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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfl oorA/enVlnsulation
<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 />T-Bar
<br />Handicap Requirements
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certificate E\,IttF
<br />FFN -l-nm
<br />FINAL
<br />Certiflcate of Occupancy o}{Ivrv o{J;zgu;DOO, tt6/
<br />Notes, Remarks, Etc.
<br />On r-Bundd D.clmtio
<br />I hfrby .f,im uidd p.nrlq of pdjury $.1 I h dnB fm rh. C6r.dn' Lh6r Llw fd rh. fouowiiS i8on G.. ,01 I 5 Dusi..s
<br />Dd ?ofcBioi Co&): Ai, Ciry d courty *hi.t dquic r phir ro c@rEuct, .lir, iFprov., dcmolhh or Eplir u, !$ucrurc, pnor ro iBlrem, rbo rqui,s t. l,plidl f6reh pmi lo 61. r lign.d tr.lddr rha h. d rh. ir lacorcd pusud ro $. Fovirionr of ft.
<br />Cdrr.td'r LiHr.d l- (clt$6 9, Cdll,cdl. wirh S..li6 ?o0o of Uvirid ! of $. Baii€r &d Profdidr cod.) or $.t h. d
<br />$. n .i.mri $frfffi 6d $. ban ln ln. .llq.d a tri@ ,Any viohdo ol s.cdo. 701I 5 b, ey sppri.el for i p.mn rubj{6 rl.
<br />lppliot lo . civil p6.19 of nd h-. d.n livc hui&.d dollu (l5c'0).
<br />_1. a Md of rh. Prl?.iy, or Dy .rDloys qith M8c! s fi.i ol. conparrion, gill do lh. work Dd rh. trud!.c n ,or inr.id.d
<br />6 offdcd fd .tl. ( S.c.704,1, Durird ud lrcl6i@ Co&: Tt. Cdtr!.td'! Licot. I-rv d@ nor .ptl, lo M own.r of rhc p.op.dy
<br />*ho build, or ifrFo€ lhffi, bd
<br />'o
<br />.lo.t ruch pqk hid.lf d hd.lf 6 thrcugh hir or hd Nn .mploycr, povid.d rhat ruch
<br />inprcvdntt e nol inr6d.d or olf.rld ln r.lc. If. hoe.K. drc buildin8 or ihprovrodt ir rold wirhin on. y.f of.onrt.tion. rh.
<br />Ow.d-DuilddpillMv.lh.bu.doofpdins$ h.or.h.norbuildorihprov.fm$.puAor.oarl.)
<br />_1, a end of $. F6Frty. h qclsly.ly coldiis *hh li.d.d @nE .rd ro.dnrud $. p.oj.d ( s.c. 704a, Bulinor ud
<br />Prcf.$ion Codcr Thc Cmltutor! Lic6r. L.{ dG ior lpply i6 6 @n6 of pro?ary *ho b{ild! q inprov.r rhd.on . &d qho
<br />coiftdt fo. luch projccB wnh . Cont!&o(, licd.d punu{r lo rh. Cdr6do"r Lkdi L.w )
<br />WORI(ERS COIltENSATION DFCLARAAION
<br />I h4cb, .mm und.r p.nrlr, oa pdjury o.. ol rhc lolloeing dElntionr:
<br />_I h6v. ed pil! mini.in ! Cdifici. of C6r6t t6 S.lfldu.. atr vort.B' c6hp.nIrion, ( prvid.d for by Sc.iion r?oo oflhc
<br />Libo Codc, for rh. pdrfo.nsc. of th. *dt fo. phkh rhc p.mit k i{u.d.
<br />_lt.vq.nd,illm.lillihwdt6'.dnp.nr.tidlnrlrscq,a r.qliEd b, Scctjor 37Oo 6f $. Lrb.r Cod., for rh. p.rfm6c. of rn.*dl ftr whid lhir poir i! irr!.d M, wdkd' .mpor. o iMc. cEi.r Ed poli.y nunba s.
<br />Policy Nmbr_8xpircr
<br />b. .omdad if in. pmi ir fd On. h!n&.d dolld l! l0o) n l.$)
<br />p6roouc. of Uc wdk ld *hi.h $h ptun it ir!u.4 I rhru nor
<br />of C.lifooi!, .nd .src. th ilI
<br />' cdp6siio..ovd8. n
<br />doll6 (l100,000),ii .ddition ro tn. coi of d provid.d for rh. S.dion 1076 of
<br />LICf, NSf, D'ONTRACIORS DECLAR{TION
<br />I h4by rfllm und.r p6.lry ofpGjury $r1 6lta'.d !.dd prcvirio ofclrprr 9 (
<br />th. Bulin6r Dd ircadtid! Cod., dd ir in lull forc. rnd.{fcct
<br />olpdjurylhrt rhd. k. cohnodion lddins p.{ffirnc. of th. wo* fd whi.h rhi! p.mn i!
<br />1097, civ
<br />aPll'tc^lYr.s DECI-AilTtoN
<br />Dmditio P@lit-AlbBr6 Nodrictrid F.d6l R.Bul.ri@ (Thl..o, !&l 6)
<br />_ R.quicd L.nd ofNo{fi..don
<br />bcohpry wnh lllCiry.nd
<br />$ora mati@Gd prop.ny fd LI
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<br />_l m .x.npi u.da S+tim
<br />-A
<br />& P.C. fo d1k Esoi
<br />(Thi!
<br />LI
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