|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing I ht/tl e,t9v* /a
<br />lnsulation/Enerqy k lb'rlil F nrffiJ "t)
<br />Drywall tl:lo.-lY ut+li\
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />T-Bar
<br />Handicap Req.I
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />YAsrllV ka--'ttlt0ltr I
<br />Certificate ol Occupans\L-- '/' '' 't
<br />Notes Remarks
<br />r--'-- v7L-,.1
<br />, Zc-o*.--z'f)-- -/to-/')t,
<br />4-- -I_r7 r 7 vc- .7
<br />7
<br />OWNER BUILDER DELCARATIoN
<br />I hcrcby rtltm undcr pcmlly ol pcrjury rnal I o cxcmpl rro,n rh. Coitt.r.s Li.cnsc ljw lor lhc lollo*ios trv (sN.70:11.5
<br />B!\i'rc$ and Pnre$i(,n Codc): Any cny o. Coutrty which requncs ! rEn.ir ro condtucr, rk&, inPruvc. dcmlith ot rcpi. uny
<br />{flclurc. nrinlo irs issuarcc. aho requtcs rhc appli. r rorsuch Fnnil b filca sisncd sr0renEnl rhDr heor shc is liccna{ Putruotrr
<br />ro lhc Drovisio.s oi th. Coolrrcrofs Liccosd tlw lchonrcr 9, ConxftncirS wilh Scction rO(I) o, Division I orrhc Busincss tnd
<br />Pr.fcsions C!dc)orrhrr h.orsh. i*cxcmtr rh.rclromand lh.hosh rbr Inc allcscdcrcmpri{,n Anyvi.lntionolSsri('n?0315b}lny
<br />anfh.anr ron Nnnn subjcrs lhc ntrlicant lo acivilpcnoltyofnor mrc rhrn five hundrcd 'lollds
<br />(3500)
<br />-1.
<br />as owncr.lrhe!!olen).ormycdplorde\ *irh wrgd{r! rh.t tulc .onrFnsali,)n. will o rhc *.rk rrrl rh. (flEiurc is nol
<br />inrcnrrcrl orotfcrcd atr elc (Sc..TOl.4, Burin.ssund Prefcrsions Codc lhc()nrracktr\Li...\clrwdocsnor0ndyro!oo*ncror
<br />rhc rnFny Bh build\ or in!)Drcs rhcNn. {d who dcs \uch k)* hirNclr.r hcrscll or Ihrough hk or hs own.hPbyccr.
<br />lrovidcd th, su.[ iDfnrwnEtrh .rc (n idcfthd or.ffcr.n ror !L li haw.rs. thc hoildina or nipre!.ntm is all wirhir on. ,cr
<br />of conplcri,n. rhcOw crBuiil$wiuhr\crh.burdctrol!$vir8lhlllEorshcdidRntriklorinfrovcr]f,Pn,!cn,forrhcPUIID*ol
<br />-l-
<br />!soNncrotrhc poFny. r'nuxclu\ivcly.onta.tiog sirhlicctrsdco rud.6lo .nn{fl.r rhc l,(,j.tl (scc 7lr4, 8u$nc$
<br />and Aofssi Codc: ThcConkldolsLilctrsc Law docs nol applyro M osncr .f fiopcny eho builds or imt]rclcs lll.rcon.
<br />xnd sho conhc( for such l,nick wnh ! Cofimcto( s) lacnsd purulnr lorhcConklck s Liccnsc tjnl.
<br />I rn,.rrtrIn un,lrr S.rtri Il & P.C fu rhn roavnl
<br />Drtc: - ()wncr
<br />rvonrrns coltiinnts,rrr<w
<br />IECIAX6IION
<br />I lucby rmnnundcr lcn0lty ol pcdury onc olrft lnlk,,ins d.clrarhn\
<br />I havcdld willnui oiraCcnilicrlcorConscnrloScli:lnsulcforsorkcs.o'nFn\ariotr.as lrovidcd i(, bys.crion rT0oofrhc
<br />t xn Codc. ror rhc pcrrormn.c oi lh. wo rbr whi.h lfu pcrmil h hsucd
<br />lhNcrn,l sillnrii rir workcra conrFnurion nNdrucc. rs rcqutrcd byScchon l70Oot lh.lrtxn O c. turrhcljtrlonrrcc.l
<br />qorx lhrrhrhrhs Fmiln n$d M\ w kflr.,,n'N'\Jr'on'inrrnccn'nHandP.lr)nunfic':dc
<br />,'", Ca.\,Q o. vio- Irc- C--o-/"t",*^-,4ba534@ I -/q
<br />-lcenilyrtd
<br />in rh.p.rfortun.cofrhc *ork for whichrhis pcnnit h issucd- I shrllnol ctrlployrnyrtcruotr in lnymatrncr
<br />s .s b bc.om subjcd b $c workc^ conpcn$rion la*rorC{liri,nir. rid r8rcc thnr if I should tccom subjecr b rh
<br />workcH' cumpcnsrion fmvniotrs of Sccl ion 1700 of rhc lih, A)d.. I \h,ll. tonhwith conuly wirh rho{ Pbvisions
<br />WARNINC hilure lo sue w.rke6 $nltc ern,n $\cm8. ( u.lawful. md sh3ll sul,iccr an.mpbltr ro diminrlpcnrnts rnl
<br />.ivil 6ncs up lo orc hundrcd lhousnd dolla6 ($l(D,fix)). ir nddiliotr to lhc cosr ot co D.nrnlion. drmScs rs prcvidcd tr rhc
<br />\Nri.n nJT6olrhc lilB Calc inr.rd anJ,tom\'
<br />Y.* z-z-ra n,,,*,.,,
<br />LICIiNSIUlotir&tlLQ8
<br />DEQASAI]AN
<br />I hcrchy affirm undq pcnalryolFrjory rhd I rn li.!6$rl rnd.r povision orCh4rs 9l6nrmrcii8 wirh s.clion ?m0) ofDivision.l
<br />ol rhe ausircs d Pmtsn'ns Gdc. snd dy lt.n\c ii in rull rom od ctI(t.
<br />b lzztqzt-t z ."",.^",.. @.-1@:e!L
<br />C!]ISISIJIITQN.LINDINIAGTN1:I
<br />I hcrcby rtirn !ndc! Fntrlry or p.ijury rhar rhcic is tr consrflction lcndins agcrcy ror rh. pcrrorm,nc. ofrhc *nrk tor *hich rhis FJnrir is
<br />i*ucd (Sc..3097, Civ. C ).
<br />AfILICANLIIEII.A.BAIIO!
<br />I ltEby rnim undcr p.trlllyofpcrjuryonc oarhc rolbwins dc.lfsrions
<br />D.nmliri.h Pcrmir+Ashstos Norificarion Federal Rcgllalnns (Tirlc 40, P.d6)
<br />Rcqut.d t trcro, Notifrcation
<br />_l ccnily rhlr rhe f.{crd rcguhrnJnr dgedinE ashcsros rcnbrald. nol appliublc b rhh Pmjccl
<br />l.clili rr llNc rcMlhn amliqrn,n hai rhc rti,k i'rronmrn i\.otrc.r I ll3r$bconlPlysirhrll Ciryttrd C.unry
<br />frdtr,.nrr\ xn Srrrr Lx$\r.ldi'rl hcrrby,xrhorir rctrcsenrarnrs olrht Cnydd cuunrylo ctrrs ulnn tlE
<br />?-/( -/ 3
<br />ID/SIG.
<br />Pool Fence
<br />tFINAL
<br />LarJfl'\ Nrmc
<br />-
<br />,tz-
|