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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsu lation
<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 />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />iv-xturrFINAL4t4IA 'A}L,)
<br />Certificate of Occupancy I,U\
<br />Notes, Remarks, Etc.
<br />OWNNR BUII,DER DET,CARATION
<br />I hd.b amd nndd pdarlt of p.rjrr rhd I m.r.npr n 6 the Conlractorr' L'c€ns. l,r'for lh. follorvins rc@n (sN 70115
<br />Bsiflcs and P,ofssion Cod€): Any C(y or Counly which r.!ut6 a pnit ro codtucl. ,hd. ihprove donolisi or relBt my
<br />sio.tu., pri.rto ns is,recc.,lso r.quir6 rhe applic t fo! such Fnnn to fil€ a sisocd st0t€mdr thal h! or she is lic6scd ,uBU6r
<br />to rhc trcvisions orth. Contrlors Lic.nscd La{ (Chafld 9. Co,nm.n.ing \ilh S4rion 70dr ot Division I ofth. Busi.ds dd
<br />Proa.sion. Cod.) or thal h. or sh. is.r.npt $ecftof, dd rh. bdris aor theallqcd ermplion A.y violalio.ofSelionT0ll.5 by any
<br />appli.an( for a pmit srbjs's ln€ applicanl to acivilp€n.ltyolnol morelha five hun&dl dollds (1500)
<br />l. d owitr o ilhe pop.ny, or my .,nploy6 wilh N.U6 a lhcn sk comr€.sal ion, \ill do lh. *ork &d rhc tudE n nol
<br />ioroded or otrded lor sl€ (Sa.7044. B$ins d ftoldsiore Co& Th. conkrdoi s Lic.M LaR doB not .pply lo u orvnd of
<br />rhep,lpdy who hr ds or nnprorBfidotr and who doesn.hw hims.lf or h6elI or r hroush his or h.r o*n .nrploye.
<br />provid.d rh.t such np' orandis m ndr intmd.d or dlIaql tu elc Il howM, rh. buildins or improvmEr is eE wnhin on. )w
<br />olconplclion. th€ O*rr Buildd wjll hlvc rhc turdq ollr.iins lh, h. or sh. dil nor bnild o. npmve ln. Flpdiy ao, tnc llqnsof
<br />_1. d own€r olrh. proteny, d .xclusiv.ly conka.ri4 trnh lic.B.d.onrad.6 ro coNrruct rh€ projal (Se.704,1, BBms
<br />md Plof6io. Code: Thc (ontracloir Liccns. Law do6 nor oppl, to ano\vn6 oaprcF.ly{ho builds ot imptovB
<br />'hdmn.and \rho onlmcrs for ch lrojeds \irh a Conrtuto(s) lic*.! puBudl
<br />'o
<br />rh. Co.traclols LicG Law)
<br />I anexcmpr undq Sdion-. B. & P.C. for rhis r.M.
<br />lrrte: Onnd:
<br />woRxf, Rs, conrPEt{sanoN
<br />Dl:ctat6llo!
<br />I hd.by amm uidd po'dy of pdjury orc oath. aollosinA ddeatio$:
<br />I hav. md will nainrain r C.diarcatc of ConHl to SclfiNurc for wo,kda .on,p.nernrn, 6 Fovid.d fo. by Sdion 1700 of th.
<br />tihor Codc. lor lhc pdfdmd.. olfie solt fo! which lhe pcnn n i$Nd.
<br />I hav€ and will mainlain *oR€rt coarp.dation i.smrcc, s r€quned ur\ s(r Dn I700 oirh€ tnbor Cod€. lor lhc p6lom&ce ol
<br />rhc sorl for whict rlis p6nir n B,uqt My eork.rs' .ofrpds.Iion iauro.. .mi6 ad policy numbs uc:
<br />-l.dirrrhar
<br />in rhc pdlo.inec. oarhc worl for Nhichnrispdmii is issu.d.l shallnol €oplordrp6on ina.y,n rner
<br />$ 6 lo b€com€ subjat Io lhc NorI6 conF$llion la*s or Califomid, Md tsR that il I should b..ome subjed lo lhc
<br />*ort6 comp€nsrionDrcvisioNolscdion lT00 olrhe Lalni codc,l shall. aonhNith comply \rirh tlNs tlovisons
<br />WARNING: Fnilurc ro seu. worlm compmsrion covdage is unlo$ful. d shall subj{cl & dpLyd ro oinrinal Poalti6.nd
<br />cnil fin€s up io on. hundrcd rh.usard dollds ($100,018). in .ddnio to th. cost ol comp.!$ion, d@g6 a provid.d for lhc
<br />sdrtu. !076 ol rh. tih)r Codc, inr.r6r d
<br />OECI,ASATq!
<br />irnds Frvirion ot Chapro 9 lcormn inB w n S..tion ?000) of Division lI haeb! afitn undc. p.nally ol p.io,y lhal I m
<br />7{47o/
<br />I hmby arm undd F..ahy of pdjury lnd
<br />$ued {sd.1097, civ. c.)
<br />is a coNrdclion kndinr a-lscy tor lhe pqaomanc. olrhc $ork ior \hich this pslnil is
<br />at8llcaNr.llcrlEarlo!
<br />I hr*yrin nundd pdal y oa pdjury oncoalh. aollowinB ddim.lioN:
<br />Dcnohion Psnirs-Aslxsros Norincarion Feddal R.rularions lTn[ 40, Pd6)
<br />R.quired tdr* of Noriti.dion
<br />I celiaylhar the acddalrcsularions Errdins sb6k6 Fnoval c nor amli.ahle ro rhis arojd
<br />slrlcrhd rltalxJreinlonnarnnriscotrd lalreroon,plyNirhallCirtandCotrnry
<br />aurhori* r.pr6drativ6 otrhis City dd Cou.ryro olq lp.n th.
<br />^.. //-t/-/8
<br />a.d77- P:22444""*'*{y'o
<br />T-Bar
<br />Flood Zone Certif.
<br />of rhc lr$i,rs md Polaio6 Codr. d ny lic.B. is in aoll forcc od €ffst.
<br />L!n,le,'! Addrs.
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