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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS O1YNER AUII,DFJR DELCARATION I hcrchyrflir undci pcMlry ()l ltrjry rhll I .tcnl|n lm trhc('o ltrclffi l.iccnsc l-rw f(tr Ihc l.llowir8 r.!sr (S0.7{r.ll.5 Au$rcsr Nd P(ni\si(r CoJ.): Any Ciry or C.umy whrh rcquircl r P.ruir ro loiiru.r. rlrc!. trnl]lrvc. Jcnxnrh o. Et).ir rnv sro.rurc. ri(trt, irs issuan.c. rls. rcqutcs rh. andtcrnr f{n such Pcnnir !r lilc r silncJ {!rc'mnr rhd h.or $c i\ liccn\cd Pur\urtri ro rhc fmvisions of rlE Conrrrttr s Li.cn{d t-nw (Chrfrcr c. Connncn.i',! *irh Sc.lnr 7UX) oi l)ilnioi I ofrlr Bu\nrs\ rn,l Prncssi()ns Codc)orrhrr hcor \hc iscxcn rhcrcnonrnndrhchi\isturrh.rl!c8cdc\cnrPtiflr.Anyvn,hitrniorSc.lnrT0ll5hvuv uprlicanr t,r oltnnir \ub)c.rsrhc rrplicant lo r.lvilpcnnlryotnor ntrcrlrtr lirc hundrcddoll!6 (55{x)) I. !\ owtrcr olth. tmtEnr. or nry cr,Ilort\ *[h q.8cs r{ thcrr slc compctr\arn,n. {illdo lhc sor[ and lhe nturrr n n.r irldnlc( or oficrcd nn sslc (s& 7O14. Bnsnrsand Protsn,ns Colc:'I'h. conkdor's LilTnt li* docs nor lt)rlyro otrowrof rhcnn,rny wlxl huilds or nnlmr$ thcmn. aod who dms !trch s(d( hnnsclror hc6cllor lhR gh hn or hcr oBn c.rfloycc\- porid rhlr uch tvrxtmnb rc nor inrcndcd or ollctul fur $L ll hoqeq Ihc htiklnE or inlhvcmnr is wUsirhi', ftlttr or.onlnck.lhcOwtrcrBurtlcrwillhrvcrhchurdci.fOovrnsrhdh..rsh.diJmrhriuornnpnrtrhctmFnyldrh.PurrMof -1. i\ oNmrol'rh. Plrp.ny, a rcxctusivclyc.firctinA sirh lic.nscd coit .rr\ ki.on(mcr lhc nnr.d (SLt. 7Gt1. Buuc\\ xl Br)ff,$Dn Codc lhcConrracroi\l-iccn\cl-asd@tn.rrPpllrornostrc'ofPn)Fnywhobuildsorimnmrcsrhcrc.D. rnd wh. conrD.r\ tur such pn,lc.n wirh!Co a.tis)liucnsql pursornr t)rhcCont!.rois l,iccn{ uw) -l amc\c'npi undrr s(r Dnre oRne. lV()l{XtiR--itrrNsATx)N IrIII.AAAIIA! I hcrchyaflnmu lcrpcidxyolNrjryomollhclnlbsi',sdcchr"rnn'{ IhrvcrtrdwillnrinruinaCcnitunr.olclrr*nrk)scll:ltrsur.lor\orkc6...r!..silion,ff Jitorided fnr b! sdrion l70tr ol'lhc tjhn ('odc. lor rhc pdlnflnrcc oi rhc work lnr *hich rhc pcrmn i\ issucd I hdv. rnd qillnui nin $orkcF co'nt^-n\rrnnr nsufui....s rcqutcd hySccri(u l7(Xlolrhc lihorCod.- firrh.ltnonrorccol rhc wo,k lorwhichrhis pcrni i! i$u.n. M y sorkcrr' c.nrFnsd ion iNuramc cari.r arxl poli.t nuDh.r rc I c.nirylhrr in rhcr.rfonrErccol'r,rc worl f.r which rhis pcnnir is hnrcn.l \h!Ll nol .nPloy !ny Pcts.r inrtryn,rntr.r g' rs l. hccoN suhjcd b 'hc roR. c.mNtrsdnnr has ol Crliionri!. mdrstocrhd irl should bccom $h,.d rorhc rokcr' .onu.nslri,n rr.vilions of scd ion lTm of rhc Llhor Codc. l \h l tudhwirh coq)ly *irh rlr* lr.vision( WARNINC: Frilurc h scurc {orkc( ..rhp.trerio..ovnr8c is unh$tu|. and \hdll suhjccr arr cnrPloys t' oi,ritul lurhEn\ a. civil lircruproonchu red rhousind dolloh ($lm.uD). in {ddirio k, rhc.os ol..nU.ns!|ioo. damrr.s !( nrovi,cd tn lhc scdion 1076ol rhc Llh)r a(xL. inrcrci.lld{ormy s lcc{ ucENsID-C0Nr&$r108 DLCIAsAIION Ihcrcby rlfinn undcr l. rlr, ofpcrjury rh l rm lilanBlundcr Provisi(noiChlprcr9(conrntn.i'rg wirhSelion'7000)orr)ivi\nn' l ol lhc lrusinc* md PDr.rsionl codc. dnd ryliccnsc h in lulllor.c dil cfic.r' CoNS'tI{UC'I'!ON I FNDIN(; A(;ENCY Ihrnhyrfltnund$nnrllyolpcrjuryrl r rhd. i\ r $nifl.ri,n h diU rgctr., t. rhc |ltrlonnrncc oi rhc Nork tr $ hrh Iht lxfnn ir PI'LIC{N DF(II \RAI'IoN l llnhy irlnn u cr pr fulry ur |{rjur r_ otrc oi rlE hlbwinr dcc lifuri,,i*l DcNnilNn Pcrnrirs A\h{nos Norifi.xr dr FcdcBl Rcaulnr ionr ( I irlc 40. Pr a, hat,,i'.,1 I drrc.ol Nor'li.rri(rl Iccnilirh.rrhcledcrlllcEuhxon\rclrdinprntno\rcx)vtrl{rcmrlpflixbltk,rhiF+.r l.cnrlirhN I hrv. re rhis!ptli.,ri,,ral \l rurhnrrhcrtnvc itriqnDrtrin is.ord-r l iPrN roconlPlysirhallCirvanJ Counrv ordi'[i.$rnd sr.rc Lnssrcloriryro hlildins connfl.ri{ r,ddlE.hyiurhori/crcnr.\cirarNcsolrhhCnludC.unryto.nlcruNnllt rhorr nf,nrnnrd prcp.dy rd ustf,rri puqx'scs ppli(mlorAtr tSi*nalur PrnilN .!nc (prinl): Formsi Steel/Holdowns Erection Pads [JFER Ground SLAB Floor Subf loor/VenVlnsu lation Roof Sheathing Shear Wall Framing lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat l\ilaso n ry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif t4 FINAL I 1l/o ll? 4 <AnN{lL 1r9 --Certificate ol Occu anc Notes, Bemarks, Etc. Set Backs issuc.l(S.c .1097.Civ C ). trndcas Nanrc: lf,nrlcr'\ 4J'ln-. - f-------r------