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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG COMMENTS OWNER BUILI'ER DELCARATION
<br />I hcrchy alfinn !nd.r pcnalty (,1p€rjury nfl I m.xc'npr tonr thc G)nrr!.ros' t,cctrsc tiw ror rhc folto*ng m$on at.
<br />Burincss .trd ProLssi( C.d.) A y Ciry or County qhi.h tuluncs r fcr'nir b con(rucl- altcr. inuovc. dcnolnh.r rct,rtr.[y
<br />dtucrurc- lriorro irr i*uaft.. nh. rcquirc\ thc lPllknnl ti,r su.h ll(rnnr kr filca \i8ncd {rrcmnr rhlr heor shc n li.cn\cn nuruant
<br />lo rh. |h)v,\n,is.frh. Conrrucrois l-icctrs.i ljw ((-hrpic! 9. Comtrrcn(ing *ilh Sccr TUD uf Divhi l of rh. Bu\incs rid
<br />Pdi\ri.ns Codc) or ihar hcor\hc kcrcnrpr rhcrefrorrtrd rhd hr\is turrftlltcgcd crcn{ri(r AnyvnnariflotSdhn?0ll5byrtry
<br />nptlicunr lrtrn ncmit \uhjeis rhc aptlicnnr ro rcivill)cnilry.fror rrcrhan liv. hndrrd dollnB(l5olr)
<br />l. !\ osncrofrhc l)lo|En!. onny cn]plors\ *ith *a8cs rs rlf,t $lc.rnlprnsrrion. trilldo rhc work md rhc dEruc k ftn
<br />idcndcd dr.ffcBl lor slc (Sa r(}14. ausincss nnd ftotc$iors Crlcr'lhc Contr.cnn's Li(cnsc tjs doc\ nor lnll} r. ai ouftr of
<br />rhc pn)Fdy qh)brildsor i'nproksrtumr! *ho doc\ su.I qorl hnnsr]i orhcnclt or rhx)rgh hk or hcr own cnDloyccs.
<br />Irovnbdrh su.h i'nnn,vci,rtrsur tror inrcnd.J n oflcrud for srL llhow.lcr.ricbuildinSo.inl,.ovcrrcnris$ldsirhiroi.jr{
<br />or.on'phri,n, rhc O*ncr Bliklcr *illhavc rh. hud.n or Frvin8 rltr lEo! shc aid En lllill or illtn,vc rhc t'nrFn, rd rF. puqrJror
<br />l- 0i o*mr or rhc rrlFny. m .xrlusivclt conlld in8 *nh ti..n\.d .onrn b^ r, con(tu.r rhc ,njccr (Ss 7or.l. Bulinc$
<br />aRl P\sfss.nConc'IhcConrractoisLiccnscLdwdocsnoiopplyro(no!,ncroin.opcnywhobtriklsornnpn)vcsrh.rc..
<br />ud $h. conhcrs ror su.h pr.rd( sith ! Cotrtmcrons) ri.cn\.d rur\u. r, rhc Cotun.rr's t,kcD* ti* )
<br />I amcxcnDl undc. Sc.rii)
<br />t lle O*ner
<br />wonxtnv colrpn"rs.rrlorv
<br />DECI.AXAITA!
