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BUILDING- INSPECTOR RECORD DATE ID/SIG.CO!I4MENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVlnsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Brown Coat Ivlasonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zqne Certift4ubty \O .x+_?-l-l?V FINAL ?-:"/')h"WJL Certificate of Occu pancy v Notes, Remarks, Elc O\\NER BU I LDER Df,I,(-AIt{TION I hmb, anirm undo pdalry.fpdury rld I m.x.mpr aro rh. aonkodos Licosc Las lor lhc folknvns Ea$n (sft 7011 5 ausinds and Prol6sion (od.): Anl, ( ny or Cotrmy whi.h r.qtrnG a pdmn to constnrcl. .116. impro\q dmolish or r.9â‚¬n an) iiudur.. rrior Lr irs istran.e..l$ râ‚¬qon6 ihc a0Flic.nr f(v str.h p6mit t' lilca sitn.n sl.ldnent Ihal h.or s'r. G licos.d pr$uanl b rh. po\isioa olrtr co.t.clors Lic.ns.d La\ i(hi/d c. (onnncncinr $irh Sdlion ?our olDnision 1 or lh. Busi06s aod l,mfesions Cod.l orrhsr h. orshe is.rcmpt th6.iiom and thc bcis for ihc all.ged cronflnrn Any viohrn,nofS.nion 70.115 hr any applrcant for a pmil subjdsthe lpplica.t lo acnilpâ‚¬nallyofnot morclhan lilr hun&d d.llds($500). l. s oan.r of rhe trol.n,. or my .mployc rirh $ aA6 6 thet ele conrposation. \ill d, rh. \ o& dd lh. $nnm 6 nor inrddqi ororl.'.d ro!slc{Sa.?044. aB'n6s dd hor6nons Codcr'Ihc conrr..tr-r l-i.ft.lj$ &cnordpplyto oNnrol lhc pmrE1, who hil& or imlrorB tn(6n, ald rho d.6 s{cn r.* hi6sdro. hss.lfor 'housh hB or hr orn.mplo}.6. tiolid.d thar su.h i'np$vondts e mr iddd.d or olTard ftr sl. If. ho$ dd. rhc tirildin! or nnpro\ orcm is $ld tr i(hin nn. \w ofconDldion. lhc (ivnq Uuilds \vill har c lhâ‚¬ bordd ofrro\ ins lhat he or shc did ml trild or ifrrhv. rh. trnFiy for Ih. puqrs ol I,6 o$nd.frh. pr.pdl. m .r. Lusi \ .ly .ontract ins \irh licds.d.oik..o6ro.onstu.' rh. lroj.ct (SE. ?0l.r. tl6m* and ltolBion ( od. Ih.(onk.cror's t.ic.nsc Lr(do6 norolplyto uo\ndoirropd!\rho hurlds or inrprovcs rhsen. and sho conracc for such Fojccls \!ith a Gnlmclo(, licereed ptru'Enr lo rhcConlr&rN s t.icrcc I-a\). lin,ere,n und& Sdi.n D.le Orner \1 ()RX !tRS', (',Olt PENSAt tON Drl],]!!Jl!9! I he'ebj_ iinnr und.r pcr0rl\ of pqur,\ oneollhe n)llnrin! declir!lnrns lha\.ud$illrnainrainaCâ‚¬nilical.ofConsorro Scll-lnsule lor \orlqs' compâ‚¬asar i.., a3 rrovidcd f.r bysdri.n r700olrh. libor Codc. for rh. pâ‚¬lomanc. otlhâ‚¬ $ork lor whi(n thc pmil is issu.d. Iha\.iidsillmrinrain$.rL.rt.omp{rq.rionimran...a3r.rtn.d[\s.dbn:rTrnofrhct-abor(odc.lorlhcp6rom0nc.ol rh. tr.rl lor shi.h rhis Fntrir is isudl M,sorld .otrlpds,rnh inqn ..cmid&dFlicr tru,nbs de Poli.yNumb.r ErptrB Al .dil rh'l in rh. tEhman(. nlrh. uork Lr $htrh rhis p6mir is issucd. I sll3ll nor dnploy,, ony pmn in eny ndnd s 6 lo tccom. subjd to lhc $od(6' comp.Nal ion k\rs ol C.litomi.. sd asrâ‚¬ lhd if I should bc.on. luhi.n ro th. rvort6' compmstnrn pmvisions ol Sdion 1?00 ofrhe tabor Codâ‚¬. Lull. fonh\ irh comply $irh rh.s tmvirions WARNIN(;: F.ilur. ro s,tr. r.116 conpdMrion .ovd+. is unla$ful. dd sh.ll suhjsl e anrloyd to aiminal pdaki6 ud cnil fin6 up o one hdtrdr.d lhorsatrd dolld: ($l .L]{r0). h addiion ro thc cosr oi conrri.nsnlion. daDi!â‚¬s as prt\dlal tin rhr S..ri.n 1076.rrh. Ltn (.d. i.idar I h6cby aflinn und.r pâ‚¬n.ll v o I psjur, lh.l I am li.osd undr For ision orChaprd 9 (canmd.ins rilh Sdion 70u)l olDn ision l of th.Lrusirsa Prcf*ions Cod.. I my lico* is in atrlllorce dcffal ,."-*.r* C/Q ",,"21,24q ,,.*,..n,,,. I0l t?1C e?rc.cT a\rKoY I ha.6y .tlim u.d.r Fnalry .lpGrury rhar issu.n(S(. !007. Ci! C ) ..nsio.ri. knJin! ^!d.y lor lh.16lomwcc oflh. \ork aor sh'ch rhis Fnni n 4I&TGILLUE(I.A8AIIII! Ih r+ aflim und6lEnaliy.f ,â‚¬rjury o.. olrh. rolh\ing Ll(ldarions: t).molirion Permils-AsbcsbsNorilicarnrn rtdsal R.!trlarions (1irle.l0. Pln6) Requtcd I ellcr oaNotificalro s coF.d l.aralo mmply wirh.llCnr.nd counry r.prMrarivB ollhis Cny dd Cou.ryro old urFn fi. ^,", uat)Jg ,^r/a [f$es SITE-WORK Ext./lnt. Lath ) "uJld "^,",81?71n