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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS oTVNER BI.'II,I'}:R DEI,CARATION <br />I hcrchy rllirm undcr Fnalty ill l--rjury lhnt I AD c\cnrpt liun thc Contrack)rs' l-iccn\c l-nw li)r thc li)ll)wing rcas(D (S(-c.70-11.5 <br />Busrncss rril Prol'cssrrn (irdc): Any City or CrNily which rcquir!-s a Frmit l() constnlcl. allcr. inrprovc. ,lcmolish or rcpat any <br />stnrcturc. pri()r lo it\ issudnc.. {ho rcquircs lhc ipflicrnl li)r \uch l*rnril tr filc n signcd statcrncnt that hc or shc is licenscd pursuant <br />t) thc provi(ion1 ol thc Contraek)r's Liccnscd l.aw ((hxplcr 9. (i)nrmcncing wilh Sccl(rn 7(XX) of Division -l oithc Busincss and <br />alplicantlirr{f-^rnrit\uhjc(tsthc rpplicintk)aeivilpcnrltyolnotnx)rclhrnlivchundrcddollilrs($5(x)). <br />\nlc). <br />anrl wlx) (!)nlrrcl\l()r\uchproi.(l\wilhi(inilri(l(tr(\)li(crsc(!plrr\ilxnll{)lhc(irilltel()r'sl-iccilscl-aw). <br />_l rnr cxcnrl)l lrtrlcr Sce lr)D . R. & P.( . li)r lhis rcns()rr. <br />lhte:- <br />w()laKIatts' ( ( )t\IPtaNsA'iloN <br />l)ta('t,ARAt r()N <br />lher.hvilllirnrilrxl.rlxn:rllv!)llr'rlrrr!1,,k(,llhel(,11,)t\rrr!rl(\l:rtxlr,rr\: <br />l-ahrr Grlc. li)r thc pcrlitrrMn(c ol lhc win k lor whi(h lhc Nr trril i\ is\u\!. <br />thc w(trk li)r which thi( INrtrril ls issuc(l. Mv w(n'kcrs (1)nll)('n\nli(rl in(uun(c can'icr dnd F)licy numhcr iuc: <br />Policy Nunrbo:_ <br />-lixpircs: <br />so ns tr) lreotrtr' suhjccr l() lh(' w{!rkcr\'conlh-[\ali(nt liws ol ('ililirrnir. r[(l urcc lhrl il I should lBconr suhjcct k) lhc <br />itlnncy \ li.c\. <br />DECT,ARATICIN <br />ol thc Businc\\ nnd Pn)li\si{nr\ (ixlc. ilrkl my liccn{ ir in lull lirrcc uxl cllccl. <br />[-iccnsc C Nunrlrr: <br />( <br />CONSTRUCTION LENDIN(; AGENCI' <br />issucd (Scc. .1097. Civ. C.). <br />landcr's Nrnrc: <br />Lrnrler's Atldrcss: <br />APPT,I('ANT DECI,ARATION <br />I l.rcb], nllinn undcr l--ilnlty ol Itriury onc ol th!' li)llowinS rlcchrati(in\l <br />Dcm()lit()n Pcrmit\-A\ttr'\tos N({ilrcrtion Ijc(lcril Rc8ulilli(rrs ( l'illc 40. l'rn6) <br />_Rcqurr.d I -cltcr ()l Nrnilicrt(nr <br />-l <br />ccrlily lhnt thc lc(lcrrl r!'8uhlr(nrs rc8tklitr! r\hc\l(t\ rcrrx)\'rl iIc rx)l rpl)licnhlc l() lhi\ pi)jcrl. <br />(nllirrrn(c( rn(i Slrlc l.aw\ rcliling lr) hllil(!in8 rr)n{lI1r(tir,,l.ol lhr\ ('(v rn(l Counly lo cill!'r uF)n th. <br />rh)vc ilrcDtIrNl pr0pc,1v l(n <br />Appli({nl or Agcnl <br />Itcrnril(,(.rxrtrr <br />t)ll <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/Vent/l nsu I ation <br />Roof Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Eneroy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />[Vlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif. <br />,/\ <br />FINAL z-7A-74 ljllrlLr <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />"*",{rz/tE <br />,*", 7/21t2