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BUILDING. INSPECTOR RECORD
<br />DATE tD/stG..
<br />Set Backs llt rq /uts
<br />, COMMENTS
<br />Forms/Steel/Holdowns nt1.z{tfd)r{.- 4..r* t<-h b t&t.
<br />Erection Pads
<br />UFER Ground
<br />SLA loo L4.44(0
<br />ubf en lnsulation
<br />/</44,Roof Sheathinq (t 7)
<br />Shear Wall 4 .|,/,tr cfi.D
<br />'Lq -,.u4crVFraming
<br />.{zzZt,)ln s u lation/E ne rgy
<br />Dywall Lt .zo!\1 -,<.lAhnc/</4,tr1lnt. Lath It/))
<br />'{rown Coat 'l l',r9 Plt(f L"o s ,^Pn .'n rve'1+*\
<br />lt4aso nry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Frnal Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />1 I I
<br />FINAL 6L
<br />Certificate of Occupancy I
<br />Notqs, Remarks, Etc
<br />_A
<br />I o
<br />;.c
<br />8v
<br />r.utlf
<br />1, t4,-
<br />'li ^ a..
<br />ih2d n /
<br />I
<br />OWNER BUILDER DELCARA ION
<br />I hs.br alfirm undcr p(6lry oi petury rhat I m .rdnE norn th€ cont,crou' Lic€.sc L.w lor lhc lolb*ins rcen (Sd.7oll s
<br />Busin6s and Ptufsion cod.) Any city or counly \rhich leNiE a pdrn ro codruct. ahs. ihprove, denolish or E!€n s)
<br />stodda lrior ro irs issumc€. ale rcqun6 ln€ applicd lor 3uch pdmit ro filc a siSned slalqncnt lhal h. ot sb. is licdsed purul 'ro rh. provisions of t. Contractois Lianscd LaR (Chapt6 9. Commencin! $nh Sdrion 7000 ol Division I oflh. Busin6s md
<br />Proacsioft cod.) o.lh.l hcorshc is crempt lh6c6om md lhc bdis foi llB all+€d cxonplion. Any viol.tntdoaselion 70ll 5 by any
<br />.pplicdr aor a ptfiit subjds Ihc .pplicut r. a crvil tm.lly o f not mor c lhan 6!c hundEd dollds (t500)
<br />2,h* **. * rn".o**'1y. or my cmplo!6 th*d!.\6rlri,v,le.on[Ensato.*illdorhewo,kadrhenruduei'lot
<br />inrod.d oro,Iscd tr sl. (sd.?o4,1. Buins ud Profdi!tu cod. Ihe conlrador's Lic.B. bs do6 ,ot applv lo e ownd of
<br />rh. pDDdy $ho boikreor ihpmBthooh. d$ho dGsu.h{o* him.lao, ntrllorthourhhborhd osn cmplovG
<br />povidcd rhat srch nnpBEmls e ml htsdsJ or ofdcd aor sal l[ now6'6. lh€ hl drs ot inpio\mr is $ld s ilhin on€ )a
<br />ofcompl.lioG lhr Owncr Builda si hart rhc bttrdm of pmrinS that hcorshcdi1@l build or in!rcw th€ toFry lor (i. FlFsol
<br />l, * osld orrh. rrpdy, m .rclusively contEclins wnh tcens.d co.racrou lo codrucl ll'c poje.l {ss 7044. t rsins
<br />dd Pi.A.sion Codc: rh. Contrctof ! l-icds. t,a$ do6 not apply ro oNno ofproFnysho builds or inprov6lhndn,
<br />and who conrdds for such prejdrs silh . Contmto(, lic6s.d puBudt ro rh. Conlraclois Licetr Law).
<br />I ancxcmpt undr Serion-.ll 4-,,^," // zr-/V o,,,,
<br />DlclAA4IlO!
<br />I hcreby afirm und6 p.nalry ol pdjury on. oflh. aollou'ins d€cl@lioN'
<br />I hav€ od $ill mnimain a cdirLal. ofcoMl lo Sclf-lnsurc i)r sorl?6 con,p.nsarid,, 6 provdcd for bv Setion 3 700 o r lhc
<br />kbor Codc. for rh€ pqfodac. of rhc *ork lor which lhc pmnil it isu.d
<br />-l
<br />h.!c a6d Nillnrainlain*orke6 comp.Balion iGurancc. s rotuned byS4non lT0oolnE LaborCodc.lorlh.psfot6a..ot
<br />rh. *ork lo. which this p€mil is isued. My wort.B comlensarion i6ur c€ cdis dd F.licy nu,nbd ae
<br />Pol'(\ Nd,rbd
<br />-Frptr6
<br />l4Z,^.u,r^.tn n""mm..orlh.$oh ro, whichr\F pom r sru.'r.I sharr
<br />$ dl !o bRcmc lubl.d rc rh. u ork4' smpsBal'on lr{ s ol ..|'Lm'i. and a?'r e rhar
<br />wor16 c"mnFsaron r'o\is,oN ufSdion r'00 alrlr Lib"r a.Jc.l shall. fonh$nh
<br />WARNING: I;ailurc ro s(u. {o 6 snp.Mrion .ov.ra8c is unlar'aul. and shd
<br />nol mploy any pd.on in dy mmn6
<br />itl should b.come lubjct lo thc
<br />coDply wilh lhoe prolisios.
<br />I subjd o dplo)€r lo oihintl p6alti= ad
<br />cnil ,in6 up to o.c hundr€d rhotrsdd dollds ($100.000). in addn6. lo rh. .ost of Jmdsey'E aroud.d ror rhc
<br />/
<br />Sdion 1076.frh€ tihr CoJ.. inldd and all lz
<br />u(-u!1,il2l!Nr! lll)a
<br />DICLi.&\Ulltr
<br />I hs.by airm unds pstlly oa pqjury lhal I d lio<d und.. Folisiotr ot Chapt6 I Grnin.ocio8 with Sc.lion 7000) 'r l)ivisi'n I
<br />ol Ihe BBi.6 od PmfseioB Codc. od my licse E in rnll lor.. tnd .ffat
<br />coll$.lcllaNrENDlNc.6ffl.cl
<br />I hftby aiItrr und( !.n.lryoip.du.yrhd rh6. is t cotrnrudion lddins as...y fo. thc pdfom&ce ollhe sort for whichlhis peftn is
<br />issu.rr(se 1097, civ. c ).
<br />alrlcAar.llclJBAuax
<br />I balby.nim ondd paaliy ofp6jury onc ofrh. aollowin! &.le.lions:
<br />Dcnolirion Pmilekb6tos Nolificatiotr F.d@l Rclulaliotu (Tn1.40, Pel6)
<br />-R.q!n
<br />d til6 of Notifrcdion
<br />-l
<br />cqi ily lhal rhc l€ddal (*ulalions rcsaldins sbdlos rmoval e nor .pplicsbL to lhls pojdt.
<br />/Ll tait, rrar t nztc raaln6.pphc.uun an<t star. rhar lh. abo!. inaomarion n corr..r I alc ro comply wirh all ciryand countv
<br />[?ffii'-.* -a s,",. r-,*' *rauu io bu'rdhs confid,or 6d hd.by aurholnc tcrr*dsii; orinis cly sd co@ryro ai6 uP.D rh..tu',"EA'z ," /l z*/
<br />-Lzgtru:a\lI
<br />SITE.WORK
<br />t7)'iq
<br />z4
<br />4
<br />Lender s Nm.
<br />-
<br />L.ndd't Addrs:
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<br />-T
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