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BUILDING- INSPECTOR RECORD
<br />SITE-WOBK ID/SIG.COMMENTS OWNER BUtI,DER I}EI,CARATIoN
<br />I hcr.$y afli n undr Fnrhy ol r.dury lhd I on cxcnrtr lmd rh. C.nradod Li.cnse tiw tu lhe follosir8 rclv,n (Scc 70ll 5
<br />Busnrss lnd Prorcsrion Codc) Any Ciry .r Counry which r.quncs r rEinrir lo con(ruct. allcr. imlrovc. dr'n,lish or qrn any
<br />{tucrrrc- rir b it irsuxie. fll$ re{luncr thc drplicanr tn such pcrnir t) ilc r \iAmd jrdcmcnr rhnr tr.r shc ( li.cnrcd Fu^uanr
<br />ro lhc prcvtiotrs ofrhc Conillclofs Liccnscd L1N (ChrFrcr 9. Comnrcncirs with Scclion 7l)(xJ oI l)ivision I ofuhc Bxsii.s rnd
<br />Prcrcssions C{trlc) or rhrr lco.sh. ncicnprthc'cfromand rhc hrsi\ lor rhctrllcscdcrcmprid6 Anyvi(,l,rion.lScdi 70ll.5hyony
<br />rtpli.anr ron p.nnn suhjc.'\ rhc lpl)li.ad b a.lv,lncn.litottur nx,c rhin lirc hu rcd dorlr{ {S5(){)).
<br />-l-
<br />as owncr ol lhc DmrEny, or my ery)l{,y{s Nilh *aacs ar th.n vnc conrrnsurn,n. *ill 6 rhc q)rl alxl rlf, {u*lm is ml
<br />i' ckldl or olfcr.d Lr slc ( Se ?044. ausinc$ md Pmlcsions G'd. 'l hc C.ntrctr's Li.cnsc l-rw docs nor npplt lo an osnc! of
<br />rh.rn[rny who builds or nqmEs thcrNtr. inn sho des clr w& hnnsclf or hfl sclf or ihmueh hh or hcr ou emrLyccs.
<br />pn,vidcdlhrr such in,rmKornh N mr inrcndci orontrun lorsh l[ lnwcvcr rhc]Diklinr orimpmrcmnr t$kl wirhinoft Fr
<br />.tco'ryhr Dn. lh. Owner Bu,tb *illhrvc fic budc. oftn)vin8 rh hc r shc did mt taild or inTr.lc thc pmFny lor rlr puqDs of
<br />Ar. ar ownM or rrrc p,,poy. ,.r cx.lu{vc lt .o.lia.ring sirh licuiscd .onlh.toA r. on$tud llr !.ojd ( Scc ?014. Bo\inc$
<br />0!d |La.$ion Codc Ihcc:onlmctr's l-iccnsc Llwdes nolryDlyro.nowncrofrropcrrywho iuildsor idprov.\ rhcrcon,
<br />rnd who.o.tn.hforsu.hp$lc.kwith{Conrridonrlicen{dl|runnrrrrhcCok,ctrtLkcn{Lr*).
<br />I dncrc,ntr u cr Sc.li' .ll & P
<br />IIS:LAAAIJQN
<br />I hcrchy rfllrnrundcr ri..Jry or perjory onc otrlE lirlk,*ins dcchmrion\
<br />-l
<br />hNc md r ill rointrin a ceniiEntc ol consfl Io sclllnsurc lor w.rkcs corlPcnerion. as pr( vid.d lo h! Sd.rhr 1700 ol rhr
<br />bbor Codc. for rhc |).rformncc olrhc solk lor whrh rh. p$mir k issudl
<br />Ihrvcid*illnrJinrJirlvorlcricotr,pctrsrrnn,i'Nrrn.c.rsrcqundhtSc.ri,n]170(,orr[ct.nh.rCodc,fotrhcp.niinumcol
<br />rhc wort f{tr*hichrhi\ pcmn is ucd I{y workcn'co rI.nsrrion insorrncc cd'ri.r rd F,li.t truD$(r dc
<br />c,,i.,, c1?(rl5 fn Lo
<br />r,1q,/40'{ t L)t^l-(t
<br />-l
<br />ccnilyrhrr ir rhc pcrloirnafc..lrh. work tor shich rhis rclnn i\ tocd, I shill n.r cnrloy otry h-Fon in any mtrncr
<br />$ ,stu a"'.o,tu \ubt cr t, rh. wrtrkcr{.o rJ).nsrrion l.w\.fcrliturnir, did rgtu rhar ,f I sholld b.c.ft subjNt lo rhe
<br />wo c.{..mf.n\dnnrpR,visionsofSoti.n1700.frhcLitxtrC{x1..Ishrll.tuniwirhcoryly*ilhrhoeprevisions
<br />\{ARNlNc Ililurc tu surc workcn' $mpcn{o1ion covcmac is utrlrnlul.
