|
BUILDING- INSPECTOH RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />\C-,t cf o-tt 514! rcl h L1
<br />Erection Pads ?\YI P"".4. u/ttl ''e<de leth
<br />UFER Ground )- |0)"u7 €v"l /yw", y
<br />SLAB Floor at lOtt><r - ,t.4, )71v4''-
<br />Subtloor/Vent/lnsu lation
<br />Rool Sheathinq ,lt
<br />Shear Wall 6/(")
<br />Framing fs(-Fl
<br />lnsulation/Energy bfi/n 2/4./-tGl v)
<br />Drywall )a
<br />Ext./lnt. Lath 7 t
<br />z4 tqBrown Coat ok l- tbp s"nl\-7
<br />Ivlasonry /44dJ rrtPL.,1.r,..
<br />Pool Fence
<br />T-Bar 1/.11 &a
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil +LL kA.-.i< <h,r',A.t/, A-..- htal
<br />Llz/ttLz b/41/- 4u
<br />Fo)fipl /t,tFINALJ*tz1
<br />Certif icate of Occupancy
<br />Notps, Bemarks, Etc
<br />3
<br />k-L +
<br />c
<br />OWNT,N BIlII-DT,N DEI,CARATION
<br />I hrr.b!,llnn xndf pcnalty ol pcrjury th limcrcm tn)m rhc c()nracro^' I-tcnsc ljw,nr lhe lblbwing it'N$n (5e70lr.5 I
<br />Bu{ncss rl Proltss.n Cql.)r Any Ciry or County which 'cqtrn s a p.rml n, consrdcl. alrcr. imptuvc. dcnolish o, EPrn any
<br />(rucruE. prnr ro ns Esuancc. rk. r.quirsrh. appl(anl ft, such pcrmr n, ilc r siStJ { cnf,nr rhlr h.or shc is n cni&l pusutur '
<br />ro rh. I'Rlvnions of rhc C.nlaclq r l,icnrcd l-aw (chtrpr.t 9. Commcnuins *nh S&rbn 7000 or Division I ol lM Brnncr\ rnJ
<br />: PlrtssionsCidclorrharhcorshc s crcmpl lhcrctiom.lldlhc hasis forrhc aUcgcd.rcmnr,on Anyvi,,lalionofsetx'n701l.sby.nv
<br />rtplicanrtura p.mn subjc.Ftlr lptlicinllo rcivilpcnrllyolnot n,.rh$ fivc hundrcJtlollas (S50o)
<br />L rs ownc.oirnc pn,p.ny.orny.mploy.c\ wxhw,!csasIhcir lrcdmpcns ion. s,ll Jo ilr work d rhcslturmi\mt
<br />intcnLJ or ofier.d for qL (Se.7O4-4. Busift$ Ml Pn'l!$$rs C,rlc: 'l h. Conki.roi s Liccns ljw &Es
<br />"ol
<br />rppl, lo d owNr oi
<br />rh. tn)Ocdy wh. tx,il'ls or i'np!)ts ih.R'h. dnd who d(.r \uch wo* himrcll o! hcncll or rlmugh hs or h$ own employccs.
<br />Frvr,cd rh such mllovcmds @ror incB]cJ orolltR{ lbr sk Il k*cvcr,llt t{ildn3 iflrf,orcmnr is$U wirhin i(re
<br />ol conpLrt,{ rh. Own.r Bui d wil hlw th. l-ddcn ol pnrvrg rhrr li or dt Jil mr bui!, or im{Bvc rhc ptuFny for !h. Puqxre ol
<br />l, $owkrolrh. pn,Il.nr. ah.rchrnrlyconkrcrin8 wnh lNnscd .onlraclors h onifld th. Pntlc.t (Scc. ?Ul4. Ausft$
<br />rnn Pnl&\bn Codc: 'l h. Contacntr s Licc.sc l-iw docs nor lpply b an owncr of pbr. ywho huild\or impturcr rhcron.
<br />.tu1 pho drrrmcll 16r such pmjcck wirh r contrct!(!) liccn{d lu uant to lM Ci,nh.!tr\ Lic.nsc tjw).
