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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS O*n.FBuild.r D(lralion <br />I h.r€by arI'rnr !nd.. peMlty ofperlury rhil I an er.mfl forn lhe Cdnticrots Lcens. bw for rh. fo llow'n8 r@son Gd 7011.5 Busin.ss <br />and Prof.ssion Codc) Any Ciry or County phich r.qrirs r pmi ro cotuitud, alr&. iftprcv.. dcnolish or rcpan any stru.tue. prior to ns <br />issuak.. aho Equiralh.rpplicrnl fo.s,ch p.rnn to fik. siBncdstsrcd.nr Ihlrhcorrh.!lic.6.d puBlanr ro rh. proviiiom ofrhc <br />ContacrorsLEns.dkw(Ch.prere,Com.r.ncins*nhS.crionT000olDrvisionrofrh.ausrn6srndProf6srnscode)orlh,rh.or- <br />shcis.r.nrDllh.r.iromindth.brstlorrh.rll.p.d.r.nDrionAnv\iol.iionofsccrion?0ll5byanrilDlicaflloraDcmnsubi..cth. <br />lpplicant to..ivil p.nehy ofnol noc thln fir. hudr.d dollnE ($500). <br />L ao*ndotrh.propcny.a,n.rclusiv.lr.onr!.li.s *ilh li..B.d conra.roR ro consltocl rhc prq*r ( S.c 70,14. Busin6s lnd <br />Pmf.sion Cod. Th. Cont.doas L!..ns.Ii* do.s norapplyromowns olpropdy*ho bu'ldsor inrprovE th.rmn, lnd *ho <br />conr.calor such prole.ts wfh a Conrrcro(, hc.6s.d puBu.nr ro rh. Contidor's L'.ens. h* ) <br />_-l M.rcmpr und.r Sdion B & Pr' ldrhir '.Non <br />1!OB-EEBieO!!8E!SrJr!NO!e!4r{IIqN <br />I h.r.by aifim und.! pcnally ot perjury one ollhc lolloNrns decln.atrcns <br />Iluv.Md*illtui ri! a C.niicalc of Cos. ro SclanNlre fo. wod.B @mp.Mnon, B prov'd.drorbyS6nonl?0oofrh. <br />Llbor Codc. aor thc pcrformoc. ofth. work aor which lnc pcnnit is issuc! <br />d.6* *o *U,-.*r- *"r*.6 @np.Nr,on insuranc..a3 ,<ur.d byS.cl'on r?ooorlh.L.bor Codq rorlficp.rior@nc!ollhc <br />io. '.surmc. .mi.r sd.olicvLvlte-\Ccr'.- <br />27 4o<> / <br />(rhissdionnccdnorh.conDl.t.difth.p.mitisforOnehundr.ddollasl$l0O1orl.ss) <br />l..n'I_vrlmr i',rlt.n.rtun ^r...rr[.rorL li)r\rh].hrhnprnnil <br />h.com.suhr{r ro Lhe yorlrs omp.ner <br />conpcn$rrcn prcvisilB ors(,,6n uoo o <br />D!,.: /L/tO//i <br />'on <br />bws ol(al'Iorn'a. and 'll should bdonre subjecr <br />frh. hbor Cod.. I sh.ll.lbn <br />".(,.workes co nf€nsrton co veras. r unldwful. and shillsubrer ah.nploy.r ro ainin.l pcnalti6 and.ivil <br />lin6 up to on. hufldrcd ltoend dollaB($100,000),inaddnionrolt corl of conpcn$rion. d!Mg6 6 prorid.d ro. rhc Sccrio, 1076 of <br />rh. Llbor Cod.. inr64r md itorn.y s f.s <br />ll.qErsEleatLla crgalDEclar{lro! <br />I h.r.by afirn und.r r.nally oap.iury rhal I dn lic.Ncd und.r provirion oaChapr.r I (.oto,n.n.in! wirh S..rion 7000) ofDirGion.l of <br />rh. Aositr.ssand ProlcsbnsCode. md my licctrsc is in lnllfor.cand eilcr <br />""''PFa!-a <br />(l)tSIlll ( l ()\ l-ll\l)liil;,\(;l\('\ <br />I hcrcby amm und.rp.naltyoapldurylnal th.r. ir a coNtruciion l.ndins.s€ncy for ln <br />i$ucd (Scc. 309?. Ci!. C.). <br />ollh. work forwhich th6D.rmil is <br />APPLfCANT'S DECLARATION <br />t).molition P.n.ils'Asb.slos Nolifrcalion lidda1 R.3ulaiions(lnE 40. Pan6) <br />R.qut.d Lcrlcr ol Notincation <br />l .crliry thar rh. aed(al r.lulrri. r.ldding abcsros rdovd e nor epl(abl. to lhi proj..l <br />I c.niiylhal I lrv. r..d ihk.pplication md inaormarion is cor.cl. I asr..locomply trilh.llCny nnd Count, <br />ordinanc.s and Star. ljss rclalinr lo by aurhoriz. rep16.nralivcs of lhir Ciry and <br />abovc nrentioncd prop.ny lor <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenVlnsul <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <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 Certif. <br />Lntt/-t-'Ltl*r-t&//o /lv "t(/6 /_2 <br />FINAL ilr*//(]Tflty/r aiu-.(t;/, <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />M1WP51\Pormil-lnspeclion Forms\Bur d ng-lnspeclion Record doc 03 31 06 <br />l- as own.roflh. prop.ny- o, my cmplot..s *ilh $ae6 as lh.ir soL comp.nsarion. qilldo rhc Lv.rt cnd Ih. rruclu. ir nol int.ndcd <br />o' ofer.d for $1.( S.c 7044, B*'n6sdnd Prof.svoNCod. Th.(ontd.ror'sL'c.ns.llwdo6norrpplytorno*n.rofrh.prep.nt <br />who buil& or i,npm!6 rhd6n.6nd who dos 3uch work hifrs.llor h.E.lforrhrowfi hie or h.r owi.hploy.6, provid.d lhlr ruch <br />impor.ncnlr r. nor inl..dcd orofis.d ror ulc. lt honc!cr. rh. building or irnprcrcm.n! is eold within onc y.rr ofcoDplcrion. rhc <br />olvrcFBuild.r will hav. thc bud.n ofprovin8 lh.l hc or shc nor build or improv. for rh. plrlok ofsrl.). <br />1::S