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BUILDING- INSPECTOR RECOHD
<br />SITE.WORK ID/SIG,COMMENTS
<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 />Z'a"+4lFraminq6/'l/t< 1)i1,
<br />ln s u latio n/E nergy o 4
<br />Drywall 5t - fu.n on
<br />Ext./lnt. Lath e1u
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Depuly Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL \/41tc b6^b
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />(,WNER BUII,DER DEI,CARATION
<br />I h.rcby llilrnr ui,ler l,..dlry or FrJUry rhd I m.km r n rh. C.nk&rors Liccn* Lrw ror rhc lollowin8 rcmotr (Scc.70ll.5
<br />ausircss and Prorcsion Codc): Any Cilt or Counly which r.quncl r Fnnil ro cI,tr{rucl, alrer- inrprove. dcmohh or Nnrt 3n,
<br />\rddurc. lrior lo ir1 nsu0mc. aho rcquncs rh. lprlicanr lor such lEnnir ro filc a \isnrn \raremor rhar hcor \hc n lic.n{d Nrsuanr
<br />t, rhc Iln)vistm of rhc Conrrackr's l-iccnr.d l- w (Chrtrcr 9. ComnrNin! wnh Sc.lion ?0(D ol Divhion I oflhc Businc$ 0nd
<br />Piorc\sidnCode) orthrr hLorshc is.xcmpr rhcrfromrnd thc brsis fdrhc illrScd crcnrttion. AnyviohtnrnotSsrbn?0ll tbyrny
<br />lpDliranr r(. pcnnir {ubjccr.thc lrplicanllo rcivilicnihyolmr!m(lhrtr firc hundrcddolhrs(S5Ot,)
<br />Lrs owncrorrhcF)p. y. or nr! ctrrloycc\ eilh w,!.\ n\ rh.ir $lc .1,mpctr{rion, will do rhc Eork ..d lh. (nIl& n d
<br />iinctrdcd or ofcrcd ror {lc ( Se.7t!4. Busirc$ ond Pmt$ions Codc: rhc C.nhdois Liccns ljw does nor llJ)ply b d ownd ot
<br />rhc pmpcny who hild\ or imprnlcs rhcc,n- and who des sEh *o* hidscltor tf,rclfor rhtuuth hi\ or h.r osncmployccs.
<br />provideil rhlr \uch impnrrctrEnt ue rbr irctoLd n oftLrqt fd $L ll howcvci rhc h)ildint or inDmrcm is $ld *irhin onc Jd
<br />ofcotrpldion. ihc Owmr Buildcr willh rc thc tDdcn olpnrvinS rhirlfor\hc did rn build or i lrorc thc pmpcry aor rhc pn4n{ ol
<br />-l
<br />!n cxcr.pl unncr Sccr
<br />54-+Y
<br />l2E!Lt3 -ll!)!
<br />I hcrrhy rllirtrr!nn.r nctrrlryolt)crjry onr olrhc lall{)sin3 .lcchrrri,n,\
<br />-l
<br />hrvc ord willnri, rirr(iniliculcoicotr*nln)Sclflnsurcli,sork.n conrcD\rrion. pn,vidcd fd hySc.rion lT00ofrhc
<br />Ldt r Codc. for rhd pcrf.nnmcc ot rhL work lor which thc tBrnr is i\sucd.
<br />I lEvc lnd *illmri'rrlin {orkcrs co rt tr\.ri{,n insursRc. rs rcqun d hyS..rion 17( ol thc hbor Codc. l'or rhc lcnnrmanceoirr. sorr' whchrtu.N'm r.iNd Mvu,tr\ai,omFn\Jn.r'n.uxn,.,rtrrrrlrlrylumnruc'
<br />cJm.r fun"4-
<br />-7.O
<br />l..nifyrhat in rhc n lforrorc olthc work ior which this !.nnir n nsucd. I \h.ll trol cmplo, !.y pcron in rny heftr
<br />w !slob(o'rc suhjsl lo lhc sorkcr( comtcNar ion lawsofcrlifonrio- !M,!re rhar irl \tx,!ld h.onr {ubj..r Io rh.
<br />trortcr..nrFn\{tn,npolisionsofSccrn'n.17(xroflhcljtnrCodc.l\lDll-lifhwirhconplt*irhrhos|)fovisbns.
<br />IVARNINC: Failur tJ $cur *or*ds cotrrpctrsrliun ..!c.l!. i\ u.llwtuI. aln] lhrll suhjcct ar cnrDloycr ro sin,iDrl lcidric\ r d
<br />.ivil 6n.\ rf t, onc hundrcd ihousrkl dolln^ (Slm.mo). ir .ddfiotr I rhc.on.lconrpcnsrrn,n. d!rogB as tturidcd for rh.
<br />ull], &lullr
<br />I hctobyrintrrund..l.nslrtol p.r.Juryrhnr I rh li.cn{d utrdd provnir olCh 9 (connmncin8 wiih Sccri'n 7(XX)) ofDnni(,n I
<br />of lhc lnrirc* rM ttolcr{ions C.rlc, od nry liccnsc n in iull n,.c el cllicr
<br />-l 3
<br />I hcmhy rlfinnon{lcr lJc.nlry olFrrrr rhd rhcrc k a coniru.riotr l,jtrdir8 r8cn.y lor lhc pcrlomuncc ol thc work fd *hirh rhi\ Nanil is
<br />i\sud tsrc .ll)97, Civ C )
<br />lrnJc' \N'trr
<br />-
<br />t ndcls Addrcss:
<br />-
<br />ATII,IIANLIETIABAIION
<br />I lEEhy lltim rndcr pcnrlry ofpclury onc olthc follosint dc.lrarion\i
<br />D.',olili,,n Pcrmil\ AslEdos Norificarion Fcdcrrl R.3rlari(,n\ ('tirlc ts). Pan6)
<br />Rcuun l! s of Norifrdion-,7y'cd'ly rhir 'h. lc'l.ml rcEul0rnn\ rcssdrn8 o.bcan. rctrn\r'arc nor lnrl'crhlc r" rh\ |n'jr I
<br />ll ccnrfr rhrrlha\crc rhF anrlrcar nn dnd ndc rhd rhe obvc nrlbrmr ion n.oNr l alre lo snDly wnh 0U Cny lnd Connly
<br />ordinnrccs nnd Srrtc tiws rchring ro buildin-s consrtucrion. !.d hcEhyrurhoirc rera*nrariv.s otrhis cny.nd Coutrry to cntcr upon rhc
<br />rholc trr ri.tudpn)pdtror iisp.dn r
<br />,\ppliLnnt or .{qrnl SisnHturt
<br />J"ql."W f:14
<br />DATE
<br />-1.
<br />uso*ncrofrhc prcrcny. rm cxclusivclyconra.rins wirh liccnscd conrru.ron ro.onntud rhc pn,rc.r (sm. 70,14, Burimss
<br />rd Prilssi)nCodc:ThcCo.trcroi\Li..ns.l-a$d.c\.orrptlyrornuwbcrofptup.ny*hobuildsori t'rorc{ l[.rcon.
<br />0nd who conrnrk tu such l)mjccls wilh aConrBcronI liccrrcd pu(unnl ro lhc Conllrlor's l,iccnr Ir*)
<br /><?LlzlPz< c-n*"''
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