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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />ngFram i <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />It4aso nry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />FINAL / - +-i1 q-\4{1d \ <br />c ertificate of Occupancy <br />Notes Remarks, Etc <br />I <br />t=F L.. <br />v <br />J \ vlc '0"--,i"9J/"'-1 1 <br />7 <br />OWNER ItUILI'DR DEI,CARA''ION <br />I hcreby amfln undd p.n.lty ol perjury lhd I an .x.nvr lron rh. ConlmcloG l-ic.nsc tjw tor <br />'he <br />aollowin3 rwn (S.c 70l l 5 <br />Busin6s and Prolsion Cod€)r Any Cily or Counly Nhich requirs a pmi Io coNrucl. ahs. improv€. doDlith tr qrn tuy <br />sttucru.. rid ro ilr irsudcc. ,to r.quir6 rhc applic&r lor such p€mir ro file a si!tud srardor rhat hc 6i sb. i! li.@d pffiudt <br />lo lhe povisions of lh. Conrracroas Lic.nrd t{w (Ch0rrer 9, Conrmcncir3 $ilh Scclion 7000 of Division I orlhc Busin.s and <br />Proa*ions Codc) or lhar hc.rsh. is €rc6pl thg€fron od the hsis lor rhc all€s.d sdnplion Any violarioi oasdrio. T0ll 5 by uy <br />appli.a lor r pmi subjdBrhc rpplicanltoacililp..alryof.or rr. rhd nv. hundrcd dollds ($500). <br />_I,6 ow..roflh. IiolEny. or toy cfrployd wrrh rvag6 6 rh€t $le compdelion. \rilldo rhc *orl dd thc sn(1d. i nor <br />inrod.{ or olTacd lor el. (S{ 7044, aosinN md PmlNioa cod. The conrraclois l,iccre l,flN do6 nol .I,ply lo an o*n.rot <br />rh. pbpd, (ho ttuilds or irprov6 rhmn. ddslD do6 tuch Nort( himsellor h6scllo! rhroush his or h6 o*n.nployd, <br />trovidcd thal s'ch impmrdaG rcnot imdj.d orofifed foreL lf, how6s. $. baildins or impnnrMt is $ln wnhin on. yw <br />ofconpldion, lht ORnd Bu dd $ill h.v. th. htrd6 oaprovins $d hc or she Jid nor 6oild or nntrov. fic pmpdy for lhe pu,loe ol <br />-1. <br />a ownq olrhe plpsly. am dclusively conlracr ins with licffii contractoE to cotutrucr thc projel (S.. 7044. Bsrns <br />Md Profesin code: rhc (onlrlcloi s Lic.trc LaN do6 not apply ro m o* n6 of propcny wto bu ilds or imp,ovB lh(.on. <br />and who conrmcrs lor ch prcjerswilh r Conhcro(s) licmFd pusMt to the Conrrcrois ljcos l,aw) <br />-l <br />a cremfl under Sslio <br />]loal.r;astg)ltrlNtAllaN <br />DECTA&!fIa! <br />I hd.by aftm u.der pdalrr oapojnry one olth. follo*ins drlo ariom: <br />_l havc &d Nill,naiorai, a C.aia,cateolCocor lo sell l6urc tor workdt conrpenslnnr,6 prdvid.d aor by Sc.tioo 1700 oflhe <br />libr Code lor lhc psfomdcc o f Ihc *olt fo, r hich lhc p6mit is isued. <br />x hav. .nd $ill nrai.rain work.u' conp€ns.tion insumnc.. 6 r€qrtcd by sdion 1700 oartc L.hrr ('ods. fo,lhe pstomdcc ol <br />$orl for \vhich ihis Dennir is iqlFtl Mv*^.1"-"i.^r;vonmh<sc: <br />(il (J,,../KD tPl SC/OA)'/^- <br />z/*k:N-"'' lL-Ct21'@s@/9 <br />I calirylhat in lh€ p€rfonnance ollhc work lor rhich rhis pn,nit is <br />$ Nn) Lt.. rsbr.dtitl{\rf'kdC.o rptnsrnr hss of Cal'MrIs .ompeBari.n prolisioBoisdrion r?00 of rhe h.oDdy wi'h rhos prorisions. <br />.i\il fincs up ro onghund,cd r'.usMd <br />*:^!:/:{:"!- <br />ision olch.pis I (comnEcins s hS6r$n 7000)oIDi!irn,nl <br />ol nr Eusinss .nJ Proadsios ( od.. md my li.drsc is in <br />\,"./fL <br />coxflaucrroNt[lDllc-actiNcr <br />I hc'rbyaflilrundq pc.alr,oI!.iuiyrh rh6e it a consltuclion lendinr lscncy for tne pdfoman.e of lhe wo& for qhich lhjs pErtrn is <br />issued(Se l(D?. (iv C.). <br />AIELICANADECIABAIIII! <br />I hdd, allm!.dcr pcnahy olpojtrry onc olrhc roll.Nins d(ldalions: <br />Deholilnrn Pcrnrils-Asbslos Norilicarion Federal R.sulntions (rnle 40. Pan6) <br />-R.luircd <br />t.116 of Norifi carnrn <br />I.driftrhd rhc Ln.ral r+ulatioB reBdding 6b.xkr &nolalm nor aptli.ablc io r[is prolecl <br />I .dil Ih{ I h.\c <br />'ead rhis lpplic Ftr is coB-r I agrEro.omply$nh.ll Ciryand Couniy <br />rnc ftlrMrati!6 oarhis ( iryai Counly lo cnrd upon rheordin0c6 ed Sralc l-assrclati.sr <br />al{Le mmlioncd pNpcny fo, i <br />/^IIlicatrt or,\Arnt SiAnrtrr. <br />\"..ir* *."qp.;,,r1,tAs <br />--T------