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BUILDING. INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNI]R !IUII,DER DDLCARATION
<br />I hcr.hy rmm under p.nnlry o{ I.iiury thd I m .i.mDt fmn rh. Contrhr Li..nr. Lrw ntr rhe foll.qin8 E.s)i (Se 7011 5
<br />Busines afrl Pn,fe*ion (i'd.) Any City or Couniy *hich r.qut.s r p.nni h con{tucr, ah.r, inDtule, d.rFli{h .r rcn,n iny
<br />\nrduft, tri, b irs nrumc...ko rquiE*rh. iprlranr titr such lkrnn ro,ll?. $i8n.rt n enrn( rh.r h.or sh€ n lic.nkd puNanr
<br />h rh. pnrvhins of lh. Conkaciois Li.nr.d Law (Cbapr.r 9, Commencins *jth S..tion ?UX) of Div^i.n I .frh. Busin.s nnd
<br />h,f.sioft Cod.) or rhar h. or \h. i!.r.mpr rhd.fro,n a,'l rh. hrst f{n rh. alLs.d crcry{in. Any vi'r!ib! of SdD. 70:l I 5 by any
<br />afl'li.ini ntril'.rm( suhrarts rh. inDli.anro r.ivrlt'..ahyolnd mrcrh3i fiv. hundr.J doll \($500)
<br />-1.
<br />rs or'rcr.frh. I)l.IEny. or myemphy..r sirh w+.s rs rh.n s,k c.'ry'€nsrion. will&' tlt sort aRl rrE rduE ir mr
<br />ini.rtl.d or orl.r.d for sak (S.c 7l!.1, Bu\ims trnd ltof.$ion\ Cod., Th. Contrdois Licens.ljwd*s iortrl)plyo m orer.f
<br />rh.nqknywlvlhoildsorimom *hnns.lrdrh.Keiforinmu8hhNorh.rovn.mphy..x.
<br />nx,lided rhd \uch impmwmn6 e nor int.nded or,'lttRl f(tr sL ll h'ftEi rlr hiklii! o. i'rfnrvdEnr t yrkl qthii om tls
<br />of.omrrLti)n, rlE OwRr ariu.. will hav. rlr tordrn of Imvin! rhd lr or n\. drl nor hdikl n imDnn! !h. tmltdy lor *E IUIIM oI
<br />-1.
<br />iro*kr Dlrh. rrr.n), ih.r.turiv.lyc.ntrerins oirh li&n{ contRn$ n' &Ji{ru.r r h. I'n,jd (scc ?(ua. Busin.s
<br />and fh,b!(nnC{de Th. CDnt.cntr's L Ens. Lir d,rs nor .mly ro in nri.r .f pnrF ysh. huildsor imrn,ves th.reon,
<br />atul vho c.nr.ck lor qtcn tml,< s wnh a Codnrron\) li.enrd Duruanr!, rhe Crofircrois t-i...k1-x$)
<br />I am.r.mt!r und.r S.dn,
<br />tvoatrEali:caurrNsArrQ!
<br />DIicl,AA6IQ!
<br />I h.rchy afrirm und.r Fnalry of p.rjury oE of 6. finh$ing ddarariotrsl
<br />-,hrvca
<br />lwillmiinrsinac.nilFareofcoikn(bself.lnlur.n,r. e6'srnp.ns i.n,r pR,vided fi, hys.crn,n l7m ofrh.
<br />Lrhn Cdd., nrrh. Frtorroi.. ofrht wo f(, *hich rlE p.mir n i\\u.d.
<br />f-Ill*c aad *itt ndtntatn qort.is c.mrEns.ri,i insunn... rs nluna, hy sei k,n r7{ir or rh. Liho, cid.. ro' rh. ,ErtDlrrrd. or
<br />comD.n\arior insor ,cc cinis.nd Frli.y nuDh.r ar.:
<br />-lc.niryrhnr
<br />m rhe Frfornrn.. ol(hr wo,k fd shich rhr pernn n ir\DeJ. I \hilln.r .mpl,,y rny p.r$n it any frintur
<br />n)ast,h.(ntu\uhj.crhrhr*orkcn.onD.nL[io la*s of Glif,mix. M i!rte rbd ifl sh)ukl h.d Euhj.dbrlr
<br />snrt.6..mp.nqrionpmvkion\oaSedion:r7(x)ofrh.lrhy('Gl..lsttrll.fonh$irhco'nnlysirhilt'im)lnn,n\
<br />WAltNlN( hilur. h *cur. ro'k.r'$mn nui,,n .overq. i\ unhwfu| rnd \hall ruhi(r an .,nnl,)ycr tr d,niiil n n R\ itul
<br />civil fin.s un nr on. turdr.d rhrusrnds. i{ nrA,n,k Lrh{ 9d.. mrrc(
<br />"",.. - ) /7Ll:7,J)
<br />r. in rddirion h rh. con of n,n, daroBes .. rnrvided Iu (h€
<br />!.]I(L!-B[1]!\1
<br />IhcrhyrffinnunilerlenahyofFrj0ryrhdlrmlic.isRlnnd.rlln)vi\i,)nofChrnrn9(o,m,mncin8wirhS.cri.nTrxxr)otDivi!i)n.lt
<br />ot $e Brsin.s .l ,'roL$i,'tri (_,)d.. i,il my licen\e k in full finc. and.ffecr
<br />,.r-*rr*,, : C ,?6 ),
<br />".,.' r-'{"-{(lll-t!!ll-1j!ll-lJ:ll2lll|l!ilM
<br />Ih.ftbyaflnmund.rFnrhyofnduryrhiithcEh|.on$rucrinnL.din8at.n.yf rh. n.rfomna of lh. sorli for *hich rhir ldmir ie
<br />i(su.d (se :109?. civ. c.)
<br />AU:I,II;ANLIIDIIA.8AJIION
<br />I lErby lflm under Fnrhyolp.rjuryon. of th. n,lL)*ing d.clrarionsl
<br />D.mliio, P.n.n$A$.{ns Noririclrion Fid..!l R.Euhnois I ritt.r0, Pd6)
<br />R.qutcd tx dotNorifr i(m
<br />-!rlyr.L|rcnt\tt \n< FtuDtr. !J,,.n,r'rfrhc'ht.rorhtrrn,"1
<br />PlW"u,n, n*, *.,u ^'\ ir.,..,tr.n {r,.'rL,hr rhi.'nr,rld'n h.rnn, r r.d n'. o
<br />',,r,linalia.. xlls'Jre Lrn.E'rins r.hu'Uin!.rtr{tu r,n. 'Dlh.'.br. hr7.r.E.\.nL(r...1'hs
<br />pJyrirhall Ciry aid Counry
<br />rllv. nrnrbn.d pnrlEny nn in\r..rioi
<br />A ,licnnr.r AE rl Signnrtrtu
<br />r)
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing ,-28'A F 97f-2tu',; z,
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL V-3'k'i2 ,ZOt'er n.1+
<br />Certif icate ot Occupancy
<br />Notes , Remarks, Etc
<br />--L
<br />Rc.v 0B 07'2015
<br />,,"",*"r,,.;A
<br />Pool Fence
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