|
SITE-WOHK DATE ID/SIG.COMMENTS
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Framinq
<br />lns u lation/ En ergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Depuly Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />lt^,,.--c,, t @FINALVltsfua 1,
<br />Certificale ot Occupancv a1r rr
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />OWNER BUILDER DN!,(NNATION
<br />, hcrcby rlltm un.ls Fn.xy (, ,criury rhar I m .rcmpr ri.m thc conta.lor' Liccnsc lj* nx rhc hllowins Fabn rscr Totl r /
<br />B!!n.{ rnJ Pdastuh Culc): Any Cn, or Counry whkh nqum! r FTnll k' ronnfl.r, drcr, inPovc, Jcn'lah 'tr rFn mv-
<br />nnrcrurc, !ri(, lD (s t anuc. &o rcqrm\ rh. appl(mr li)r such!.rm b lllc a {gncd sttlcmnl lharhcordrtrli.ciscd Dunumr
<br />b rlk' pR,vtion. of rh. Coitr&ln s t-Lcnscn Law (Chrpr.r 9, Commctuitr3 wirh Sccrion 7000 of Divrnn I ol th' Btr$"* 'nJ
<br />Pn,lcssionr Co'lc)orrhrr lror\h: I c\cmpr rlErctrcnr anl lM 6rsi! turrlt lcscd c\cnrPri(,, Anyvk'laLoiofs&lon?(,.1156yrny
<br />,pph,nt nr apc,m subcchthc rprli.anr b aciv,lP.nahyottrorfrtrcrhrn lir. hunJrcd dollln ($5OO).
<br />t. as o*ncr ol rhc Itr Fny. ui my cmllolccs wnn !!scr ar rh.n nJk .omp.n{rb.. will ,io tht wDl* ,,rl lh. (ur@ is tror
<br />rnrenJdl orofnrcJ n, sdlc (5&.704,1, Businc$ aad Pmf.$n,n\ C(rl.: Th. Clonrracktri l"tcn{ L,w docs frn aorly tt r..wncr ol
<br />rhcnn)p.dy who huilJs or impn,vcs rh.dr, aii wb drxs srch un* him\clior h.r.lfor thbu3h ht ot hcr own.mPlovc.s.
<br />pR,vklcd rhi $,ch ma$rcnrnr m ft, dcn].d orolnrcJ,nr eb Il h,ut!r. rh. $uillllg or nn orcmnr ssoltwithiron. ttr
<br />ofconrrbir. th. owncr aur]cr *ill havc rh. bunlco ofptuvin! rh tF or shc ,lxl nn lltill or nrytus rh. In IEry f( rh. f 4$$ Df
<br />I. rsowncrol rhcF,!.ny. rm.rcluwvcly.onta.rm3 w( h li.cn{'l onkrttrt ro c.n(rucr llf, t)RU..r (S.c 7u-4, Buqncs
<br />anit hrl.si,tr CGl.: Thc Conta.l{tr s t-rccnrc I.awdo.s noratpltn' an.*ncrofPn'lt ywh. hrllJs or rmlovc\ rhc'.on
<br />rnrl wh. conrrucrst).suchp!*(hwirhaci'nlrd.lo(Oli.ctrscdpurlurnrbrhcGrrlckr'sl,i!.nseLaw)
<br />_l nnc\cmfl n cr Sc.rn,n
<br />WOru(ERS' COMTFNSATION
<br />DECI,ARAT('N
<br />I lrcrchy allirm undcr p.mlryot tntury trc ol r lrc ,hll.win3 'lcchnronr:
<br />I hrvc{ qillminlainaCcdilrcar.olCon{nlt,)Scl!lnsur.li)rro.^'comlcnsrtnn.(rpnrlidctlli,rbvSccti{n.1700olrh-
<br />trhtr Ct c, n rhc lcli,rune oi rhc turk lnr wh(h rh. ldnlt s ssucJ.
<br />I hivc ani will nrinraio workcri (mtcnlllion murln c, rs rcqu trcd hy Sccril)n .lT00 ol rnc L $r Colc ,nr rlrc p.rti'rfrrn" 'r
<br />rhc w.rt li)rwhi.hrhis p.mir ir n{rcn. Mywotkcn (rmpcnsarion in{raNc lricr &al }rlicy numbcr dc:
<br />-l
<br />c.nrlirl ir rhcl{rltrmrNcol ihc work lttr whichrhnI1. ntir is i\\ucJ,I \hru n r cnrPiry 3ny Pcrotr 'n
<br />rtrv m!trnc!
<br />$ askrtEonE{lt.r h rls w.rkc^' conpcnsd n,n bN\olCrl'tum , rtrd r3rcc rhrril I stx'uLi b.\.m suhlccr (,rh.
<br />R crs con,i.n\dn tnivartrs.lscuri.nl7(N)olrhcI- xtrCd]c,I drll. fi,nhw h()nltlly wrrh rh$c Povisi'n\'
<br />IIARNINC: f{rlurc b vcurc work ri ( rF_n\ds, !r)vcD8. '\ utrhwhn. mJ sh.tll sut'F.r an cmll'vf h.nniml I'. Jrt\ md
<br />.ivrl lnr.s u!' n, onc hon .cJ rh)uqnd dollrr ($l(r0.lll,). In d'l ur lr) rhc.o( ol 'omP'is'!r(tn dMm8es rs p(rv'ti'ri nY rh'
<br />Sccrt, 1{)16 ol rl( lihr(ixL. hr.rc{ 3tu1 t.rmy \ lic\.
<br />AoDllenr:-
<br />LICENSF'D CONTRACTON
<br />I}ESIdEAIION
<br />I hcEhy allimun,lcr r.n,lryorp.rjury (hal I am liensd u' cr rt)vr6. ol Cha,'rcr D (conmfrin8 wllh Sc.l ion 7000) 'l Divnmn I
<br />of rhc AusnEs MJ Psnc$n,ns Cod., .nd my licnsc i in lull ture dd cfLd.
<br />Dale- ContBd(
<br />CONSTRUCTTON t FNDTNG AGENCY
<br />I hcrchy anrm und.r p.ndty ol pcrjur! rhar rhcr n t dln{nrclbn hnlins rs.ocy rdr rhc pcrlorofrc or rhc sdrk i(r wnich rh! Fmir i\
<br />issucd lsc(, .109r. Civ. c ).
<br />Lcn&rs N,m:
<br />-
<br />APPLICANT DECLANATION
<br />I hdby aflim undcr pcnlhyofpcrjnry ooc otlhc foln)w,nS dcchttlnrflq
<br />Dcdnirio. Pcmn+Asb.slos Noli,icdi,,n F.Jcrdl RcSulrtons (lillc 40, Pan6)
<br />_Rcquihd trtlcr o, Ndilidriu
<br />I .cnni lhar rh. ltdcrtrl r.lrlxrion\ rcPrtrli,re lshc{os.cnIulrc norrPpliut lc h rl[ nt,icr
<br />I.cnilyrhxr I hnv. rc{l rInrnrr th. rlr)vc $lnlmrrn,n '\ r.trc(r
<br />ordmrnc( d Srarc lrws Eln ing
<br />rh,vc mnto cd ln,lkdy ntr
<br />,\nplicant or A(ot SiEn.
<br />u///
<br />Set Backs
<br />Shear Wall
<br />Liensc Cl,*:-L,rcn.c Numbcrr
<br />--
|