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BUILDING- INSPECTOR RECORD SITE-WORK ID/SIG.COMMENTS OWNf,R BTIILDDR Dt]LCAR IION I hEeby artrm undd p.f,fllty ot pBjury lhal I an .xe,npt lnn lhc ConirBckr6 l,icqse La* aor rh. lolkN iry r..$n (s( 70l l 5 Busi!6s and Profdion Codc) Any Cily or Counry $hich r.qun6 a Fnnil ro .omttud, ahd, impro!., donoLish or r.p ey srrucluc, Fi(tr ro s sudcq al$ rcqut6 rh. a$li.er f.r such F.nir to fi|. a sign.d slare al rhal h. or slr G liccns.d puNoi lo thc previsio.s ol rh. Conhctois l,icâ‚¬ns.d l^ lchaprcr 9, Cofrm.n.i'rs wirh s.crion 7cU0 oa Dnhion I oi t[c Ausincs ed Profi$ion. ( odc) or rhd h.orsh. b.r.mpi lhd.lion aid rh. bdL forth..llc8.dcrmpliotr. Anyliolalionofs.cxon 7011.5 byany applicanl aorapmit subr<lslhc applicadtoacivilpâ‚¬nallyofnolnoElh fivchundr.ddollas($500) l. a o$nd ofrh. tmp.ny. or my anplorG Nirh trauG a rh.t el. .o'npensrion. Billdo lhe \eork d thcsrrudLn! t mr intod.d o. ofl6.d aor mlc lsa 70,ri. nusin6s .nd Prot6sions Codc t hc C.nn.dois t-ic6s l.ar do6 nor amlv o an o$nd of rh. p'oFdy lho boilds or iipmvd rhnon..nd $ho do6 srh "oi{ hims.llor hErlfor th.otrsh his or h6 osn.mfl(De6- prcvid.d rhal such ioprov@ls a. nor in(dddl or offdql fr el. lf. ho$'a 6. rh. huildiu or impNldnar is hld \ thin onc )w oi compl.liotr th. osrd Build.r $ ill ha\ c lh. hrrd.n ofproinS thd h. or shc did mt hrld or i4ro!. lh. rhp.n) ior rh. purrte ol l. a ow.d oarlE lrop61r. m .xclusiv.ly cof,racl iry \rnh licctrsen .onn adoc ro conn'lcr th. Iri)dl (s< 7011. Bustr6i ud PFrdsion Codâ‚¬:'rhc Conrdctois Li..hs. Las do6 nor rpplyt. ano(nd of ,ropdr_ (ho buildsor nnproveslhe'â‚¬on. and sho comEcls for soch prcjers $ iih a ('onl!fro(, liccnscd pursunl lo rhc C.nrBclr's t-icsi. lj\ ) I m.rofl rda SBtion . B. & P.C. forrtk r6on. D.t. Orrd: r!)a{E8S:(Ar!EEtlA1!9! UICTABAUAX I lEeb, amnn unds poalry olp6ju'r onâ‚¬ ollhc n'lh$ins d(laaiions l hacâ‚¬ ed sill mainrain a Ccnificaic ot Consent ro S.la.lBurc for $orlm compâ‚¬netio . 6 prolidcd ror h) s<i(r 17tr0 of rh. tnbo. Qrd., lor rh. pdfommc. o f rh. wori for $ hi.h th. p6nn n isu.d I havcand{illmainlain sori6 comp.lsahon insurancc. as rqun.d hy s(hon:r70oolrh. Latrr(odc, fMrhc ltYlonnM.. oa ,r i! is!.rl My {.rkds co,nr6erio. insur.n.. cani.r od Flicr tru,nbd fl. C^ w66 (V33975 ,4 ta I cdlifyrtut in rh. pdaormanc. oaih. worI aor$hi.hrhis pdnrir is issual.I shall.or cmploy e alo bâ‚¬corc subjcl lo l& workm conp.nsalion latrs orCalirofr,a. dd +rfr rh.r ial .hould b.{or. sbiet lo rnc {orl6s' snpdexon ptuvilioN of S.<rion 1700 oarhc t-rtbr Cod., I shall. lonhsnh .onrply *ilh tl..s provisioos I'I RNINC Failurc to suc *orlds mmpmsalion covdasc is trnl.waul- d shall subjd an on. hundrcd rhusand dollars |tltr0.tr00). in addirhn lo rh. cost olco I h@by.mm und6 ,.nally o f Fjury lhfl I rm licdsd unde Foisio. olCh0pr6 9 {.omnEncin* *i'h Setion 70dr) olDivision l of rh. BGin6 sd Prof6sions Cod., dnd my hccM t in iull rorc. and .ftet ,..9 z '-?,/a,/,--av7rr cQlirBucllotLEtDtNc-dcElcr I hcrcby amm undd poalry ot pdjury rhd rh6. i! r @.srdcrio. Lndi.e aga.y aor rh. pâ‚¬aormmc. of rhc \ o,k lor \ hich lhis Fnn b issu.d (56 3097. Civ C.). AITIIIANLDIIS.dAAUQ! I h6d,, amm undr p.nalryorpqjury on. orrh. idloNins d(lEar(Jni D.moliriotr Pdmils-Asb6ros Notification Fed.ral R*uhn'ns (Tirle40- Pan6) Rcquncd L.tta of Nolifi catioa l.difr rhd rh. Lddd r.$ularions rc*adin8 ab.sM r.movol tre tror applicabldorhis pmjrr Icenilyrhar I havc rcad rhisapplication dslal.thatrhc ordinanc6 and Slalc l-aws abor. mdtioncd propcny auihdriz. r.F6dr,tn 6 oir ,\ppli.anr or ,\gcnr siAmt t^l,\D-.-is :':^'wf Set Backs Forms/Steel/Holdowns Ereclion Pads UFER Ground SLAB Floor Subf loor/VenVlnsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Drylvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif /1 -t t1 FINAL b74 ?l L )rrr/>r Certificate of Occupancy Notes, Remarks, Etc DATE ."",.".,/< f --f_-----