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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEREUILDER DELCARATION
<br />I lrrcby lllirm u cr pcnally (, Frjury rhar I m cknrtr lrun rh. conhcnxr Lcctrs ljw tu rhc tull,,winsi.a$. 1scc.r!:11.5
<br />Brnncs a P!,acson Cc{.): A.y ciry or Cou,ly 'hrh rctllncs , lem n' coiirud. axcr. mPmvc. dcmolth or rcnat any
<br />drucrur.,onorrr s ls{r,ncc, iko rcquncs rhc aoDlicanr lorsu.h pcrmir k' liL i sisncd nalcmnl rh.l lEor drc n li..nscd pudu,nr
<br />ro rhc F'vti()ns o, rh. Contx.roas Liccnscd ljw (Chrflcr 9. CommelErn8 *irh S.(rion 70(D of Divisitn I of lhc Busmcss an!
<br />Pn .sons Cod.) or rhdl hco!shc scxenur lhcrclion and rhc l,arir lir rlt dlL8.d cr.rPrion. Any v{'l.lionolser n'701L byrny
<br />q'tlEdnt n)r a pcirn subj(ls rhc amliL,nr b r ciql lcndr, ol nor nn,c rr'u fivc hundretl Jnll{s ($500)
<br />-1.
<br />a\ owncr ol lhc pnlEdy. or ny c,npnlye! wilh w!sc\ !s dri, enc cohtcn\d i, w,ll do rlE vork d lh. ner@ is nor
<br />l.frl&l or {ficrqi ltr slc (Se.7044. Itrsiftis hJ Pnna*on! C,xi.r Th. Contra.ntr s Liuc.sc ljw dds nor .rply h d oqncr of
<br />rhepn,Fny whoh ildr or in{ft'vcs ltuB)n, snd who tn$ such md( hmscllor hc^clfor thtuueh his or hc, ow. cmnlorec\.
<br />povrd.d rhrr su.h mlDwmnh mnn inrcRlcJ ffofiia ntrsh.ll. k)qcaci rlr builli4 or rtrtFovcmnr tioB wirhin oi. r.r
<br />ofohthriln, lh. Owncr Buills will h!rc rhc llurJ olpm na rha h.oishcdil nor btrru or iml,nrrc i.he poFny forilt pib*of
<br />-1.!sowrErolrhcFJl.ny,x
<br />cr.lunvclyco ra.lh8 wilh li.cnscd uonk.ct,s ro.anrrocr rb. Ptuj&t (scc. ?044. Busi'rcs
<br />,,rl Ptlhsl)n Cod.: Thc C\nrB.rn s l,iccnsc l-aw &rs lor apoly t, d o*n.r or pR'F ywtn) huiLjsor imF)vcr rh.rer,
<br />atu, who qr Bch tur srh ptuj.ck wdhn conra.ro(s) lrcnscd Nsuanr b IhcCi,nt,.kn'I l-icchsc Lae).
<br />_l "mcrcn,tr ufticr Sccton . B. & P.( li,rrhr rcrn,,
<br />]!oB6E8S:CA!!EDN[Ar]O!!!lr4!.4f&!
<br />I hcreby alltrm utulcr Fnillyolpcrjuryonc ol rhc folk,winS dtluri(,n\l
<br />-I
<br />hrvc jrxl *ill mai.lain.CcnilE.lcofConenr ro Scllln\urc lbr wortda .tnIEnsr!.n. as lovid.d nn bySeri,n r70o orth.
<br />L:bor CoJc, lor rh. pcrtam ol lhc wrlk tur whrch lhc llcmil s hsucJ
<br />I hrvc anJ w'lln'rtr a workcF..nn nsrron Nurln c rs rcquilcJ tySccrtr,n:1 C:rdc, ttr rhc pcrbrn,rrt. or
<br />I't''r'^tt onaj--Na
<br />^tvraq_g o I z o
<br />rhc perlnrmnucolrhc w.rk ntr whrch I \hrll nol cmpl,'y rny pcFon rn nry mrn
<br />{) r\ t, h..onr \uhFcrk,rhc*orkcr\ ro lncn\dnr, lJ*!ol
<br />workcis'cohp.nsrtonpRrrtotr\ofS.cr'onlTUlofrlrlihrCGlc,lshrll.ttn[* h(onfly w[hrkR Pn]vsnnr
<br />WARNING: tuilurc b *.urc BDrkcis comFns{i,,n ..vctuE i\ nntrwhrl. dfrl shall cmnl,)ycr i' .n'n rl lctulrics rnd
<br />rnr. Jrnl,3cs rs tfl,v'd.d tur rhc.ivil l,.ci up to dft hundrcd lhousln'.I dollss (Sl0o.0ol)). in
<br />CoJ.. n .r.n rnJ rrrnrr! \ rc.\
<br />.?.
<br />tr.1 t.\R\Il0\
<br />I hcrchy allirm unJcr J'ctrlllyol pcljury lhd I m lr.s€,i unncr p(,vnon dl Chllnc 9(ommh-.iry wirh S.cridr Ttv.l()) ol Divfk)n:l
<br />of rhc Buin s! rtrJ Pn,L$iors Codc, d my li.cnsc G n tull t}R! rxi .ljccr.
<br />+c34 40 s
<br />0
<br />CONSTRUL-T!ON LENDINC A(;ENLA
<br />I herchy afiim udcr pcnllry oipcrjury rhar thcr. ^ r conslruchon lc.din8 iscn y nlr lhc pcrlodan& orrltc Rtrk for uhnh lht rmir n
<br />trnRd (se..1097, civ c.).
<br />APPT ICANT DE(]LARATION
<br />I lur6y allm unncr pcnalry or p.rjury oE orrlr tnlbwinl dcclarahons:
<br />Defrnirbn Pcrmin-Asb. os Norificarb. FcJcrrl Rceuh nhq (I lc 40. Pd6l
<br />_Reqrtcd tr(cr of Nril.,6n
<br />l.cnilyrhrr I hrlc !.rJ ihn rtrl riin,trtri is.orrcr. I r8rcc n, con,try qnh rU Ciryiml Counly
<br />onlinrnc.s aft] Sr.r. trwr dhtut8 ra bu r.prc\cdrrrc\ olrln\ C yrtulC.utrr
<br />t
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloorivenvlnsu lation I
<br />Roof Sheathi 1/J,t%,'4n<./n\+
<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 Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />I
<br />FINAL / I-Y'l.x> 71 lnlo{
<br />Certilic of u nc
<br />Notes,tC
<br />2L u
<br />Forms/Steel/Holdowns
<br />/f/Vnt / pq4wv
<br />'.r'L u'/
<br />rtrl aSrcc r[ il I sk,rld h.c. E sub].d tullE
<br />IxnJcr\ AJJns
<br />-
<br />I.cn,lylhri rhc ,idcril ft'sulalnns rg{iina ,\hcn.\ Emoral ar. or rftltdhh t. rhN I'r,1..r.
<br />2o
<br />I
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