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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS 01!NER BUILDER DELCAR 'NON <br />I h@by ,mm und6 pdalry oapdjury thar I €rcmpt from rhc coit,crors Lic.nse Ljw aor (h. followin! r@n (Sar r0ll.5 <br />BusinBs md Prca6sio. Cod€)r Any Cn, or cou.ry s,hlch r.qut6 a !6nn ro .odrud. ah6, nnprove donolish or r€p.i@ <br />srruduc. pnor ro irs issuecc. also rcqutB lh€ spplicant [or such p.nnit ro fil€ a sisn.d sraronot lhal he or shc b Ii.6s.d p66r <br />to th. provisios ol thc Conl.aclois Licens.d Law (Chatld 9. Commcncin8 wnh Sdion 7C{0 of Division I ollhc BusFs dd <br />PDasions Cod.) or Ihrl h. or sh. is ermpl lhsctom ed th. b.,is aor thc allcsed .x€mrrion AnyviolarionofsccrionT0ll5brah, <br />applic&rao.rp.mnsubj*lsrhcatplicdtroacivilpcnahyolnormo.€rhofiv.huodr.ddolles($500) <br />-1. <br />6 owns of lhc prop6ly, or my nployG wilh waaB c ti.t slc omp.Ml ion. \'ill & lh. "ort a.d thc nr*iu. 6 rcr <br />intdd.n or o'Iced aor sle (56 7044. Busindi ed hof*iors Cod€: Th. Conlnclois Lic@ bw rL6 nol rpply lo m ow.r of <br />th. pmpgly vho hrilds or inprovB lh6o., .d who do6 such *od him.lf or hNlf or rhrcush nis or hd oM .mployG. <br />provid.d rhar luch iDproi,66ns e noi htadol or or6.d for eL ll howr. lh. brildiq or improvoB'l t $B wnhin {n. ,@ <br />ol complclion. tt O\nd ttuildg will har lhc tod.n ofprovi.g rh, hc or sh. did nor build or inpmw $c poFly for $c purposof <br />l.6owndofrh. propdly. m.!.hBivclyconkadi.s $nh lic.6cd .o.trmro6 ro .oBl{ct thc prej€cl(S(. ?044. BB,.s <br />and hll6ion Codc: Th.Contrdor's l-i.c.sc Latr do6 oor applyro anoNr6 ofFop€nyuho build! or iiprovs thdon, <br />and who contracrs lorsuch projecls wirh a Conrmcro(, licsed pu6u t to rhc (ont.croir t,ic.N l,{). <br />-l <br />en crcnpl undd Sclioi-, B. & P.C. forlhis rce. <br />lr.t.: Orn€r: <br />WORI(ERS' COMPENSATION <br />DICIASAIIg! <br />I h6.by .mm und6 p6dry oipajury o@ ofrhc lollovans d(la.dotu: <br />-l <br />havc xd will rminlaln a C6rific.tc of CoNar to S€lalreur. fo. wskcc comp..or io., a Fovided for by Sdrio. l?00 ofln. <br />Labor Cod€. for ih€ pdfo,rmc. of lhe vort aor whic[ rh. Ff,it b isu.d. <br />!l h,,. and s 'll m.'nra'n vork.c compcrr 'nn 'cur&cc, s rcquicd by S.dion !700 of lh. tjbff Cod., aor lhc pqfomsc. of <br />r[. *orl arr*h,ch rh(Fmn is isu, Mywo m'composar'oniNU'..ffidadpolic!truobne.,cmd 1Al^ -//"- <br />6-t.1 <br />_I ccnifythai io rhc pcrforroncc of thl sork for which this ll4roil is i$u.<j,I shrll nol mployanypd$n in any mtuner <br />e a lo b..om. subjet to th. wort6 comp.Gar ion laws oacaliaomi.. md asr rnat if I should b€conE subj(l lo lh. <br />$ork6r composal ion prcvisions ol Seclion 1?0{ of the Labor Cod€. I s}Ell. fonh*ilh $mply virh lhoc lrovaio6 <br />WARNINC Failurc to su. wort6'compdsarion covcmr€ is unlawful. aad shallsubj{r e aployd ro dmiml Frhks dd <br />civil fines up ro oa€ huDd,eJ rhousod doll6l$100.000), ifl addnFn to rlE.osr oaconrpcNrio.. d.iaga I prolid.d ao.lh. <br />Scrion 3076 ollhe ljbor C.de inlded ed r(orn y s fc. <br />3- 2t-t a P-L- <br />r r(:aNsEpa6NTR4( ron <br />DECIASAIION <br />I he.bt amm undd Fnahy oa pdjury lhal I d licaEdj undd For6io. of Chapid 9 (.o,rndcin8 wnh S.dion ?000) of Division 3 <br />ol lhc B6in6s ed Pofsioro Codc. od my licm* is in tull forcc md Gr'fdl <br />10 i)oY66> <br />7-2 t 11 <br />colslal](IloN.LllDllcic.ENcr <br />I hftby nmm und6 pcnahy ol pejury thd the ie a coisrndion LndinS agdcy fo, thc pElomecc of rhc work aor fiich rhis pdnn i5 <br />isso.d (Sd.1097. Civ c.) <br />AITLICANI.DECI,A.BAIIA! <br />I hq$y o]Imb ondd p.,ahy of pnlury on. ol th. lollowinU d(L,atiof,s: <br />Donolilion PmneAsbdtos Nolifi olion F.ddal R+ulalions (Tnlc40, Pd6) <br />Requt.d Ldrd of Notifi cdioo <br />I ceniq lhar rh€ f<tral reaulal'ons reldding Nt{irtr renm\alae noi rpplicabl€ b rlris prolLrr <br />I .dily rhd I hav. rad rhb applicarion dd srar. rhd $. atrr. infonnario. is codd I aSre ro comply Nnh all Cny and County <br />ordinm.6 ed sl.re riws relalin! to b{ildin8 codfldiotr dd hd.by .othorn. r.pr6drativ6 oithis City od Coury to dr6 upon th. <br />)-21-p <br />4z!_k <br />Set Backs <br />Forms/Steel/Holdowns <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywa ll <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Ce.rtif1/) *rU-.ta(q.e tcc-22 <br />I <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks , EtC <br />Erection Pads <br />UFER Ground <br />Ext./lnt. Lath <br />r T------ <br />I