|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DEI,CARATIoN
<br />I hcrcbyalftmu r.l)tMhyof|.luryrh l m crcnrni nurn rh. Conricnri l-iccn{ hw l'o, rh. I{nhwing rclw,Blscc7l}.ll5
<br />lrusinc$ md Pdision Codc): Atry Ciry or Coudy whi.h rcquircs a pcmrir kr .ondtucr. alrs. inPrcvc. dcnn i\h ,tr rcl{ir try
<br />.furc- I'nnt, irs k\rao... dso rc+ncs rhc lpplicrnr n, slchFnnir t, filca {ign.il id.mnr lhnrhcor shc h li.cnsc! pur{urnl
<br />t'lhcpovtion{oilhcGnlrocin\l,iccn\cdLaw(Chrprcre.CommcBinslirhsccinr7(xDorDiviln:lofrtulrusiocssantl
<br />Pn,rc\sidsCod.).rrirr h.r\hc ( crcnlPr rhcrdfr.nraid rhc hi\is rnlhc illcgcd crcnuion Any riohrion oI Sdbn 701I 5 hl rny
<br />rlpll.a hrrp.irnrsuhF.Frh.0pt'lic!trrtorcivilpcDrlryolnornrrcrh iivc hundrcddollar(S5lx))
<br />tlaarliBslaut!)Nsarrax
<br />DICLABAIIO
<br />I hcrcby rr'lttr,rndcr pcnrlry ofn rjoryom oflhc n)lk,wins lcclrari{nN
<br />l hrvc md *illmrinrsi( rCcdiiicrrcofConynrt, Sclf lD\urc f(tr so cr!co 1Prn\Jion. rs trovid.d lirbySccri(n,.17(X)olih.
<br />l,atu Codc. f.rrhcpcrformoceolrhc s.rk inwhich rhc Frrnir i\ hsucd
<br />(Zrhr\cJLI*'llmrnra,nu'trkn'.,n|cn\Jrr''n\urrn.c.r\rcqrn.dhyS..rofl7(x)ofrhclrtnr(idc.lbrrhcp.rfonrftror
<br />rhc s.& ntr*hirhihi\ p.nn is ssucd Nly *or*cn ..nrr. \di(,n insurarcccnm.r flxlpolic, nun rcruc
<br />c*,i",, 5'1q k F,ndqzt\ 3 blzb/t3
<br />l..dify rhtrr in rhr tcrf.rmrR. o{rh. qolk nx whi.h rhi\ Fi,nn is isnrcd. I sh.llnot cn{loy lny l.non in any nun.cr
<br />so3stolrronEsuhlccrrolhcwortcls'conricns.rionlnw\ofC.tir'ornia.anna8rcclhllillshorldb.$msubj.ctrortE
<br />"olkcs' onD.nsdion prornions oI Sc.rion 3700 of thc ljktr Codc- ! shrll. tnn h$irh compl, sir h rh,\c pb ns.
<br />WARNING Ftilurc r. wur. workcrl conrrcnrari( .ovciflgc i( uilrwtul. i.d shrll suhjccr M cmplorr lo qiminnl lcntrlri\ aid
<br />.iril fin.\ up k, onc hrndrd rhousind dollrs ($ltn.flDr. i', trddirnni i. rhc.o( of compcns.lion. dln{gcs rs pnvidcJ f{tr rhe
<br />sriiun.1076 ofrhc lrtin cod.. icrcq inrl onfy \ lii\
<br />t,'",ElO($ Appricon,:d/1?@
<br />DICIABAIION
<br />I hcrchy!flimundcr pcnllryofrErjury rtu I om liccnrd udc, provnio! orChlprci 9(..mmmni8 Bilh sc.tion rflx)) otDirisi,,n:]
<br />oi rhc Businc$.nd Prolcsions Codc. a myliccn* is ir full lorcmdc,Lcl
<br />B lot7g.3tr
<br />,",", llg/16
<br />APPI ICANT DECL{RATmN
<br />I hc$y drm undcr Fn.lly ofpniury orc ollhc following dc.lamrions:
<br />D.mlirion P.roirr A!h. os Norifi.arion Fcdcml Rcguhrions (Tirlc 40. Pnn6)
<br />Z&cqnift d t nd orNdiic,rhn
<br />d-t *niry rUr rt" i"a"a,"Blbrionr Esulirs ashBros rcn{uluE nor llplicoblc ro lhls pojsl.
<br />TAI.rdiry rhar I hav. rc.d rhis appli.lrmn un $ar.lhnr rhc 0lnv. infomoriotr iscorer. llgr rocodtlysirh rU Cirya.n coumy
<br />ordinaft.s and Srar. Lrws Elari.e ro bu ildine conn.rio.. trn] hcrby lulhorirc rctre*nrar ives of rhis Cir y and Couniy ro .nls uB)n lh.
<br />!to!c mnrioncd prcpcny for insFtrion purn*r
<br />Lr.,\pDlirxtrl o' \!rtrr \i[nalun
<br />Z Arb,)lo\ul
<br />1ta/8
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf Ioor/Vent/l nsulatron
<br />Rool Sheathino
<br />Shear Wall
<br />Frami ng
<br />lnsulation/Energyuyal S/2*l$ 5rr*t65-t >'ls,\ h ttEil*
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Ceftif.
<br />FINAL tr v@ t->t 2/ A. rgt
<br />Certif icate of Occupancy
<br />Notes, Remarks , Etc.
<br />Set Backs
<br />UFER Ground
<br />-l-
<br />ar o*tur ot rhc pnpcny. o. nry coployr$ sirh waEc\ a\ rhct sle conf.nsrr io.. will do th. *uk ,flt trE slnElurc is ml
<br />inr.n&d or ofrciud for ulc (Sd.704,4. Busincss and ltlofcsli.nc Coic Thc Contd(r's Licctr$ Liw docs nol apply ro rn owndr of
<br />rhc F)pcny shobuildsor illrIrroEs rhcftln, bdl*ho&rs\khkd hinx.lfor hfsllorrhmugh his or h.r owtr cmploy.cs.
<br />providcn rhlt such ntrPnNcmnrs m ml htcd.n o! oficrsl lhr q!: Itl howcvcr, rh. hriHing or irymkmn! is sU wnhiLr .nc )tJr
<br />of.onphlirn, rh. Owncr Blill.. pill havc rhc hurdcn oil,mvnf rh.t hc or sh€ dn ml ttriH or impmrr rrc lI)p.iy for rh. ruq$tnf
<br />_1. arosEof rhe pror.ny. !ncichsilclyconrEcrinr wirh li.en\cd conhcr.r h connfl.! IIE pft,Jc.r (sN. ?044. ausinc(
<br />01t Pro6$jon Cotlc Thc Conlru.lor's l-iccns. Laq docs nnr rpFltio.nowncrofproncnywho blild\o! inpr.v.s rhcrc.tr.
<br />lnd who d,nlmcrs for slch lmlrrs wi'h a C.ntr&k (\) liccn\c BUd ni rh. contr!.kr's Lic.nsc tiq)
<br />I am.xcmfl lnder Sccrn,n ,B & PC. forihilrcN '
<br />Drl.: OM€.
<br />rI)x$f,ltr1ll)NrrNDlN(i j(iliNrr
<br />isucd (S.c 1091. Civ C.l.
<br />I .'nc''( Nrnr.
<br />----T------
<br />---+--
|