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BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNTR AUILDER DI]LCARAIION
<br />I hcrcby !ftnm unls pcnalry ()f Frrury rhal l.mcrcmpl hom rh. Conrr.ctri Licnsc Llv n, rhc nnhwin3 rcr$n (Scc ?0.115
<br />Busirc$ u'i Pn'lt$io! C(Jc): Any Cily or Counry $hnh rcquire\ ! ncrmir t, con{tucr. rlrcr. impn,k. &nolish ur rcIair any
<br />nnr.xtrc. I'norlo irs isurnc.3l$ rcqurc\ rhc r0rlk.nl ntr nEh lErm,l nr tilc i siEncJ slalcmnl rhar he.r shc k [ccn*,1 N^uanl
<br />n' rhc !lr1)vr\i,)ns oi th. Conrr!.nn s Liucnsd Lj* (Ch{prcr e. Commcn.in8 *irh Scern,n 7O0O oi Divni,,n I oi rh. Busincss and
<br />PioLrsons Cdlc)orrhar hcorshc iscxcmor rh.diom rnd rh. bas! turrh. rll+ctl cxcmfln)n. AtryrnnilonofSer$n ?011.5 byrtry
<br />a rl[rnr L' a rcrmir srhjcrtr rhc appli(anr b a crvil Fnalryofnor tutrc rhm nvc hu.drcJ dollrs ($1(x))
<br />L !s orncr ol lhc pmFny, o, my cnrployccs with w.rcs.s rhctr slc clBp.nsanon, w l,lo lh. ultrl and ltE slBls is mt
<br />Dtc cJ or olttrcJ li)r {lc (Se.?044, au.incss .trd Pr.,lrsons C{}ic: l he O).t&tn s f.icns trw 'locs nol amly h in owrcr Df
<br />rhu p$ltny wliJ ho'lds or mtn)rs rh.e\ arl who d€s skh woil h'hscllor h.rscltor rtuoulh hN or h.r owtrcmployc.s.
<br />F,vi'lcJ rhrr su.h inpnNcmnk u nor hicnrctl or oitrcd li}r eb. lu h,kvc,, rtE huiliry or iq)nMmnt R y'l(l wirhin om ,r{
<br />ol $nDtttrxr, rh Ovno Built. v l h{r dr tud.n oI lmvmg rhar h. or \hd Jrl to huild or m{nr\r rh. f,oFny ntr lhc Fqr)r .l
<br />l, !sowmrol rhc ltn)lcny. rerclusivclyotrtrr.li.! wfh l,.cnscd lonlraclon !' .onstrucr rh. pnrcd (Sri.704,1,Ilulnc$
<br />a th,iixsbn Cslc:'fhe O,ntratttr s l-i.cn!e L.w drs n.r rpplyb ano*ncr ofnopcny wlx, hrnJs or m,Ifuvcs rhcrcon,
<br />atul who.o rdcBtor such pr)F.ts wirh. Cotrrdcb.(sl lrcnscd N6urtrr k, thc C\ntra.ntr r Liecns tjw)
<br />_l nm.xcmpt undcr Scrt
<br />.lllrxf,Et5:.coutENsall0!
<br />DECIdBAIIQ!
<br />I hcrchyalltrn,unJ.!Fnrlryol p.!uryoncolrhc l(nl'vingilc.lsarion\:
<br />I havc lrlwill mairtsin aCcniicalcolConsc n, S.lEln$rc li, workcr'.ompcnsari,,n, as providc'l lbr l,y Secritr l?0Oolthc
<br />Lalu Co,lc. tur lhc rEriormln(c ollhc wod lo! which thc pcn iisucd.
<br />_lhJv.anJw'llmainrrinwor[.^'.ompcn\rti,,ntNurrn.c.]\.cqtrr.JhySc.r(,n]7U)olrhcllhorCbJ.,nrrhcp.rturmrn(ol
<br />thr eorl fttrwhrhrh'i F.mn L\ Ls\lcJ Mywork.rs conP.n\rrion ,xuriec (irrr r Bnky numkrd.:
<br />202
<br />qgl c.nitythar,irhc !.dnrmrnc.orrhc work ir wh,chrh'sFrn( is dru.d,I shall nor cn{ .y anytc(on n.nymdtrmr
<br />$ Ns lo li<a$m subrd lo lhc rol(crs comFnsario.laws ofcaliioniu,,nd lrrc rh, itI shuld he(,m uhi( nr rtE
<br />woikc^ cohn nsarion 8)visirm of S.( n.1700oarh. trhtr C(rL.I $,lL nflh*irh $n!ly wirh rhos pnrvsnrnr.
<br />WARNING: F nurc b *ur. wrkc6 coml.nsaton rovcrr'lc is unlawlil atul shdll snbFcl ar cmploycr lo lrinin0l lrMlras .nd
<br />.ivJ tnrs up i, dnc huklrcd rhou\rd doll{s (S100,O00), xuJJir,un ro lhc c.ll of $mpctrsorbn, dam8cs !s nn,vi!.! nr lhc
<br />Sc.ln,n 1076 ol lhc ljhtr Culc, int.rcsl ind lnorrcy s ttcs >J B--ZK
<br />DECIJEAIION
<br />I hcEby aI1tm u*lcr pcnally o, F4ury thrt I am li.cn$d undcr provision oiCh.pls 9(uommruine *irh S&rnn lUlO) orDrysion l
<br />of lhc Busincs inn Pdtsions Codc. dri my liccnsc n in hrll ntrcc and cilcct
<br />lb 963?3
<br />".,n.'ff.L* *,^,,-
<br />I hcEby dtunundq lrnalry olFrjury rhal rhqc n a Llnsrtuulnn bndine a8.rcy nn rhe pcrflrmm. orrh. u li)rwtuchrhri Fmn i.
<br />ksucJ lse.309?, Civ. C.)
<br />A8&&ANL!ECIAEAUq!
<br />I hscr,) limu8l.r FnrlryofI'crjur, onc oirhc ltl!,ving dcrl!Bri,n\:
<br />Dcmnnion Pcrmns^stcsros Notfi.lrx l;cJcral R+ul.lrns (T lc 40, Pan6)
<br />tt.qukJ lrrr.rolNotlirto,
<br />I ccnirylha( I havc rc.l lhis applilinon ann stllc lhallhc uhN rnntrmdll,n N cotrc.r laerecn,L-iplyw hallC y,nJ Counry
<br />ordrrkcs.nJ Sr.lc t2ws (-larinS ro bu,ldrng.onsd(rion, d aulltrtrrrc!rcsc ltivcs otlhis Cily an,l Coun(yb cnrq ulton rlE
<br />ulilvc m nnEd !n)E-ny ld uNnccx$
<br />Appli.. or A€trISi(nalore
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulationi Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />I /L- ^L L?'v r Drr-.4>-/
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />UFER Ground
<br />T-Bar
<br />Flood Zone Certif .
<br />FINAL
<br />D.rc'
<br />,*., zr/ t/r/zoz /
<br />IxnJcr \ A,lJrc-
<br />_l cc
<br />'lyrhnr
<br />rhclcJ.nlrcgulrr('n\ rgdJin! Alfnos r.molrla nor {fli.rblct, rhis F,rc.r
<br />*,, z/q/..21
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