<br />I rnrcr.n,nr un'lcrSc.r(,n .B &PC n{!hi\rcrvn,
<br />lIORl(ETS' COMPNNSATION
<br />MllaS4rlo!
<br />I hrrthy rl1mrundcr pcnalry.l pc.jury on ollhc lnlbwu,e 'lc(lrrrtun\i
<br />-I
<br />hrv..Jrl w'll rumain ! Ccn ialc otcon* l{' Sclllnr8 tur workcii-donpcns.lion, a! povided tui byscction l?00 ol llrc
<br />Litrtr Cdlc, lor rtu pcnbtuc. otthc wo* id which rhc rcmir is isru.'l
<br />-I
<br />hrvc rnd qru.rrinlrin workcs .omPcnrarion insrrancc,.r rcqurcd hy Sculi,n.1700 ofrh. L3hoi cotlc. fr lhc pcriomMcc ol
<br />rhc strk Lrwhi.hrhs pcmr ii isslcd. M, work d oml.nsdion D.urincc.arEr s FrKynumh.r m:
<br />c.nnyth,l inrhc p.rn)rronce ot rhc work rn wh'chrhslcirnit N tsuc!,I $rll fr c'nthy .ny lcru in an, hanftr
<br />r\ r, hc.omc $hrcr!i rhc wo*cri eonE-.srl!,n hwr.lC!l'k'ru rn,l rgrc. rlr n I shoul,l hc.oft nrl&cr rorltc
<br />Lom0.ns,!n,h ftuvrions ofSc.li,,n 3?OO ol rhc utrtr c(rlc.l srtrll, hnhwilh.omply wirh rbsc Pbvrsions
<br />RNING I'ailurc n, E.uc w.rk ^ comr.nsatn'n.nv.rutc r rrrhwlxl, znJ sh,ll suhr.cr M cmPloycr lo dindxl Fmlias rd
<br />Itrs un b om hund..d thou\and dollirs ($llx).lxD). rn lJJ !
<br />1
<br />DEC!,A84UAN
<br />I hcrchy alnnuftlcr pcnahy drFrjury th.t I am LensJ undcr Fnlvtnn' oiChrfl.r 9(conrmrcins ui(h Sccrion TOtr) ofDivriot I
<br />o, thc Rusircss an! Polt$bnr Cod., u my ltcnsc * n tull forec ad cal'.cr
<br />gaxsr8ucuoltt[NDtlc-LqENcr
<br />I h.i.hy rflnn undcr Jrnalty ol pcrjury rhd rhd. ii r coh{fl.rnn lc.,.linS aScncr lot rh. Pcrlormmcc ol thc work lnr whi.h th6llrm s
<br />i\(cJ (Scc llD7,Civ. C.).
<br />APPLICANT DECL RATION
<br />I lEr..ny anim un icr Fn.[! ol peijury on. orrh. rollowin8 Jcclmrn,ns:
<br />Dcmol,tion PcrmilAstEsros Norificarion F.dcrrl RcSuLtkrns ( l illc 40, P!n6)
<br />_Rcquird Lctt.r ol Nolifuiion
<br />l.cn,lyilur rhc r.dcr.lrgul on(rgd.l[3 !s6c(o\ r.fr)v]l]rc norrptloblc h rh$ Imj.ar
<br />ordindkcs !trdSlrrc ljw{ rcllrin8 ro buidmgconnrucrtun. $xl trBc'cprc{nrxrivc(dlrhNC ylndCounrrrocmcruBltrhc
<br />trh,r. n.nhoftd p()lkny l!tr trNtccr(nr r/'u/t tAnnli(!n( or Ax..l Sisnnlum
<br />Pcnniltr nan'c rprinrr:-
<br />,EI
<br />//1 F/-p/A .&Z to4
<br />',G4A
<br />'rt(rq -
<br />otqnd
<br />,u.4fi1
<br />;Z/-Z):t
<br />RtbZ *?z,J A, z,)ta{a d t GtL*zfr'
<br />Lcn.lci\ Name
<br />-
<br />I
|