|
SITE-WORK DATE tD/stG.COMMENTS OMd-Build.r D.clrliid
<br />I h.6by .fiih undd pa.lt, ofpqjury lh.l I a .ioB lm fiG ContrGid' Licd!. Lo* tor th. follo*ii8 rcdo. (r4.r0l L Buiidr
<br />md Pof6rio Cod.): Any cir, a Counry ihi.h Equt.i . p.mn ro corElcr, !1r... inprcv., dmlith or cpan ey rucrurc, Fior ro ir!
<br />irrute, rls r.qun6 fi. rrpli6. fd D.n pfrn lo tlc.risr.n fit hat lh h.d rh. ir li6r.d puBust io ih. FovirioB of th.
<br />Cdthdd! Licd.d Ls (O!+(.r9, C6lmcir!*irh S& d 70OO of Divirim 1 of lll. Burin.s d ircl.sid. Codc) or rh.r h. d
<br />!h. ir .rmri lhfrfrB ed 0F bri. fr $. .ll.trd dn9ri6 .A.y viol.rioh of S..iion 70, I J by ey ipplicoi lor . p.frn rubj.ci! rh.
<br />lppli.el lo . ciril po.lty ol not h@ thM fie. hutulr.d doll&i (t500).
<br />_1, s M6 of rh. pro?.n , 6 m, .nployc.r with w.Bd s th.ir rol. c@F!.doq will do ln. work .nd lhe xtuctur. E nor inr..d.d
<br />d olfn d f6 r!1. ( S.c 70(, BuriB 6d !rcfand Cod.: Tn. C6r.r.td'r Li..nr. lrw dc .ot r?ply ro u owic. oa rh. pmp.ny
<br />*ho buil& d ihFoB lhm, hd vho do.t ruh wdt nim.la d hdda d rhrcu8i hir d h- own mplorcr, protid.d thlt $ch
<br />improvddl, e not i 6d.d tr olf.Gd f6,!1. lt hwd6, rh. building or inprovam.r it rold wnhin o. yc& of conptdion, t.
<br />O*nn-Buildi *ill h.vc lh.b!rd6 ofprcving in h. or lho nor build tr imprcv. l.r rh. porpor of rql.)
<br />_1, ! ow.d of th. prcF ty, 6 .rclqiv.l, c6tn llns wnh lim.d dr.c6n (o .drruct lt. proj.q { S.c. ?04a, Burin.tt Md!rcf.sioi Cod. Th. C@n<r! Licdc kp do.r nor .ppl, to u opnn ol pr@fiy who buitrtr tr improv.! rh6.on , Md who
<br />coir6ds for ru.h prcj.c!3 *ith r Cmrero(r lienrd puBu&r ro in. co.rkror! Licds. La* )
<br />_l 6 .x.Epr undq S.dion
<br />WORKTRS (IONiPF\SATION DECL^RATION
<br />I hd.by ifiim ltdn p.i!lt/ of Fjury o. ol $c follo*itr8 d.cldion!:
<br />_l h.E ed *ill mrintin r C.nifici. of Conrdt to S.lfJnruE ad eork6' .mp6r.lioni s rrcvid.d fd by S..rion37ooofth.
<br />Lrbn Codc, for rhc p.nffie.. of rh. vqk fq which $c ptrn L nr@d
<br />_l h*. ..d will m.iir.i, pdt6' .otrpslnio inture., B Equlr.d t, S.ctio. 37oo of th. L.bo, Cod., fs rhc p. omuc. of $.
<br />wdt fd whid lhn p@n L is.d. My wdt6' .mp.n im iEuroc. .ui6 sd lolic/ idhnr !r:
<br />PolicyNuhb6:_
<br />#*d;;#ffi;fft On. hun&.d doll@ I!100)
<br />WARNING: Frilur. ro r6uc wot6' cdpd,ldoi
<br />Iind up to 6. hundr.d rhoulbrl doll6 (l100,000),i.
<br />th. Llbor Codc, intffir ud tm.)! i.6.
<br />I rubjclomployf to oi6i l p.n.ki6 ..d civil
<br />, .lrm.8d a providcd lo! lh. Scc on 10?6 oa
<br />LICf, NSED CONTRACTORS DECLAR-ATION
<br />I hdby rmfr udd palq of prjfy 6 I d tic.nt.d u.da prcvtid of Chalrd 9 (wnh S..rion 1000)olDivislon3 of
<br />lh. Bu,ind od Pmldidr Co<l..6d hy lic6!. ir in full l*. bd.ra.cr
<br />7-
<br />I hdby lmmui.Lrpd.lr, ofpdjlry t $6cir.c@ntu.r
<br />kt@d(sc. 1097, Civ. C )
<br />ofrh. work forwhichlbir !.mn h
<br />AIII ICAIITIS DEC' AILATTON
<br />D€nolnid PmlB-Atbdd Norili.rdn F.d.d R.8ul! od (Tnk.0, Pln 6)
<br />_ R.qlicd L.td of Notiiicition
<br />rdovll ,. nd lpplic.bl. to
<br />comfl, *nh lll Ciry rnd Counry
<br />ordinmcd sd St . L.u rcl i.8 ro buildinS rhir Cny MdCounry to.nt.r ulonth.
<br />$oe. hadon.d Aop.rty fo intDcrid 3-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfl oorA,/enUI nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Requirements
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certificate EVDIb E f'r
<br />FFRNI 2ntq
<br />FINAL
<br />Certiflcate of Occupancy o,.ruu o-"J' zwl'556,667
<br />Notes, Remarks, Etc.
<br />1
<br />BUILDING. INSPECTOR RECORD
<br />D{. Ornd
<br />I
<br />f------r-----
<br />rL_+_
<br />i
<br />I
<br />I
<br />I---l
|