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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />U FER Ground t
<br />SLAB Floor
<br />I
<br />Roof Sheathing rr/tt/tl,&f)
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />/L
<br />FINAL 1L/or/rK z'M//. 1
<br />Gertificate of Occu an
<br />Noles, Remarks, Etc.-_____7-
<br />,
<br />BUILDING- INSPECTOR RECORD
<br />OWNER EUILDER I}EI-CAR TION
<br />l \dch\ rfftrin und.' pemh) ol p.rjut rh l an.r.,np fru'h rh. (onnrr.'r lL.n(ld('.rrl'ef,,ll."\'nrt$'nrsh._url 5
<br />tr6tr'Bs arJ nulNrotr Cod.) An) ( i) or C.unr) \hch re{un6 a tstrtr r.' oNrrud..,'6. nfrc\q dn;&"",'
<br />slodue, pnorto irs isuMce, also ,e<tut6 rhc applrer for slch pdnil ro 6L a sign.d skicmdt r h.l he or shc is Ucm*d pUNaJlr
<br />10 rhc prolisiore oirhc Conta.lo.s Lic€nqd t-aw lcnaptq 9. Conm.nciru Nith s(rion 7000 olDivision I ollhc tlusincs a.d
<br />ProLsionsCod.)Drrharh.orshcis.knFrhBcnonr&lnEbasieforrheallcs€dcxflption.AnylnnalionofSe.lionT0.rl5byany
<br />appllcnnllorapnnitsubjeclhcapplicanlloacivilpcnahyofnolmor€lh fiv. hu.dred dollds ($500)
<br />$" .*"* ,*. ,.*y. or my €mplolE wirh wa86 s rh.n eb compc$dio.. wiu do rh. woil a.d rh. slrnnrc is nor
<br />inrdd.d or orls€d lor sal. (56 7014. Busins dd PrulsioB cod€: The Conlractois l-ic.6c t-d* dod n r 4ply io orvnd of
<br />rn.popqly who boilds or nnpmv6rhtrarn, turd ryho d.ssu.hso nimsclaor hcell o, rtrcugh hir or ho own.oplot6,
<br />provid.d rh.t such nnFovoEnr u€ not intfld€d ooitq.d tur sh ll horv6,6. rhc hildins or imFovffir is eld { irhin.n. ,d
<br />of conplctFn. rhc Ovnq Builds will IEE 6e hnkn of Prorins tha he or sh€ did nol build or hlaoE thc F!I,$y tor lh€ pu.poc of
<br />-1,
<br />6 osr€r oflhc prorsry. an .\clusi!€ly .ontraclins virh lictu.d codra.roB lo co$ttud lhc prejEl (Sd. ?0{4, asind
<br />&d ltofdion codc: Th. Conrraclois Lic.nsc Law do6 bor opply to an osn6 olpropcn, who blilds or improvd th(on,
<br />and who contEcrs lor such p,oj€.ls wirh a Coiracto(s) liccB.d pu6udl rofi. (ontractois LicN L.v)
<br />lxtr, c\cn,tn unJc, S..r
<br />D". \\\B\18 o"."",6
<br />I lrrchy 3flirm under Fnalry o r t.ilun on.ofrhc roll(NmS dccl:trdhons
<br />-!
<br />h!v. dd {ill
<br />'naiiuin a C6l i,ical. of Comcnr lo Scla l6ui. lor work.6 conrp.nslrion,6 pror id.d for by Sdlio,1700 ofrh.
<br />Lsbor Codc, for lh€ pdfomocc oflhe so* Ior rich the pmil ie isu.rl
<br />I havc and {ill maintoin wort.rt cohp€calion iNur.nc., s r.qut.d by S(t ion 3 700 ofrh. Lnbor codc, ror lh. Faof,mcc oa
<br />rfi. work lor which tht p€mit i! isud. My workc4 comr€nRlion iBudcc crnid @d policy nu,nbd ec:
<br />Polic, Numbd:_Eipn6:
<br />thalinlheperform.occofrh.workrorwhichthispc.r,risEsucd.lshtllnorchployanypc6oninany'.8
<br />e a ro b.ronr subjd o rh.*orhm compsarion l.*soacaliaomia. Md asre llul ill should b..6nc subl(r ro'hc
<br />q 0116' conptrsalion provisions of Sdtion l?00 of the tibor Cod€. I shall. fodhl nh @nply $irh rhos pmvhions
<br />WARNINCT Farlurc to su€ Nort6 conpe@lion co!@s. 6 unlasful. dd shall srbjar dnployq io olninal Fahi6 ad
<br />civil fin6 up lo onc hundr€d thou$d doll6 ($100,000), in addhion u rlE cos olcompcNtion. dadrB6 d provided for rh.
<br />sdtun 1076 ofrhc l2bor codc. inrer6r rnd droiir.y's aa fldo, 6.ul.r!0.1,1
<br />r r r rIiL r or i[n'r on
<br />DTI1,,\R\IIU\
<br />! hd.by ailfln unds r.n.lrroapdjuryrhar I dn lic.trel unda Forision otCnaplq s (.o'nmdcinr srh ssrion 7000) ofDirision l
<br />of rhc Buso6s ed PtufesioB Codc, dd my licmlc t in rull lor.c md.ild
<br />Lic.Be Clas:-Licsc Nunbo:
<br />CONiIAU(:IIONIEIDIIC.ACI!(I
<br />I hdcby imnn ondr p€nahy oipdjrry dDl thr€ it a consrrudiotr lsrdins asmcy rorrhc pdlommcc ofth.work lor which lhis p6rn is
<br />issucd(sE 1097. Civ c)
<br />-l
<br />cdiry rhar lhe lcddal r.gularions rcsadi.s 6b6kx r€moval e .or arpli.abL o rhis pmjd
<br />iay thrt I h.!c rad dis apdication sdsrolcrhat thc abovc infonnatio. is cod..t I asre ro.onply wirn all Chy md Cou.r,
<br />ordine.6 ed $.tc rlws r.LrinS ro buildins coBr ctiotr d haebyaurhoriu r€rr*.laliv6 oflhis Cny dd Couniyro mrd ut{nlhc
<br />r( \8 \g
<br />Subf loor/VenUl nsulation
<br />Lender \ Add*
<br />AITLICANLDECI.ABAIIA!
<br />! hod, 6ltun und6 po.xy of pdtury on. ol th. lollowing dd ldations:
<br />Demol ion Ptrirs Asberos Norificarion F.d.ral R*ularions (Th|.40. Pan6)
<br />R.qu;.d Ldlo of Norifioioo
<br />il".:. ;:::;::.:'"'JfiLo 6u'.t d-rr
<br />pemi,Rnome(prin,,, 5"Na 6anourdp-5
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