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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEN BUILDEN DELCARATION
<br />I h.rc6y afirn lrder l.lllly of pcrjur, rhar I !m crcq)r nom lhc O,ntructna Lice.sc tlw rir lhc lnlk,{in! rc,en lstu 70ll 5
<br />Busnr{s md Pn fc\sn,n Ci d) Atry Cny .r C.nnry which rcquircs tr Fn,ir b .on{fl.r, alrcr. i.rUor.. ftrmli\h .r rclrn y
<br />srrudur., Inior ro ns nsu0ncc- alh rcituncsihc alfltotrr ior such pcnnir h lilc r si8ncd n(tcmnr rhar hcorshe h licei{d purulnr
<br />ro thc DnvtnnN ofrtE Conracror's Licctrscd tjp (chrrr.r 9. Cofrnrn.ine *irh Sc.rio. 1000 ol oivkion 3 ofrtc Uu\incs lnd
<br />I'n,rc$n,n\Code)o!thrr lEorshc h cicnrrl rhcrctmm .nd rhc bu.h lor rhc rllcrcd cxcnrpln'n An!lidelionofSccri,.?Oll5hyliy
<br />iprlicrdf.rdp.flnircubjc.krhcrmlicanrbr.i!ilp.mlttornornxrdrhnlilchunddd.lles(StoO).
<br />-1.,\
<br />o*nerofthc rmrEny. or ny emrlo)€cs tirt sryes a\ rhcn wh.ompcns(ion, sill do rhe sork turd rhc {turm n Nr
<br />i cxlcrt or olTcrcd ror slc (Sd.7044. ausift\s and Piofcssions Cuic: Thc o)nticrois Liccnsc Lls docs nor srply io rn osncrol
<br />rhc ptr,r.ny sh, brild\ or inprorcs rh.($n. dd wlx, dd\ $.h w,* hinrrlfor hcr\clior rhoD8h hh o, hc, o*nrmpbyecs.
<br />fl)vidcd ihur su.h impmrcmtrIsN mr inrcndcd doffcEt lbr elc II howcrcr. rhc tioildirs or impo!.mn' isv,lll*irhino e Fd
<br />of.omplcro.. rhc Owftr Buildd will brv. ttr hud$ ot lmliig rhrl h.or dr dil n hild.r nrymlt rhc Impdy li, thc t!rp.* ol
<br />-l.a\owncroirhcntuf,criy.an.rclusivciy.oDticrir8Bir[]rcc.rdc.ntrn.loreb.onsrrucllfuptr+cr(Sec7(]:l4.Bu\i"r\\a'xl Pn,l6rirn Codc: Thc Co.rrcroir Lic.nsc t-a$ des nor rpJrly ro an o$ncr.fpn,pcnt wh. buildr or nnpmvcs rhcrcor.
<br />rnd who conrruch ri,r such lmicr s sirh r Conh.ron, liccnscd Dusunr lo rhc Conhcroi s l-iccn* h* )
<br />-l
<br />rnrcxcml undcr Sc.linn .B &PC turrhi\rcd$n
<br />Dnler o*ner:
<br />WORKrILS'.i) TPENSATIO-
<br />DIICIABAII(]N
<br />I hcrcby trr',tmxndcr ncnllry oiDcriuryotrc oirhc rollownx iic.lnftriors:
<br />-l
<br />havc.dsillmrintrinaCcniiicntcofConscnrlo Self.ln\urc lnr*orkca conpcnsarion. !s pr.ridcd lor b, S(rn,n 1700 ot rlk
<br />bhor Codc. hr thc lrrfomocc olrh. wolk lor which rh. p.rnrir k issrd
<br />-lhivc
<br />an,l eillnrninrih worken compcnsation insuruncc. a\ rc{tuired hySccrinl?(x}oflhc LrhorG)dc. ror rh. pcrLntunc. or
<br />rhc wo forwhichthn pcflnir is iss&rd Myworics con{E.salion insuranc. caric. ud Ix licy n 'nh.r uc
