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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground -)
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />ln s u Iation/E nergy
<br />Drywall
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Depuly Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />-/-t
<br />FINAL l\"22-iF (?C )7 )
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />OWNI]R BUtI,DER DELC RA'NoN
<br />I hcrch! aafinn undcr Fnrlry r)t pcrjrry rhar I d.xd.rrr fro rhc ('otrtr.krs Liccnsc LaN for
<br />Busi',.\s rrtt Pnr.$i.n Codc) Any Cry .r C.unry *hi.h r.qunc\ a !.nnir ro .or(flct. rltcr.
<br />sfl.turc. priorio irs hsunncc. rh. rcquircsrhc.!plh,trr lor such pcmirl.lilc o sisnctl !raremnr
<br />inrprovc- &rtuli\h or rcpat
<br />ro ihc pmviti,,ns or rhc contr.ror's Liccnscd tiw (chrrr.r 9. connncnrnrB with Scclion 7tu() of Diri\n,n I or rh. Brsincss and
<br />Profc$ions Lbdc) .r rhar tE orshc iscrcm/ th.r.fron lnd thc bnsh forthcalkPedcxcmplion A,y liol,riondrscdhn?01l.sby,ny
<br />upflicnnl lor n lcrmil suhjcclslhc rpplicul roacivilrcnrllyolnor.mrcrhli livc hundrcd dolltrs(S50o).
<br />l,,s o*irr orrh. l( Fny, or my cmploler wirh qrgc\ as rhcn $b comt'.nslrion. willdo lhc sork ajd rllc {turm n R
<br />intctrH or ofcrcd for slc (Sa 7i)44. Busim$ lnd Pronsions Codc, Th. Conrrdois Lic..sc tjs d.cs nor efly ro rn owmt of
<br />rhc F,pcny whobLildsor iq)ows rh.E)n, nl who dds$chu,& [nnscllorhcr{lfor rhrouah his or hcr own cn,tloyc.l.
<br />pn,vidcd rtur such irnprolcnEnh @mr ior.'nlcd or oll'c^\l lor slx ll ho*Nci rll hildin! .r irqhv.nrnr h $ld sirhin onc ,sr
<br />of..npLtiotr, rtE opncr Buihs ll hrvc rhc htrd.n oi pn,MnB th.l hcor(h.dil mthiklorimpon d'c pn,Fny ror trr puqb*or
<br />_l-asowmrofrhcpror.ny.a'ncxclusirclycontacrinssirhlicer{dconh.nrsrocotr{fl.rlhcnn)j{t(sc.7(!14.tlu\irr.\
<br />.M Pl!ftssi Codc: Thc Confac!tr ( Liccns. Lrwdocs e{ il)pl!b ano*ncrol'pn,r.nywho btildsor imtovc\ rhocotr.
<br />rid who co radstuskh pn,j.ck wirh, (i,nt&,(n ltci{d pursua0rk'rhcConr,chis Lirensc Liu).
<br />-l
<br />anrcxcnu tr cr Scclio
<br />Dore: Ovn.r:
<br />]loatr[&s:rl)ufltNsdllaN
<br />IT}:CLASTIIIJN
<br />I hcrcby alrirnr undcr p.nllryofpcrjuryo.c olrhc rhlLsiry dNln.llIions:
<br />I havo on wilr mintoin a Ccn iaEarc oaconsn[o Scll ltrsurc ,or workcn coqr.n\d ion. .s tn,!id.d ror hy S.cr ion ]10.J of lhc
<br />Irh, Celc. for rh. ngtornDftc ol rh. *o for which rhc pcrni ( issued
<br />-lhavcand
<br />willmonrhin workcr'.o'npcnsarion inslrnncc. a{ rcquncd bt Sc.rn,n 1700 orrhc Libor Codc. ror lhc prtri,rn nccol
<br />Ittr vork lu whichlhh pcmit is isud My,ortcm conD.n\dn'n in\ur, c..trri.r xM Policytruflb.r m
<br />_l ccnifyrhrr in rhcr.rfortuncc oi rh€ wo for *hichrhhI)Ci! ir is issudd.l \hdll nor cn[loy ,try pc6on in lny mDnncr
<br />g' N io bccom subicr b lhc woltcr( comFns.rion l.*s of calibrnir. snd a8rcc rhd ir I sh,x ld h..oft subic.r ro lhc
<br />wo,kcs compcnsalion pmrhions ol Ssri'n 37(xl oa rh. L.tnr Cdc. I sk l, fi,nhsnh .o'nPly Rith rhoc ,mvhions
<br />WARNINC Ftrilurc ro sui. wortcK sn[cns.rion ov.rdCc F u la$lul. and shrll suhjecr !n emplorer h qinind Fnxkics rnd
<br />.tr'l fincs ur n, onc huiJrLt rhousnrd dollrs tyrx,.(xx)). in rddiiiotr ro rhc.osr of.ompen\arion- datug8 as rrdridcd Lr rhc
<br />c^.,,,," m?;".,h.r,,E,.."i.,^,....,."d,,,,,,r".,.."
<br />,.,,, bltlltb 1,/*". Lavv^tn (svinn>n
<br />x LI|ENSID CONT&{CT0R
<br />/ \ DESIAAI'I)B
<br />I hcrcl'y omrnrunncr ncnelr).fnt,lry rh,/l m licdl|re.l unrlq F,vi\n,n olChsprcr 9 (commncins *irh sccrion 7uJ0) oiDivnion 3
<br />' rl'c Bu{ic\! rnd Ph,lu*'on(ccuc. Jlfu n'yltr.n{ F n iuljj,{.u dcl'e1
<br />(?Z o
<br />?icv,qvd..(tls4!@
<br />I h.'.nyrintr,und.r n(nrlryoi trrj t .onnfl.rhn lcndirg.gctr.y ior lhc ncrl'ornEncc ofrh. \ork f.r whi.h rhn Frntir is
<br />istrcd rscc 109? Civ C I
<br />'L
<br />a Ul/'
<br />l1l5o Ntw y Sr d Lloi ,lovnfii^v^tk1 q?
<br />APIUIANfIEI;LANAUIJ!
<br />I hc,!$y afiim nndcr p.nolry olpctury onc oirhc inllo*ins dccladions
<br />D.n irionPc nir*Asb(sos Noriii.diotr I'cdcrul Rc3uhrons (Tirlc'10. tun6)
<br />Rcquicd t trcr ol Nolifs.tion
<br />dc nor rrplictrblc lo rhh projrl
<br />rfonsliotr is conccr I arfe b d,mply wirh all Cn, nnd county
<br />'y 0urhorizx rcprcsenrarivcs ofrhh Cn, and Couilylo.nr.r lFn trE
<br />,IrXLrfL btt *," g}lqlq
<br />SITE.WORK
<br />Ext./lnt. Lath
<br />"",., fl(ttlltL
<br />t--t--
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