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BUILDING- INSPECTOR RECOHD
<br />DATE ID/SIG.COMMENTS , OWNER BTIII,DER I'EI,CARATX)N
<br />I hcreh, alftr lndcr ri.n!lr, o, Frrur, Ihar I a .icnDr lrc rnt Conkrcttrr Li.cn{ I-rw lnr rhc nnhwins rclen (scc 70:ll 5
<br />Bu\in.\s and Plrcs{ion Cod.): Any Cit or Counry shich r.qunc Fnnir to con{ruc1. lllcr. impmrc, dcn,li\h or rcpan My
<br />$ru.tur..,rn t) irs (suaR.. also rcquircs rhc.pplicotrr rbr chFnnir lo filc.sign.d darc,mor rhar hcor\hc rs liccntd !trNudi
<br />l(, rlre pfl,visbns orrhc (l'.tr.rofs Liccrscd Lrw (Chapr& 9. C.nxrrkin8 wilh Sedion Trxj(r of l)ivi\i.n -l of rhc Bu\irrc* otrd
<br />ProtsnN Cddc)orthnrhc orshc iscrcnU lhcrcliom.nd rhc hosk lnrrhc (llcscdcrc'nprion Antvir,l,riotrolScclion?0.ll.5hyany
<br />(rnlicont lor r pcirnit subjccrs rhc lprlicanrro ucivilpcnalryolrcr nnrcrhrn fivc hundrcd dollr^ (S5otr)
<br />t. x{ .wncr of rhc prof,c.ry. or fry .mplorrcl wnh wagcs N rhcn $b .onll,c.sai ion. *ill do lh. uoir ard rh€ smdm n n,
<br />i cdcd or ofcrcd for slc (SN.r044- Busitrc$ md Profcssions Cdc 'rhc Contaclois Liccn* Ii* rL.s nor ,pdy b 0n owDci of
<br />rhclnrdy wk,t ilds or inpoB rh.N...rn wh. d,btrh Hrrt hnnsclt r hcNlf or rhnu8i hi\ or her o*n .n1t)ldyccs.
<br />ptuvid.d il[r such inwokn.n. (. nor inr.ndcil or olT.rcd for sL ll tbRvn. rtE ttriHinA o, nl0mEmnr is sld wirhin onc Ftr
<br />ofmmphrhn. ric Owncr BuiLl$ will hak rh. bodcn ol proving rhtrt h. or sh. did mr build or imprcvc thc lotEny fo, rh. ,urt)$ ot
<br />I. r\ owncr ofrh. pmpcny, am.xch\ivcly ro t.cring wirh liccn\cd contn kns ro.rtrllrucl l,r triccl (Scc 7o1tl. Bu\i"r\t
<br />.ftd EoL$htrCod.'IhcCotrrructnsl.iccn\cl-rwdocsnorapplyio!nowtrcroftm!. ywho hoild.or inrp!.tc\ rhercon.
<br />aM who .oirrr( lnr su.h pmjccr {irh , Gn ncrons)licctrscdlunuonrrorh4Contlcroi\l-ic.nscllw).
<br />I anrcxd rpr uidcr Sccrioi .A &PC.tuthhrca$n
<br />D.Ie ()*m.
<br />]r!)3[xBs:(!]uflNs rIoN
<br />osel. SlIIta
<br />I hcr.byrl1nmtrtrdrr tfnrlryof nc'juryo col ihr f(rlk)*i',9dcrlxhrtrtrr\r
<br />-l
<br />hsvc und rill
<br />'EinuiD
<br />s CEnific corC.nknrbsclrlnslr.rorworkcrrcompcnelion.0stmvidcdlorbySc.rionlT0oorrh.
<br />Labor Codc. tu ltc rslbrmmc of Ihe work ln lhich rh. rermir ! h\n.al
<br />I hnvc,nd *ill rinrtrin workcrs compcnsurion insumNc. rs rcqutcd hy S(l ion l?m of rnc lib(, G)d.. for th. pcrfon*rre ol
<br />rhc work for which rhis pcnnir ir issucd My*ortcN .ompc.sarion insunrcr clnic. sJ F,lic, nunrbcr -c
<br />I ccnifyrhd inrhc perfornunccoftlE work for shi.h rhis ncnnir is i\\uc'1. ! shall mr cmpk,y rtry pcn.i ir atrynDnncr
<br />s !s to bcom subj.rr lo lhc wodGs cotr{Ensarn,! bws ofcllifixnh. xid as toc rhar lf l lh)uld hc.om ruh
<br />*o*cr! con{xnsariqr pmvisnrns ofS..itun.l?(X).frh. Ljh, Codc.l {
<br />W,{RNINC: F lurc b {cu.c workcrJ.onr.nsoiion covcn8c i\ utrh
<br />$irh omply wirh lhoe pm!isi{,n\
<br />Ycr r. dirnnrl Brrlrk\ rrl
<br />cril fincs up ro onc hundr.d thousann dollm (SloO,uJO). in ddir
<br />Sc.tion 3{}76ofrhc tnbor Codc. intcrcsr md atrormy\ lccs
<br />drn E.s rs povi,l.d |,tr rhc
<br />DACI 4RATI(}N
<br />I hcrcbyaffifl.und., F.ahy of:rerjurr lhnr I sm li.Tn{n undcr prornio. ol Chrfrcr 9 (conrh*nclng wilh Sccit,n ?(ln) ol Division l
<br />ol lhc Busimssand PmfcsionsCodc. !d nrylic.ns n in rull lorcc ond cI
<br />COXSIBI]CIIONIENDIX( !iI'NII
<br />su.d lsc. rl)c?. ( i! C I
<br />AIIUIANLDECIIAAUqN
<br />I hcr$y.,Imr under pctralty ot rcrjury orc ol rhc tollowin8 d(lamrii,.r:
<br />D€mliri,n P.rtunc Ash.sos Nodficdion FcdcruI Rcgulalirrns ( titlc .l1). fan6)
<br />-R.+ncd
<br />bI., of Ndifrdion
<br />-l
<br />c.driyrhd rhc rcdcri,e8ularioo\ rcsfldi',8
<br />I ccdilyrhar I htrc mrd rhnnppliuri(fl nlnrr.irc trco'hply wnh au Citynnd Gunl,
<br />o'dtr kc\rnd srrrr lrs\ rchnngnr bulldif8.,n{
<br />l.inc Drnliqr.d rrn,pcdvtl. insF.rin purlx^c\
<br />ivc\ oarhis Cnysd Counl! to cnls up.n lhc
<br />^ppri@nr
<br />c
<br />^!en'
<br />sisnoru+=r
<br />r"-,r,**.",0.r",, t-ce{tfl*&b,"-&-Lz-
<br />Set Backs /a=
<br />Fo rm s/Stde l/ H o I dowhfr .7,/r.i34 Vt*rW Fxsf fao4,p6-s
<br />Erection
<br />UFER Ground
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lr/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1l*Lt ls
<br />Certiricate ot Occup-nCyT
<br />Notes, Remarks, Etc.
<br />SITE-WORK
<br />SLAB Floor
<br />Shear Wall
<br />t nJn s AJdr!.
<br />*,.,7-l l- l8
<br />IfT
<br />I
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