Laserfiche WebLink
SITE.WORK DATE ID/SIG.COMMENTS OWNAR BUII,DIiR DT]I,CARA ION <br />I hc.chy i(nn und$ l)cn0ht .r lcrj!ry ih.r I ad cicnfl lmrn rhc Contrrror' l-ic.nsc L.w lor thc lollo$ins rcnson (5(.70.11.5 <br />Busine\! rtrd Proicsion Codc) Any Cily or C.trdy which rdqun s d Fnni! ro .onrrtu.r. shcr. nnpnvc. d.'nolhh r rtnnr rny <br />(rucrurc. prin tr irs i\roanft, rls. rcqrne\rhc applicinr ior suchricirnir <br />'o <br />ilcr stmd \raic'rcnt rharhcorshc h liccnscd !ururnt <br />tu rhc FR)vht'ns olrhc Conrrn.kr\ Liccnscd t w (Chll)rd 9. ConnRrcirg qnh S..lion 7m(l.fDivkion i.fth. Businc* rnd <br />Pmfc$ions codc ) or rhtrr h.orshc h crcn{r rhc,cLo'n ud rhc hnsis lnr rhc ilkscdcxcnqn{ Anyvioldb.lolScclionTlrll.5by{n, <br />dPrli.atrr fttr opcmrir subjechlhe opnlic.n, ro rcivitpcnnlryofnor norcrhm fivc hrndr.d dolh6l$5(XJ) <br />l.rso*ncrolrhcJroI.ny.ornrycnrDlove\Birh\'.!c(n\rh.ir\)lrortri\itrni.trilldorh.{dk rhc{nr.ruNr. (tr <br />inrcMcd nr .llcrcJ ntr {h ls.r 7f,4.1. Btrsinc\! lnrl Pnlisi(ff c.dcr 'l hc com n rn l Licc \c Lrw docs n.r .mly to ntr o*n.r oi <br />rhc pmpcny rtir hlikh or imnrovcs llrto\r. dwhodoc\{.h$l hnns.llnrhcrrllnrrhrotrghhisorhcro*nc, otcc.. <br />trivid.d rhrrruch i'npmvcnrnr\m ftn inrcndcd oncEd frr\ lc ll hoscrcr. rh. briklin8 o' i'lllnrvdnrnr i\ qnd trirhii.i.tr <br />ui..'n|ildi, . tu Own r Buil cr sillhavc rtr hunicn.rnn,!i're rlhr hc or sh. did Rn huikl or iqno!. rhc pmfdy fir rhc puqxMff <br />-l- <br />0sosmrorrhc pnrFdy.,m.r.iu(i!.ry.ontD.rins *irh licctr{dco.rrrcroF6onsrn'clrhc pojccl(Scc 7tn4. Bdnm.\ <br />,l &ntr\sion Codc:'thc Conl,rlols l-iccnsc L.wdoc\ trorrFtl,k, rtr.Rn.r orlr.pr 1" whi, blikh ur i'ntrovcs rhcr$n. <br />,trd sh. LUnDcrs r{r skh rr+cr *irh I Cotrtrrcron r liccr$d pursuanl io rhc Conlm.ior's Licctrs tiw). <br />l,dcxcorpr undcr Secln,n-. a &PC forrhhrcannr. <br />Drl.: O*ner: <br />woRKERi' coMiEi\is^Tl(|i\ <br />IIIIIdAA.IIA! <br />I hcrch! rrfi .nrnd.r Ji.n,lry.rlrcrjrry onc of rnc lirllo*in8 dcclinrions: <br />I h,vc iJ]d will'nairuin! Ccniri( c ol Conscnr lo Scli. rnsurc rfi worke{ comNtrsin,tr. as pmvid.d for by Sar ion l7(x) l11[ <br />Lnbor Code. for rhc Frfomlncc ofrhc wo* lor which (hc p.nnir N h\ucd. <br />--l hrvc rn(l wrllrrnnnnr s.rkc -coi1ft \ nnr in\urncc. xs r.qun.d bvSccli(n,l70Oofrhc l-xh.rCotl..lorrho p!rrarnrxn.. of <br />rhc *qk lbr*hi.h rhi\ ncnnlr i\ i{$ca llly trorlc^ .. p.tr\xri,, i,Ntrrrrro.ardr J noll(y n unr. <br />t'0licyNumbcr l\ptcs <br />l.cniryrhar i rhcpcrfoflrunccorrh.sorkaorwhichlht|x rn is irsucd.I slrdlr nor cnrdo, atry ,,.son inrnynurncr <br />s nsrob$onE subjdr urhc work$ .onrFn\arn r Isw\olcxli r x!'.r r[rr ill fin']d G{.onf, \DnEd k)r,{ <br />solkcF comFNnli.npmvhionsof Scchotr :1700ol rh. I I \hill. nlnh\ir[.onln\ trirIrh{x. t]i{i!i\iinn <br />ll suhtNi ,n cnlloycr ro fin Ml lrMha\ and <br />.oi1p.n\arn[, dr ug.s as providcd tor rhc <br />DEe! AjII!)N <br />undcr !rri\ion otChrpr.r9lcommcncnU wirhSccri{'n 7(XX)) of Diri\io,.lI h.rcby.rrnmund$pcmllyorpcrjuryrl l ul <br />It- <br />g <br />I hcrcr,y affirm undcr ocnalty of Frjury lhlt liErc is a .onddcrb. krndine ae.ncy ror rhc Frronmmc or rh. *ork ror whbh rhh tmir i* <br />irsucd (S( 109r. Civ C.). <br />AIIITANLDECIAEAIIAN <br />I h($y alllm undcr pcnrlry orp.rjtrry onc orrhc li)lk,sirs d(hrarions: <br />Dc'n,lntunPcrn,irs Ashcno\Norificatinrcdcral Rc8uhtioNOnlc.l). P0n6) <br />-Rcquncd <br />ktrm ut N.(ifr{ion <br />_l.cdiiy rhnr rhc ridcril rcsuhrn,nr8 rshcslosr.,trtralnrc n.rJlt'liobL r. rhis F)j€l <br />iotr nconcd l,Ercc Io comply sirh ullCiryrnd Counry <br />'us ::1 T*"d.H[;',''. <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathinq <br />Shear Wall <br />D rywall <br />Ext./lnt. Lath <br />Brown Coat <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />FINAL I t/n //b 6/vto/tr lO- <br />PancY rr-1Certificate of Occu <br />Notes, Remarks Etc. <br />BUILDING. INSPECTOR RECOBD <br />Subf loor/VenVl nsulation <br />Framinq <br />lnsulationi Enerqy <br />Masonry <br />Pool Fence <br />.l rhc Bu\i'i.s\anJ Pn,lc$nnN Cod.. Md my llccn{ is in tull6r.c d.llt.l <br />$ <br />I