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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWN!]R BUII,DER DEI,CARATION
<br />I hcrcby rrl]r und.rp.mlryorpcrjuryihriIm.xc'ryrrn'mrhcC.rkd.k}{LiccnseLa}lbrrhciollo*inrrcr$nlSLc70.115
<br />tsusiD.s ! Prcl'c$ion Codcl Any Cily or Counry Nhi.[ rcqunc! a Frni' h condru.r. alrcr- inuDvc- dcnr,lnh r rcNn dy
<br />{rucrtr'r. lrri{trro irs i$u!.cc- rlvr rcqltc\ rhc$plicnnr i,, such Jf,nnir n, lllc r signdd sdcnrnr rhrrhc.rshc is licenscd lursu! r
<br />ro rhc pmvnions oi rhc Cotrracbis l-iccnscd lis (Chaprcr 9. Commrcing sir! Sccrion 7tl(D nf Divi\ion -1 of rhc Busin.s a.d
<br />Piofcssi(,ns Codc) or rhar hcor\hc i\ cx.n9r rh.rcfn, rnd rhc basis fffrhcrllc8cdcrcnrfrio AtryviolarionotScclion?O]l5hyany
<br />ippl,.nllll'orrltrnrirsnhjsrsthcopplic.nrbrcivilrrctr.lryornoinrcrclhnnlivchufrlrcddollrr(S5m)
<br />Lrs.skrofrh.pn,p.ny,ornrycnlpkDr.\{irhsrg.\usrhcirv,l...mltNdir.willdorhcaorkmdlhcslmrwismt
<br />inrcndcd o. ofcr.d ld qlc (Sd.XX4. Busincss Md Pi.fcsdN Cdc Thc C.nri.to. s l.ie.sc I rw do.s nor apply b an ou.cr .f
<br />thc Impcny who boild\ or nn (its th.R)n. u{ atx) dfrs chk,rkninsclforhcncll.rrlmtrghntorhcro*ncnPk,ycc!.
<br />provntd rhar such iryro\sE,r$r mr inrcndcd orollird lnrsh ll ho*dr.r rrr hildi'rB or nqmvcnrnr h sold wirhin onc rc{r
<br />ol.Dtrqrcln,n, rhc Owrr Buildcr willhrvc rhc burdctr ofFovin8 thd lf,.r shc di] nor hrild or impror thc fmFny lor rhc puqx,r of
<br />-l-oro*ncrofIhcI,r.rcny.amcxclusivelyconrrrrinssirhliccn*dconrrctrsn,.otrsrdcrrllrojdr(sc.7014.Burirc$md hufLssirn Codc ThcC.ntrlor's Li.ctrs. Lrw docs norrpplrb ano*nd ol tropcrlywho tuildsor imtmvcs rh&.on.
<br />und qho !,nlmds tu such pojccc sirh a Orntricro( s) licctr*d pununr k, rhc onrracroi\ l-iccns. bw).
<br />-l
<br />rncxcnrrl undcr Sccrn,
<br />1yatr&t&5_rcuEElt ra!
<br />II'CIASAIION
<br />I herchy affirn hdcr Fnolry of FUur, o.e of rh. followins d€lu.rion\
<br />d Uvc ua wilt minruin a Ccniftarc or Consnr ro scl nrurc rd workcn .onDcns0lion. as Dov'dcd tu hy s&r ion lT0o or rhc
<br />hbor Code, for rh. Frfolfure ol rh. w.rt for whkh thc Fmit is i\\ucd
<br />fC, t," und * r, .o,n,o,n *orkcs comrcnsslion insuraftc. I requn€d by s€l n,n rTtro ol rhc lilru cbdc, lor ihc pc.forMncc or
<br />th. mrk for whth thn pcrnit is 6scd. My *orkes compctrs.xon itrsulcncc cari.r alrd poli.y nunbo ft:
<br />-1--..^.
<br />", ' l- 1, i -Tns"-..^* e-.-
<br />"-
<br />-Y(,o i-] r{ qq 35 c,4 / da/ 2_. ,.\
<br />I ccnily rhrr in rhc pcrfonun.d ofrhd work nr whi(lr rhi\ prnnir n i\{rcd. I \hrll nol cnrploy !n, pc!\on in any nBnmr
<br />v, r\ h tluf, subiar lo
<br />'hc
<br />wo*cn compctrcrrion l.ws ol Caliroirir lnd asrcc rhar ir I sh.uld h.{ont srhJer rorlf
<br />workcn conrpctrsrrnr pnvkionsolSccrbn lT0oollhc Lrttr Q)dc.l\h.ll. fonh*iih..mrly *irh rhu{ Pioviri.ns
<br />WARNINC: Failurc ro rcurc krker\ conpcnqri,n .orslgc is rnlatrlul, rnd \hdl \ubjcd {r cnrdoyer h, ninrirrl ll.nrht\ rn,l
<br />civil fin.\ up b.trc hrndrcd rholund dolL^ l$lr]I),ffn). in addiriur b rhc.oi ofconr!.nsariflr. d.trugc\ 6 nrcv cJ fff lhc
<br />sccrnni 11)7(,ol rh.Lhtr(r)dc.i,i.rcnr drr!trfu\'\lcr\
<br />9/z.t /t g *s--
<br />LICENSED C(TNARACToR
<br />DIq,AAAIION
<br />I hcEby.iinn undcr lcnrllyoitcdury lhal I ar liccnsd undcr pmvtion olChryrs 9lcommkins wirh sftridr 7fiL) olDirision l
<br />of rhc BusiDcssaxl Protassions Codc. (t myliccnr h iD lull fore lnd cfltcr.
<br />Q-tz 9k t tro
<br />. 1/zq /t*.-""*- y<- ---L-R -4r
<br />CI}NSIBI]q:IONIENDIIGIGDN(:X
<br />I hcrby artrn und.r FnnllyofFrjurylhlt lhm is. onsrrudion kndins asercy l{)r rhc pcrfonuE. orrh. *o* rot whichrhir lcnnit h
<br />hsucd {Sc. :li97.Civ. C ).
<br />AIILIIANLITESASAI]ON
<br />IttE5,am uidcr Fn,k, of Frjury on of rhc folbwing d*lrar iohsl
<br />Demlii.n PcrmitsAsbcsros Norific ion Fedcral Rqular ions (litlc 40, P n6r
<br />-Rcluircd
<br />Lcllcr ol llotifi urion
<br />I.cnilrlhtrt rhc fcdernl rc8ullriotrs Egardir8 osbcsros r.rmvnl nrc not apllico$lc lo rhtpnUccr
<br />dccnilrrhur I Mvc rcad rhis ftlicrrn,nud nrrc rh rhc abovc inrormli.n ..rccl I a8rft r, conply wnh lll cilt and counry
<br />ordinanc$ and Shrc Llws rchlins io building connru.ri.( ud hercby ourlbri.c i.r.r.rnrivcs oirhis Cnydd Counly ro enls lFn t*
<br />n'v. nEtrrioncd porcny for inslE lion,ur!reEs
<br />nrro*, - n".", .t-**,)Z --,E- A-9S-
<br />p"-rr**-.ron*r, K M i.r''.,r \ P..{z
<br />q/zqlts
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u lation/En erq y
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />It/lasonry
<br />Pool Fence
<br />Handicap Req
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Cenil.
<br />flt'1 \tg ila4rt,
<br />Certif i cate of Occupancy
<br />Notes, Remarks, Etc
<br />J
<br />COMMENTS
<br />Erection Pads
<br />T-Bar
<br />FINAL
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