<br />c,,,,,,,, , ehtr-.<tD el F-6
<br />+ht ..,.tcq to 4-6 >1.2t4'lq
<br />l.onili rhrr io rhc p.rfonurc olrhc Lvork {or qhi.h rhi\ |ir.lir i\ i\{rd,I sh(ll D.r cDI'loy atry tt60n in trtry 'nrnn.rv, Nbbc(nn u$jcl l,'lhc sork cis' co nll].nsti tnr llra ol Calil'ofli( Jrlrsr. rhrrifl \h,ru t c.mnrblccr ro rhc
<br />sorkdl .o fcn\rrioi pmvi\i{,i\.fSccrt,n:17(X)ofrh. trhtrC{{lc.l \hrll. nJnhwirh.o rply wirh rh.{ ln,vhions
<br />IVARNINC: tuihrc ro ccurc wortcN conEtr{.tnnr covcrigc r trnhslill. rtrd shrll {rhicr an cnployc! ro qiminal rErrlri.s rnd
<br />civil lincs up k, otrc hund.cd thousind doll.n 15100.000). ir iddittitr to rhc cos olcoflrlcns(rio]. dirage\ rr lmvidcd lnr rhc
<br />Sccrnr 1076 ol rhc trto Codc. inrcrcn aM .norncy\ lccs
<br />a\ -( tJ . t(a ,rpori.,nr, ts
<br />DECLAMIIQN
<br />I h.fthy arinnrnd.r Fnrlryofp.rjlryrhnr I m liccn$.i und( pmri\n,n ofChrprd 9 (.omnrncin8 Rilh Sccrion ?o(xr) olDivhnrn 3
<br />of rhc Busiressnd Protcssn'ns Codc. arn nry liccn\e t in r'ulllorc dcllcr
<br />C--tc-l .:r,rc N,n,n-r r < 6d6't(t
<br />a-tb'tV ,.,*.,- * Llo-jr Q-.oq es
<br />CANEIBI]CUIINI.INDIIIiSGENCI
<br />I hcrcbyofinorundcr lcMltyofpcrlu.ylhol rhdc is0onstrucli.n lc ins ascn.y for lhc pqlnrnurcc of rhc sork titr whi.h r his llrmir h
<br />issucd (Sc..:109?. Civ C.).
<br />AIELICANI.DIiII.AAAIION
<br />I lrrlry rilitu undcr pcnulr, ofpcrlury.nc of rhc foln)*i'r! d.clrnrnnr:
<br />Dc rlirion Pcrmirs Ashc(os Notincarn,n FcdcrnlRcs!larionr lTirle 40. Pan6)
<br />Rcqutcd k[c! oI NolifEalbn
<br />-,
<br />(.niiy rnd rhc lcdcralrcaulurions rcgEdn,E lshcnos rcmovul!rc nor apllicabic b dis Frr..r
<br />l&l..nr,t rh:r lhr\r n.rd rhr\Jpr,lKIm rt {. r rhrl}r rh\c 'nr,Jnrtrirdnda.. J',o srdc Lnw" rlr,nf rn hurldint c.trnd\r,nn. Jrrl hrrchyJUrh,.
<br />sc.nccr I rsre h compl) $irh lllCirynlld Counry
<br />rcrrcscnrari$s olrhh Cily ond Counly b enrd ufi'nrhc
<br />rIxn.
<br />'ncnrioncd t'op.dy fn i',Lprcri(r,
<br />Appliotrr o. Asetrl sisE(ur. >(
<br />f .-,ir"" nnn," rp.irrrr(
<br />"",.,' qlb'(0
<br />L)-tt--.tL Uv V'r ,a./
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation /1
<br />Roof Sheathinq to/tr,//l 4q+u,I
<br />Shear Wall c9
<br />framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lzlaso n r Y
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif .
<br />t
<br />FINAL i//6 //{^&-Cerlilicate ol Occupancy /
<br />Noles, Remarks , EtC
<br />n
<br />Set Backs
<br />knd.r. AddE\s
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