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BUILDING- INSPECTOR RECORD
<br />COMMENTSSITE-WORK DATE
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Shear Wall
<br />lnsulation/Ener
<br />wallD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonr
<br />Pool Fence
<br />T-Bar
<br />Handic R
<br />De Final Re rtut
<br />En ineer Final Re rt
<br />Flood Zone Certif .
<br />-zz-FINAL
<br />Certificate ol Occu anc
<br />Notes Remarks, Etc.
<br />OWNER BUII,DTJR DELCARATTON
<br />I hcrchy arftrm undcr Fnalty,, Fqury rh.r t !n crcnlr to rhc adnkrnn- l-$trs tj* tui rhc truowma rc'ern (sc''?oil l
<br />Busincs , P(nasio! Cdlc)r Any Cry or Coonry shirh rcqurcs r Fnnn nr .ondtucr' .lrct. mn!'Y', &molrh ' rcnrt 'n,
<br />sruclurc. nrstr b ir\ rsu!trrt. rl\o rcqoii( thc r{,plE.nr l'o. \uch Flnnl l,r lik r !8kd narcmni rhrr lr u shc is li&n{d 0nsulnl
<br />n) rhc pn)v(knN ol lhc Conrr(kr\ Liccnscd La* (Ch.Pr.r 9. C.flrncncLn! qith Sctrion T000 .l Drvisioo .r oI th' Busin'* dnd
<br />Pinasnons Codc) or ih3r l* orsltr F c\cnrnr rhdcftu and rhc hlns lnt thc allclc,l crcmtrDn. Anvvid'rtr"dtS"lion 70115 hy'nv
<br />rrpliu,nrl,,, rrem[ $rbjeols rhc , 'hrtrr to {uivilpcnahyornor nxrc rhrn tiv. hnndtcd Jollrs(t500).
<br />L N owncr ol rh. pbpcny. o ny .nfkty.cs w lr w33cs ri rhctr $lc conlEnsarion, will ,lo rh. w.lk an! ll* nrurm is n'r
<br />inr.rial nr.ftarcn Inr \alc rse.?(l14. llulinc\s and Pnnass.ns Gnlc: lh. Conrh.ktr \ L,ccnsc Lr* Jocs ndr amlv lo u own( ot
<br />rhc pn'Fdy wln, bu is or opmt\ dmrn. who&Esnchmid(hnns.llorhcncllorrhDughhisothcrowncnflovccs.
<br />t)n,rd&l rlur u.h inrr$rcm.rs m rtn dcndcJ or ol1 Rl h, srh Il lnrwcv.r rrf, lnriLlinS o. imnmvcmnr $ n'U wirhin dnc ,t
<br />;ro l,k:lDtr,llEO$*Bu lcrwrllhrv. rh. t{nicn ol Druliry rhf,r h.or\hcdd fr, ht l or inrPNrc rhc pmFnv ntr r& Nllrr$ oi
<br />l, r\owncrol rhc t'rop.ny. a'n.xctulv.ly..nrt?.ring sirh h.nqi lotrtr(k,^ b c.n(rucr th. pt!.cr (Sc. 7l!4 Bunnc$
<br />$,1 l\trla$krCo,L:thcConrra.nr'rl-r.nscLdwd@snolrpllyk,.*n.rolProPcnvwh('bu'U\nrrn{nrvcsrh'rcon'
<br />inJ trho conr.crntrurh tmjccrs wxh a ontrcro(t liectrscJ pur\umr h rh. Cofir.ttr's l*cns l.rwr
<br />I umcr.hrr utr,icr Sccrirn-, B & P.C. n',rhi\ rcr$n
<br />woRKEX-S', COIII ANS TION
<br />DECLARATION
<br />I h.rcby tm utulcr !.nalry or t'djury om ol rh. follo*ine dc.hntn,ns