<br />.ivil lincs up ro oic hundrcd lhousrnd dollas (SI[$.0{X)). ir ldir r ol.omprnvri{xr drnracs a\ Pi{Jridcd nr rhc
<br />s..ri(nr 1076.{ rh. I *rn (.i1.
<br />DICI,ABAIII}N
<br />I hcrcbyrffiflnundcr Fctr.lryofNrItryrh l 0N liccnrn uM.r tmvhion ol Chanls 9 (conrmncins *irh Scrion 70fi)) or Divisi,tr l
<br />of rh. Busircs and Pmtc$ion\ Codc. lld ny li..ns i\ in lull iare anl cfftcr.
<br />CAIEIAICIIONIENIIIIC.&CEN(I
<br />I l*sb, dfirn undf |f,nrlryof txrturyrh.t rhtrc is r.ofstucrion LMirf oecmy lhr rhc nslolruNc oflhc sorl for *hich rhis lxr. r h
<br />k\ucil(S.c 1097. Civ. C )
<br />A.IIUCANLDECLAAN.IIAN
<br />Itl{br.linnu ]trlE rkyollcrjuryoNof rhcli'llowin8dcclnr.tio.s
<br />DcftnIior P.flnils.Ash.{os Noriicarion l;cdc(l Rcguinrionx I Iir]c.g). Prn6)
<br />Rcqtrircd krrcr of Notili.rrion
<br />l..nilvrhrr rhclcdcnlrcguhriotrs r.gar(ting xstf,no\ rcfrvrLrrc mrlPfli.rhLc h thn t(,rr.r
<br />1..'ril!rlrrr I lh\c 'cftlrh\ rtd nm i.n is.orccr. I (E€ ro conrly $ irh all Ciry nnd G,rnry
<br />ord nx rc\ xlsrntl-r(\nl ing()hri[lnrs sc nlivcs olnrn Cily ond Counl, r,.nrcr uE,n ihc
<br />rtnvc nEnrioncd nn)p.ny i)r lnstc.ri,n,Itr
<br />Appli(lnl or A,l€nt Sirn!t'm r'a'/'t
<br />Set Backs v/
<br />Forms/Steel/Holdowns ,r)/\/
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing t?-29-t6 t1cal D04 ?') 6)-Y-
<br />Shear Wall 1o-u- t6 Acarl
<br />Framinq la t-t-t-o .42 -.)
<br />Insulation/Ener Sy -Drywall 6/bD/71-/a--
<br />Ext./lnt. Lath €rt*rzr /@-
<br />Brown Coat t$4t19 a,--,-
<br />lvlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL ,'i:a>'Z
<br />Certificate ol Occu n .C
<br />Noles, Remarks, Etc 7
<br />a--v-/
<br />? q -//-/ r7
<br />DATE
<br />shrll {'bjccr rn cnfk)y.r r) di n rl,rdtrrlics rnd
<br />y-y'-rs
<br />I rrJr' \ A.ll'.-.
<br />,.c \t7
<br />Erection Pads ta'/
<br />to /tto/t *n/,f/rr
<br />Pool Fence
<br />Flood Zone Certif .
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