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BUILDING- INSPECTOR RECORD <br />SITE-WORK ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />ln s u lation/Energ y <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 />/7 <br />FINAL //4//A 44n"";)Z-, r: ,2(--l <br />Notes, Remarks, Etc <br />OWNER BUIT,DER DELCARA'tION <br />I hdcb, amnn und6 paully of p.rjury rhrl I m .r.,npr ftom rh. Conrracto6' Lrc.nse tj$ foi thc lollowing r.Mn 156.?011.5 <br />ausins d Prol6soo C.d.): An! ciry or Cou.ty vhich rcqui6 ! pdnn to cotrnrucl. ahr. improv. d.molish o. rtl)atr e] <br />srru.luc. Ihor ro irs isu c.. oho r.!ut6 lhc apphcdl ror 3u.h p€mil io file 5 sisn {t ahdr thal hc or dE is licded pauanl <br />ro thc prcvisioN ofrhc Conrracrois Lic.nrd L2w lchapl( 9. Cood.ncinS wifi Seiion 7000 of oivision I oflhc Buin ss ed <br />Pml€sions Cod€) or lhal h. or sh. is cxcmpl rhq€fiom ad rhc bdis for rh. alL8.d €roplion A.y viololionolsEto. T0ll5 bvanv <br />applica lor a pdnn subjals thc agplica.tlo a.irilr.nanrol.ot norcthan livc hun&.ddollds(1500). <br />l.6 o\racroflhc proFny, or mt.mPIo)E *ilh *as6 6 then *r. .omp.nsslion. \illdo tlE so* dlh.slrudrnrur <br />inrdd€d oi olTd.d for sl. (SE 70,14. BBine sd Prcasiotu Cod. 1tc contictor s Lic.tr L.w .106 nol tpply ro m ownd ol <br />rh. pmDaly rho hlilds or iqrov6 rhd-n di who doe such \rcrl. hnft.lf or h.sll or lhroush h$ or hr o*n .mplov.6. <br />prulidql lhar su.h imgoro6ls 6€ nol inrddalorofrad fDtsaL.l[ hoNd6. th. hildin8 or imFovoEn Eeldsifiinon. t@ <br />of.ompl.lion. rh. (h,nd Bdldo will hnv. lh. hr&r oiprormr tha h. or shc did nol hliB or ifrIrot d. p.trpdrv tot lh. flrpor of <br />l. sown6ofrhcpropEry, m.rclusiv.lyco raclina$'lh lic@d coilBcloB lo c.dtrud th. Ford (SE. 7044. &rinR <br />and Proftsion Codc: Thc Cont.crofs Licds. Law doB not applylo d o*nd ofPropdly *ho builds or inprordlhron, <br />and sho conldcls aor srch Ftrjdlsvilh a Conl.r.1o'1s) lic@d pu6mt Io th. conlractois Lk.M L.*1 <br />-l <br />mcxmfl mdasdion-, B &PC aorlhis r6on <br />Orn.r <br />\toRt(F,Rs' coty PtNsa tloN <br />oEo,6tauo! <br />I hs.by 6mrfr undd p.nally of pgjury o.c or the idliNinu d(l&alio6: <br />I h.r. ud vill mainrain a cdincarc of Co6ot lo Sclr-lEurc ntr rDrkdt con,P.nsrion, d l,or id.d for bv S(.lion 1700 of lhe <br />l4or Codc. tor lhc !Efom&.. ol rhc wo* for which thcpmir E su.d <br />-lhalc <br />and s,ll Minr.i. sork <br />rhc *ork aor $ hich this porit s <br />i.su6ncc. s ..qutcd by Sdtu. 1700 ofrh. t bor C.d., for rh. pslomamc ol <br />workds conrp.Mion insure.. .rid tnd policy nuDbd d.: <br />{?c-c1 <br />I .dliay rh.l in rhe psaomanc. ofrh. \ork lor shich rhis pcmir i3 issu.i. I sh.ll n{l onploy anv p.Mn in -v ndnd <br />$ s lo b..o'n. sobjar to th. Nork6s' comp.nsan.. la\vs of caliaomi.. Md asrd rhar if I should b..onr suqal to thc <br />{ork6.onpdslionpmvisioNofS{rnrnITOOoarn.hborCod..ls\all,ndh{nho,nplyrilhthoep6vGio.s <br />WARNINC ljailur€ ro su. wor[6' cohp.Balion co!cra!. $ unl,waul. ed shall subjcl & dplo]s lo sihlnal Fuhi6 dd <br />civil finB up lo one hu.dr.rl rhousd dollds ($ILX-|.I]()O), m addirion ro the con olconp.Nrion. dauad {r tr'rid'n ror th' <br />\^t <br />I h6cby afim uod.n paalry oi pdiury <br />ol lh. BusinN ed Prefsonr Col., <br />r,rcDMl,lrl:oNrBA(raa <br />Dfct aSaI[ <br />an hccnsr undd Fo\ision otChaptd 9 (.o,nrm.in8 qith S..lio.7CS0)olDivision l <br />o ( ooY tr,2 <br />I h€Eby imm undd pGrlly o I perj'ry <br />isstr.d(Ss 3097. Ci! c ) <br />i. r.oBrrudion lodin-! a!{cy fot rhc p<foflnoc€ oilh.sorl fot shichlhis lrsiit s <br />AlSllcANrDEClA&gO! <br />I h6!b, arfb ondd paahy ol pgjury on. ol ih. lollowing da leal ions: <br />D€nnnirion Pdnns-Ashctos Nolificalion F.dnal R.euhrions llille 40. Pan6) <br />-Requtrcd <br />I atd of Nori6.!tion <br />restrlatiom Eredins arb6ros r.rno\.1ee not appl,cabl. u rhis prordr <br />readrhsapph..rio.edsrarclharIheatrirernronnari.discoEsl.Iisr€locomdy\dhaUC,a.dCoum) <br />.oBttucliotr md h6€by aulhoroe rcpr6otalir6 ofrhir Cty Md Counlyto 616 ua)n rh. <br />,rtDlic.nr or ,1SMt SignNlur€ <br />L <br />Dtr,c: rzJt"U <br />DATE <br />Subfloor/VenVl nsulation <br />Flood Zone Certif. <br />l(\\ <br />G <br />I <br />I <br />tt <br />=