<br />I nlvc ltrl wrll minrrh ! Ceniicxr. olConscnrb Sclr_lnsurc ntr *o,kc6' compcnsarbn, $ F)vidc!,or bv Sc'rn'n lT(xlorrhc
<br />btdr Orle, li)r rh. Frfomr.ncc ol lh. wo* nr which lhc Pcmir $ 6sucd
<br />-l
<br />h.r ud uill hninun workcs co.f.nlrton rnsuEn e. as r.quftrl iv Sei t,n lTtD of rhc Lihot Cod' ttl rhe Frrolmmc ol
<br />lhc xxk turlhichthis pcrmir is issu.rl. My worksr comn ns,hon insumnce.riq drlFlicvhxmb" m:
<br />l.cniyrhrrinrh.t)crforme-.cofrhc*orklnrwhi.hrhx!. n r sn'c'1.I nllllnol cnlPlo,anv Pccdn in3n,nrincr
<br />q' Nbh.oft subie.^l brhc workcs' .o nrtc n\rr on lrwsolCallll)mE. snd 4e rhar ill rhould bc.om srhlccrt0 rhc
<br />worlcF co rpctrsalionpovnn,n\ofsc.tirn.lT(){ofrh.tibrC(lc.lshrll.lorihw h .onPly wirh lln}$ tn'vllons
<br />wlnlnC i'o't,.. t, ..,* -urke6 conll}.ns,non c-vcnec is u.ldwrul. lnJ shrll suhjcct an cmlk'vcr b sini'ul tEtr'hics m'l
<br />civrl lincs u0 b onc hundrcl lholenJ dollrr (tloo.o(n). in aJd (nt lo lhc .on df compens io' dimtcs as lr vtrl'J nx rhc
<br />Sc.rknr.1016olrhc Laltur Cklc, inr.rc{ .nd ftormy s litt.
<br />Daicr- ADDIi
<br />UIENSILqONISACIO8
<br />DECLABATION
<br />Ihrdbyrtlirnuftrcrpcnalryorocrjulyrhrrlamlcns.nundcrpn,vtonorCluprcr9(co.rEnuins*irnSetr'n?000)orDivi(ir''1
<br />ol rh. Bu\incs .nd Prulcsion\ Codc, d my nccnsc is o tull l(}ru. axl .tlccr.
<br />Lr.tr\cChs
<br />CqISItsuCIONI,INOIXGjj;NNCI
<br />I h.Fhy rfltrn undcr licnrlty ol pctlury rtrar rt'crc i" a .mslrucrrrn Eftling nlctuv lbr rhc I}. nrMtrcc ol rhc work l{tr which rh' Fmil is
<br />isruql {SN .1047, Crv. C.)
<br />APPLICANT DECLARAfIoN
<br />I lrrhy tmruntlcr lEulry orFriury o.c orrh. rollowxrs Lrccld,arnrn\:
<br />Dcm.l !,n P.rnn$Asicnos NoulicdL.n lrcder{lRclular'on\ (lrrlc 40. Pd6)
<br />R.qutrcn lr(crdl Ndr l.ii(tr,
<br />-lccnn-vlhal
<br />rhc rcJcrdl rc-rulllions rc![Jms ashcnos rem,val &. nol {di.rhlc ro rhr tln)jcar'
<br />-1..n'lyrh
<br />l h.vc ral rhii atdEx n anl drrcthdr lh.abvc inlnnrdon $cotrccr.I.ErerocomPlyrfhrllCrryandCounrv
<br />-r&r*s'a Sr.lc Lrws rlxrirtiio t'uiLlins oi{o.rion. lnr hcrcby,trrrnnizc rcnr{nrarvcs ol'rhis Crr tnd Cou'rvro drct ur}nrlE
<br />il$vc n hroncdnopcnyftr itup.crnn pnr.'{s
<br />\pDlic{nr or Agcnl liEnaluF.-
<br />Pemilee nrmc (pnnl):
<br />IEEEI
<br />Set Backs
<br />Roof Sheathino
<br />Framinq
<br />I).t.:-
<br />r
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