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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS
<br />L d ow..r or rhd pmp. y. n.r.lu(ivcly .onhclinS wilh liccoscd co racloN ro .on(tu.r rlE l)mjc.l (Sa 7ul,r- Bu!rcs
<br />ind Pollssiatr Codc: rhcContlclor'sl,iccnrcliwd@snorrprlyk',downtr.rpropcaywnobuildsornnprovc\rhcr.on.
<br />, d who .onra.N ntr such pmlc.r eirh rConr.cr.ns)liccnscd pursulnr ro rhc Conkrctoas l-kcnk tle)
<br />-l
<br />a cxcmpt unds Scclio
<br />tr!)ntr[&s:-l:oMBlNs rloN
<br />DECLI"8IIA!
<br />I hcrcby rllirm undcr D.trllty oi pcrjry onc olrhc n,lbwinE d(hrarnnr
<br />-l
<br />hrlc dd will roirrain s CcnilEsrc of C(,nr.t t. Sclflniur. for workcK .rnf.nsor ion, a\ nmvidcd for b, Scdn'n 37m of rhc
<br />Labo. Codc. for lnc pcdomune of lh. w.rk for ehih rhc Ffrn k isrucd.
<br />.gavc ,nd will nrainrain workcs conDcnsol ion insurcmc. !s rclut d by Sdrk,n lToo or thc bbor Codc. ro lhc pcdorrone or
<br />rhh N nirF r.uc!. M\ unr\cr. .Nrl'.rtrutrrhcr,r$-r /. l-- IH.r
<br />-l.cnily
<br />rhar in rhc pcrronuhcc orrh. woik ror shth rhis l.nnl t nsucd. I shrll nol cnploy ony lctun ir tny monrcr
<br />s .s b b..onr subj*r ro rh. w.rkc6'con{,.n{rri,,n ls*s ol'Callbrnix- and asrcc rhrr irI sh,uld bccom suhicr ro rhe
<br />wortcs compctrslio. prcvisionr ofS€rion 1700 orihc L,h, CdL.I *hnll. tunhqilh coDply qilh tho$ Pm!isi{,i\
<br />WARNINC: lrrilurc ro surc *ork.ri ..nD.nsariotr .ovcr,ec is unlnwlnl. nnd \hall subj(r M cmpk,!.r lo aiminil pcmlrics and
<br />civil lincs up ro onc nlndrcd rhousand dolles ($l(D.fix)), ir rddnnrn ro rhc.o( of .ompc!\nri,,n, d,tugcs 0s Pnvidcd for rhc
<br />'.,", Atlzo i' crcn ddonf,y \ lt.\
<br />I hcmby iflin utrdcr pcnrllyoincriu.y !m li.cDsnundcr p'ovisbnof( hxtrci9l.o NcncinS wirIScc!htr TOXJ)ol Drvisiotr ]
<br />.r rhc Busi.cs Nnd Pofc$ions Codc. a{d mylicensc h in lu0 bN 3Blc8c.r
<br />6 ta s?37/
<br />c""'*"*, C(ezn Litrr},-L
<br />CONIiISIJEIIONIIiNDIN(j.ACINCI
<br />I h.Nby dlnnundcr ll.trlllr, oltcrtuyrhil lhqc n aconnruclion ktulins racn.y nr rhc Frfoirruncc ollic sork rn shi.h rhis It,mir il
<br />is\ucd {str. :1097. civ c.)
<br />APPLICANT DECI,\\ITION
<br />I h.rcby i6unds p..!lry orFrjury om of rF. follouinS dcchrllions
<br />DcBnirion Pcmns Ashc{os NoIiflc0rion Fcd.ral Rcgularions (Tiile40, Pan6)
<br />Rcquircd lrn.r of Nolilicar6t
<br />-lccnifyrhatrhctcdcElreEul,ri(,6sftgrdi.8Nh..senbv,l!rcnola,)pliclhlclolhnpbtc.'4:-r..nOr rn^ rn*" *,O,nh applEarn,n,nd dsrc rhi rlie abvc inronMrion N corccl I asre lo omnr, wrrh dll cir, rtrd counly
<br />ordiMecs xnd Surc hus rclDring h hilding .on{flcoon. drd h.rcby rulhorir rcprc\c ny dd Counryro ctrrcr nEnrrlE
<br />itnvc mnri(incd nroocny tur in\p.crion purBxcs
<br />/tpoli.otrt or ,^E nrsi8nnrrrc ^", r/<zlbe,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Irrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL 2////-zlzt ,L-UXttoy
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />O1VNER AUILDER DELCARATION
<br />I hcEb, nttm rnder p.nalry ot pcrjxry thar I rn.rcmpr {n'.r rh. conr..toF Li.cne tiw fo! thc follo*ins rcaq,n lscc 7011.5
<br />Busnrcss lnd PmLssion Codc): Atry Cily or County which rcquircs o rmir ro onsr c'. ax6. inprcvc, dcmolish or aPat uy
<br />nDdurc, lriotro irs hsunce. aho requircs rh.!ppli., nr snch Frmir t, fiLdsisn d sdcmnl rMr h€orih. is licc s.d ,)ursuinl
<br />b lhc pruvtions orrh Conl$cbls Liccnscd bq (Chlptcr 9. Comrmncins ,irh s..rion 7un of Divisiotr I oI lh. Btrsinc* rnd
<br />P,onssions Codc) or rhar l.c o! shc iscxcnrpr rheEliomandrhe husn fitrrlrlllcgcd crcmrrio. Any riolariotr of S(lbn 701I 5 bymy
<br />arpli.anr ror tr p.mir suhjetrhc aptlicdnrrorcivilpcnrlryornorrrcrcthanfivctu.drcddoll s(S50o)
<br />-l-
<br />a\ owr, ol rhe popeay, or Fy cmpkryccs w h wtrgcq as rh.n n c .lnpcnsrlion- sill do lhc hrt a l rh. iduE ir mr
<br />imc sd o' oncrd ror eL (So. 701-4. Busircss ond Pmlcssnrns Code: Thc Conrroclor\ l.i.cn* llw dm. ml omly lo an otncr ot
<br />rh. polrny wk) hoilds or irqx,rcs lhcmn, anA who des \uch wo,I hihselr.r h.r$lror rhmugh hn or hcr owncnplor.es,
<br />t"ovidL{ rhri sDch nnlr.v.'Enrs N n.r intc*ldl or ofl.r{ f.r sk. tl howcrcr. rtE huildiry or ir'IlnEmnt issHwirhinxft Jtr .
<br />.Icotutk,ion, rhc OsM Bxildur will turc rhc bulc ofpr,vingrhnrh.o.sh.dil dn huiu or i.grnrE tc topeny for rhc puqn{ ol
<br />p.t \N*r*, 7b t-, r:OAAb llcs z-- ,.-,,',., Er/ll / 2t
<br />/zo/zo
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