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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I**1r^FINAL n/ult4
<br />Certilicate of Occupancy I
<br />Notes, Remarks, Etc
<br />OWNEN BUILDER DELCARATION
<br />I h.rcby rfllrn undcr l)cnrlly.f pcrjury rhul I crcnrpr trcn rhc Cddtacror Licc.sc tjw ror rhc iolloNin8 rca{,n (sec 70.115
<br />Irusi.cs and Potc$bn C.dc) Any cny or counry whi.h rcquircs 0 Frmil ro onnrud. nlrcr- imF)vd, &mlnh or EPrn !ny,
<br />sru.ruc. llhrro ns issuanc.. also rcqunes rhcal,Fliclnt for suchremilro file a sisncd N,rcmn( rhll,r.rshc is liccnscd plmmr
<br />ro rhe pnlnion\ ofrlE Co.kr.ror'i Liftns.d ljw (Chlprcr 9. C'omftncing wilh Sccrt,n 7fi11of Divi\ion.l of rhc Busincs and
<br />Pi{,rcssionscod.)orrhnr h.or shc iscrcmfl lncrcfro andlhc basi\ tor rh. allcEcd cr.mprio. Anyviol,rion.fSccrirnT0:ll5byan,
<br />amli.anr tor a permir s!bj6_rsrhc aptlicstrr ro "civiltcntrhy.rnor nb.c rh.n fiic hund,cd dolloF (!5($)
<br />L as owmr olrhc ImtEny. or mycmployes wirh wascs as lhcir $le c..\*nsark,n, willd. lhc strk orn thc (tur@ i\ n.r
<br />intcMcd or oflcrcn for eL (Sa 7044. Bu\incs snd Pn,rc\sii,ns CL{c: TIr conrrror's LkcnE L!* dms nor sprly r, nn owncr ol
<br />rhc ImFdy qb boildr or in{'ros rtrmn. ond who des $ch $.ri hinNc lf or hcr*lf or rluouEh hh or hcr own ct.Pn'}ce\.
<br />p'ovidcn rhar \uch i,nlruvcnr.h rc 'r, i cndcd or oflaEd for sh. ,l ho*cvcr. lhc tlil1in8 or improtm r k $tt lirhin (N )ea
<br />of comptlion. lhc O*ncr Buildcr qill hlw rlE h!,rlcn ot pmving lhd h. or \hc did nor huikl ot imtrerc lhc l)I)IEi, f(, rhc ,'urFM .r I
<br />_1. oro*lErofrhc pn,I.ny. ,m.r.lusikly cotrkrrri'rE wirlr ti.cntcd co Ni.lor s ! i cor{'!cr rhc IoJ..r rscc 70,1-1. Bu\i'rc\s
<br />i Pnnl:lion Codc: Thc Conlr.crols Li.cnsc Lrw docs nolrnply k, anowncr ofni,)Fnt sho huilds or itnProrc\ rhcrcon.
<br />lrd who conrmcrslorsuchpmFcr\ wirh i ftinh.tlr(\ ) Ii.cn\cd Dutru0trl lorhcCo lc(tr s Liccn\r t-trw)
<br />-l
<br />nncxcnu trrdcr Sudi{nr . a & I( L' rhi\ rci{rr
<br />TON.KE&i].COIIIIINTAIIIIND[(!AA (}r
<br />I hcrchyrlfn'nu cr ncmlrrof pcluri o rof rlr fdk,r'ire dc.l rrnN
<br />-l
<br />hxlc sri *ill nDilrai', r Cdifi.trr. of aons.d r) Sclf-l,Nurc lor $oltcr' compctr\ar ion. as fturid.d fd hy Se..r ion :17(D o I Ihc
<br />Lahor C(ic. tor lhc pcllomunce of rhc work nr uhi.h rhc ldrnn il kqrd.
<br />lhavcrndwillminriirworkcrrconrlctrsrrioninsumncc.asrequtdbyS(rnnrl?0O.lrhch6oCodc.lorrhcPcrformrmcof
<br />rhc eork td which rhi\rrnnir is i\nrci.worlcrs conDcnslrion insuranc..,nin arl rri.y Nnlhct irc:
<br />-l
<br />cenifyrh3l inihc pcrformtc oirh. work rir *hi.hrhi\lcm r t ssucd.I shrrl nol cmDloy rny n notr t'.nt trcr
<br />v, as t) trcomc \!l,jccr t, rhc snlk$J .o rNnsd ior l.Ns ol'Crlil. rir 3n{l agN rlrr ir I \ll rl hc.oD nrhiccl n, rh:
<br />worlcn coDpctr\rr i.n pmhir, \ ol So.t or 37(X) ol rhc I ibr C.de. I shlll. i(fi h$irh rontpl, s,rh rh.{ !r ovisidr
<br />r\\RNIN(, I.. l'trch r,'r s.it . 1 't r,r '..\rcivil iinc\ ur lo otrc hundrcd rholsJnd ollars (5
<br />::;!T]T+tOt0
<br />I hcrcbyafatrnundcr pcnohyolpcrrury lh{r I ror licna\r u u povision of Chagc! 9 (conmnc in8 wirh sNrbn 7000) .r Dirision :1
<br />.t rhc Busincs r.d Pblisions Codc..nd nry liccnsc h ir iull nnce anl.r..r
<br />4 o
<br />"r,", 4 7/L
<br />I hcrby aliirm undcr r.nalry or lc uryIhsl rhcrc h s con(ddion lcndins aa.ncy ror rh.,,srornsmc oflhc wtrt tt whi.h rhh,'&mii i!
<br />hsucd (Sa. 1097. Ci!. C )
<br />A.PILIIANI.!rc1]IN{IPN
<br />I hcEby.frim uMcr pcnllly or pcrjo,, onc ofrhc rdlosins d..rmrbns
<br />ocNniior Pcnnik.Ashcstos Noliiic n,n Fcdcnn Rcgrlsrt,ns (Tirlc,10. Pan6)
<br />-Rcqutcd
<br />klrcr ol Norili.uri,n
<br />I ccnifyrhor rhcltdcinlr.sul0rion\ rug{ding r\h.{o\ rumolrl nrc n.r Jfplicihh n, rhntr)J.cr
<br />-l
<br />cc iiyrhir lhivc re rhi\rrpliuitr Md narcrhnr rhc x
<br />odim ccs amlSrltc lf,w\ rclding
<br />atnvc trEmioncd Dn,pcny i.r
<br />,\pplicanl or /lgetrl SiADlu
<br />Pcm'it.r nanr.tDrin0:
<br />I
<br />L.ndcr. Nam
<br />-
<br />trrcci' AdCr$'-
<br />l(/1,,
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