<br />I hcEhy alfirn undcr NMlryorncruryoft ofrhc nnbwins dcclarnri.ns
<br />-l
<br />havcanlwill 'uiinDin aCcnificalc.fConscnt ro sclr-ln\urc tu sorkcr' co nDc nsat ion- as rovidcd tu hy Sccrion]Tm olrhc
<br />Llhor Codc. lnr Ih. pcrfornunm of rhc w.rt lor which rh. ,cmir is i\rucd
<br />lhrvc nnd *illmiinroin *.ricrs'con[cnsarioi ]nrurnicc. !s rcquirci I'y SLrtio! l7tro olrhc hbor Codc, for rhc f{rfornuncc of
<br />rhc N rkfor*hichrhi\ pcnnir is issu.{ My*orkcrs .onpctrurnrn i.\lnrcccrnicr lnd noli.y nunrbcr arc:
<br />J
<br />tq.L
<br />lccnityihrr inrhc p.rfon*rmc olrh. woik fu $hi.hrhn p.rnir is isnrci,I shill Dor ctrll]hy rry lxmtr i'r rtry [rkr
<br />s !sro h&oft suhjNr r,rhc workc .onu.nnrti(D irw\ or crlif(fnir d rsrft rhrrifI should bcc.m subjcd lortE
<br />workss.ontf,nurioifl)vti{Jns.fSccrirnrlTr)Oofrh.tntxrCodc.l\h!Lt.lonhwirhconrplyNirhlhorprevisions.
<br />WARNING: tuibrc h ccurc sorkch .o'npctr\ ion.ovcmsc i\ unlowlul. rtrd \hdl suhj..r nn cntl(,ycr (r aiminrl lcMlrk\ d
<br />.ivil rincs up ro onc hutrdrcd rhonsard dolldA ($llx),(Xl}). i,r rllditiotr b ihc c.j ofconDcnsarnn! dnm lc\ as tmvid.d rr rhe
<br />SLrrion]0?6 ol rhc lit r(qlc. inrcrci dM arionrt \ rcc\
<br />HAY 17 201&*,.*,,,
<br />DECI.ASAIION
<br />I hcrcbyamnn under Fnalryolpcrjury thor I am li.cnsd xidti pmvnion ofChlrrcr 9 (onnrcncins sirh Sccli,rn 70(x)) ofDivirion 3
<br />oi rhc Brsircsand Pmfe$ionsCodc. and ryliccne is in {ull loEu.dcrtccl.
<br />a,\o a1^4c\
<br />1111 f{ lffi""*'*V ):,tt<
<br />CONSTRUCToN ! FNDIN(: A(]FN(IV
<br />I hctohy amfln under t[mltyofFrluryrhir rhm is a coNruction lcndins aScncy lbr rhc l)crfon:Dmc ofrhc work for which rhi\ F-nnir is
<br />tsu.d (Scc .1097. Cir c.).
<br />APPLICANT DF(:I AR,{'IION
<br />Ilxrcht.lUnnunddrFnrhy f pLrjuryancoirhclolhwinsdc.lrrriois:
<br />DcNrnion Pcrnirs Ashcsros Norificarinn l,cdcrnlRCEUhln)n\ ('rirh 40. PdO
<br />-Rcqutcd
<br />hnd.f Norificrri,n
<br />I ccniryrhlr r he lcdcral rcEU hi ions rcSaniing asb.sos rcm.vll arc nol oprrlicahlc rolhi\rrojccr
<br />Accnit:y thd traec icd this dpplicario. orri narc rh rhc,hov. nrlonturion i{c.rNr ItrsretoconrtlyailhallCily{ndCounry.rtli' n.c\ rnlsrrrc Lr!\ rcldrinL ro huinlnrs roD{nr.rirn ofrht ciry and counryr, cnrcr upon rhc
<br />rlDvc ,renr ioncd lr,p.ny ror insF-crion
<br />Appliotrl orAg.rl SiAtr !r.
<br />A,o,t
<br />*,"maY 1
<br />Set Backs
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Shear Wall
<br />-/c )""De,VvrZ4
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Pool Fence
<br />T-Bar
<br />De t Final Re rt
<br />En ineer Final Re orl
<br />Flood Zone Certif .
<br />FINAL ,-/?-/t'//a54.fvr)
<br />Certif icate ol Occupancy
<br />Noles, Remarks EtC
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />Roof Sheathinq
<br />lFramino -/L
<br />lnsu lation/E nerqy
<br />Ir/lasonry
<br />Handicap Req.
<br />I
<br />Ja"
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