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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation l
<br />Rool Sheathin s //:-44ns.itt
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />ryIr/ason
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL zls Dt*t n o \.fi 6a
<br />Certif icate ol Occupancy Ir
<br />Notes Flem arks, Etc.
<br />OWNER BUII,DER DELCARATION
<br />I hcrcby rrfinn und.i p.Mlry or Nrjxry rh,r I a .rc'nfl tnnr rhc Conra.lon Liccnk bw lor thc lollowire rcrv'n (Scc70:llt
<br />Dusinc$ ,nd Profc$ion Codc) Atry Cit, or Counry shich rcquner a pcnnil ro conslru.l. alrcr improvc- dc.blish r trrt rny
<br />slrucrurc. prior l{, ils hsulncc.aho lcqlircs lhc applicrnr for such pcn.ir ro nEasisned {r'cftnr rhrr h.or\h. n lrc.scd puAuonr
<br />lo thc pmlirions of rhe Conta.ror's Li.cns.t Lrw (Chrpr.r 9. C.nrm.kirs wirh Scctiotr ,m0 of Division :l ol rhe Bu\incss lnd
<br />PmltssionsCodc) orlh.r hcorslE t crcflpt llrrcliofl!trd rh! b.sk tu.lhc ntlc8cd crcn{'lb! Atryviolrrknrors.clioiT0ll5hyltr,
<br />rnplicnnr n u tcnnir subFcrsrhc trpplicanr tJ acivil pculryofnor mx. ihrn fiv. hundrcddollars($50O)
<br />-1.
<br />as owncr ol rhc !o!crty. or nry cmDloyces qirh wo8cs !s l,rcn sob conDen\al ioo. uill do rhc soA ,nl trt stu1r is ml
<br />inrcndcd or ofidr.d lor {le (Se.7(N.il. Busincs and Pmicssn,ns Codc Th. Conkr.ttr\ Liccne bw docs mr at y to mosmr ol
<br />th. tmp.ny who builds or irumws lhcmn. lnd who des such *rit hmsclfor hcr$lfor thrcuEh his or h.r o*n cmpl.yccs,
<br />pmvidcd rhar such i'npmknElt uc mr inrcndd o! oftcRl for $b Il howcrr lh. ttrildirg or ispmwnE is k,ld *irhin orc F{
<br />or compLrion. rhc Owncr Build.r will hlE rnc hndcn of pmviry rhd hc or shc dil tr.r buiH .. inD.otr IIE ImFny for rhc puryn{ oi
<br />L rs owftr of th. ln,l).rly, mr.xclxsivcly .onha.ring siih lic.nscd &nrr.hE lo .otrrlrucl lhl pr+cl (Scc 7(}|1. Buri,tcs
<br />rnd PnrssionCodc:ThcConrEroist-iccns.l,awdocsnoriDplyb.nowrcrorpror.n,whohxildsornnpii'vcsthcrcon.
<br />itrd who <, nds lor such pmjcB wirh 0 On hcb(9 liccnsd lursunr ro rhc Co.rradol s Liccos ljw )
<br />-l
<br />!mcxcnr uDdcr Scclion
<br />Dalq O*Nr:
<br />won,'Ls' cotnpr,'isarro,n
<br />PECIIIIAIT9N
<br />I hc]jt) Jflirm un.lc, Fmrr) "f lcliurynnc Jlrhc folln*irF dc(L,6li, 'a
<br />lLlr"* ",,a * irr *i"*i,'
<br />"
<br />ccd'ficarc or con\cnr ru scrf lnslrc ,n' *.'kc^ s'npcn$rion. 's Eovidcd ro. by sNriotr l?u) or rhc
<br />trt-r Codc,lorrhc pcrio.mrc. olthc *ort lor whichthc Frnrir h s\ucd
<br />. nrvc and will nkimain worko, compcNdriotr insur.kc, ns rcquncJ byS.crionsT00ofrhc tibor Codc. for rh. pcrfortutc of
<br />thc \f'k l(tr \l,nh rIn tc'n,y workcrJ .ohlcn\ar6n nNutur..Gricr i Oni.ynumb.rtuc
<br />el,lnlR, *,*,,Z
<br />-l
<br />cnilylhlt in rh.pcrl'onnanccoflhc wort lo, whichrht pcrmir is k\uc{l.l shallnor cnpbysnyr.rson in any n'an cr
<br />so $h bccom subjc.r ro rhc *orkcB conip..sdrnr hws orcnliromD. rnd rBEc rlur ifI should t .om subirr b rtf,
<br />workcrs.o'nr.nsatn,nlrovirionsofScclion3?(xrolrhcL.bo,Gxlc,lshlll.ronhwirhco'tplywirhrhMptuvisiotrs.
<br />IryARNIN(; F"ilur. t' *cur. wDrkcrJ..nr!.nntrion..v.dgc i( utrhwful. and \holl suhjat !n cmt'lo)rr ro aimimlpcuhL\ and
<br />civil fincs uf ro onc huMrcd rhotrsand dollffr ($100.(Xx)). in rddirion to rh. corr ol.omn nerion. d]rogcs.r ln)ridcd for Ill
<br />RUale
<br />DECIJIAIIQN
<br />I hcrchy rfimundcr pcnalry ofpcrJury thd I am liccnsd !trdcr E.vGion ofCtuprd 9(.o.rmncing wnh Soriotr ?Uro) ofDivisk,n l
<br />ol lh. Busincs,nd Profc$io.s codc. at nry liccn$ is h lull iore arnc&cr
<br />o 8,
<br />Z 0 t4 c o
<br />AITUCANLDICLTBAIIO!
<br />I hcEby nmm undcr pcnslry of perrury orc oarnc folbwinS declnrations:
<br />DcnFliliotr PcrnrirsAsh.sos Notilic0rion fcdcral R.Eul.rions (lillc4l). P0n6)
<br />-Rcquircd
<br />t.trcr of Nolifr calbtr
<br />. _l ccnify rhd rhc lcdc ral r.Er hr nnN Egfding a\hcios ftnrvalarc nor nmltrhlc r. thn [l(ist.
<br />!lrcnryrhJrIhr\cNaJrhrannl'. on dxl qJrcrhx, rhc trt[rc inftnndion hconccr.I nsrs r,r comply {irh rll ciry idCoutrry
<br />.rdin.mc\ rnd SI c lrff rLrling b buildin(.onnrudion. tuJ hcrcbyaurh.rizc r.rrcsnldivcs oirhn C y rnd Counr, kt cnld uPon rh.
<br />rh,vc ,.trri,nrl pmn nyln' iNl,.cri{nr
<br />\pplichnr or,t!.nt Si[trrlurr ,*," t fz_Ttz<
<br />Forms/Steel/Holdowns
<br />SLAB Floor
<br />,//)/b ,
<br />Ext.i lnt. Lath
<br />/z-9 .-,*.,*l[
<br />c!)NtlBlJcugNtENIltNc lNlI
<br />I hcrcby allrrn und.r tfMlry oftcrlnryrhar rhcrc h i cotrsructiotr lctrdirB ogcncy for rhe pcrl'ommc olrhc *orl lor *hi.h rhi( p.t.rir ir
<br />is{cd (SN. -1097. Civ. C.)
<br />I.iJ.''\ AJdr.$
<br />(brcra,
<br />?-o
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