couty which ,.qun6 . p.mt to @arfu q ![q, impoE, dlmlilh or rcpt uy .tudurc poo, to ir.
<br />i8u!nc., rko .cquirs rhc .ppliq tor Dch pesi ro fil. ! !i8n.tl ilrrcnor !h.t h. ot th. ir li..ed pudul ro 1n. proviriod oftho
<br />Co tucror'i Lieed Ltw (cblprs 9, Comcncing with s@rion 7000 of Divilion 3 of th. Bulir* ad Prof6lioB Cod.) or thlt hc or
<br />.he B qempr lnq.&om.nd thc baa fo. rhc lllcScd q.hp on.Ary viohtion olSsrion,03Lt by..y.ppliqrt for r p.mit !!bj.ci! th.
<br />.ppliqnl io a civil p@hy ol rct norc L'un fiv. nundr.d dolk! (1500).
<br />_1, a oMq of the Drop.ny, o! my.mploy.d wirh Mad $ dE 3oL conp.B{lo,L will do !h. work.nd tn. slhcrdc ir no! inlod.d
<br />or od.rcd for sl. ( Se.?0a4. B$ind ind Proa*lioB cod. Tn Contilctoa! LieM Lrw do6 mt lDpt ro h ow ofth. Fop.ny
<br />wno build! or inprov.s th.r.oq lnd wno dod tucn worl hiDalf or na!.lf or il[ou3h hn or h.r oM dDloy.o, providd drt'uch
<br />ihprov.m.nE&.nori.nd!dorofer.dforsaLlf,how.v.r,1h.buildingorihprowm.nti!eldwnhinolcya.ol@mpldio4lhc
<br />OwrBuildf wiu h!v. rh. burd.n of p(oving thll h. or $. nor build or ihprovc for lh. purpolc ofsl.).
<br />_1, B oMq ofd:. prop.,ty, rs qchliv.ly @.r[.rirg wiln lic.N.d @nk!.!o* b oErrud lh. poj..t( s*. 7044, Buine ed
<br />P.of.sion Codc: Thc Cont.dor'r Liedc t w doq iot .pply ro 6 oMa of propEiy who buildr or inprovs rhsdn, lId who
<br />coiEAcl! for 3ucn proj..s witl r Co.&.cbr(, Icd.d plaufl to rh. ComEdoir Lic.n!. L!u)
<br />_l 16 .x.mpi und.r Setion
<br />-B
<br />& P C, for this r6on.
<br />D.t : OBc:
<br />I,VORKERS COMPENSATION DTCLARATION
<br />I hd.by Atrm und* pcdry ofpajury o.. oftlE following d*hr.tioB:
<br />_lh!v.lndwillmi .in ! C.nifi6t olcoB.nr io S.r-lEu. for srk@'onpcedotr a providcd for by Sclior 3?00 ofdE
<br />bbor Code, for 1h. p.rfordnc. ofd. *o* for Btich th. psnn i! Bu.d.
<br />_t h!v. md wiu haint in eo*6' @hp.c!1ion inruEn ., u r.quied by Scc-lioi 3700 of6. hbo. Cod., for dF D.rfor6ne ofth.
<br />*hchln6 pdhh E Lru.n Mv woi!6 co$D.n$tio. iNur.ncffi6&d policy numb.r ucX :tale+r,n.)
<br />rori"y r.,uo@'pi,*,
<br />(ThL s.clion ned noi b. @npla.d ifth. pmn n fo, on. hui.!r.d dolha {t100) o! lcct)
<br />z,-01
<br />WARNING: FlrluE b *ur. worL6' @npcBation
<br />firB up to on. hufrdr.d lnousDd dolha ($100,000),it
<br />rhc Lrbor Cod., in&rd Md anom.y'r f.d.
<br />-\ \-r Y/o'*gr " unlo\#"1rna ruiiibr..l .. .nplorq ro eihiulp. 116 rid oql
<br />rddnion to rh. or 6f @npd.rio4 d.dgd d previdcd for rh. Sdtbn 30?6 of
<br />LICENSED CONTRACTORS DECLARATION
<br />I hocby !fflrn unds pcmltt ofp4jury rhrt I u lic. cd udd povirion ofchlpG 9 (anfr?n ing wirn S.clioD 70OO) ofDivision 3 of
<br />in.BusiDss and lrof6sioDs Cod., lnd ny Iic.E. is in tuU fore lnd.ft clI L,o (.
<br />CONiSTRI'CTION I ENDING ACENCY
<br />I hqcby lffiro sdq p@ly of p.rjury dur dE& is ! .oaulclion Lnding rgocy for $. pffomns of fic m* for which thi. pmn it
<br />tsu.d {S.c ,097, Civ. C).
<br />APPLTCANT'S DECLARAIION
<br />D.nohioa Pmhr.AlbBros Notiflc.tion !.dGBl RcsxLt od Onh 40, ?!n 6)
<br />_ R.qun.d ktld of Norifidtion
<br />_r c.diry rh.r de f.ddil rcguhtions rqudin8 6b6tos rmovll !r. nor lppliobl. 1o 6is prcjccl.
<br />I .cn,ry th I have .od tni! lpplicario. a.d natc rha! the ibov. inaormdioD is cor.ct I lgre lo coftply wilh all Cty lnd Counly
<br />ordiMnce lnd St!t. L.ws r.hling .orotrudioA snd h.rcbyaulhoria epG. !tiv6 ofthi! City ed Clutyto 6t r uponth.
<br />abovc hcnrio!.rl propqry fo.
<br />sDocrion Forms\Buildino-lnso€ction Romrd.doc 31
<br />T-Bar
<br />I cenify $!t i. rh. poform.e ofrh. woik lor whrch tlit p(ni!
<br />b.can. subj.cr to th. work.c 6np.n,arion l,ws ofc.lifo.niA, sd
<br />compcnialion provbons olScdtion 3?00 of th. tlbor Codq I shaU,
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