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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNi]R BI]ILDER DIILCARATION
<br />I h.rcbt llltn undcr pcnllry ,)f !.rjur, lhar I an excnDl irun lhc Conlrucror' LkDn* Ijw lhr lhc roli,siig rcnn,n (scc.?lrrl.s
<br />Busi,rc\l and Prorcsion C6de) Any City .r Cornry which rcqun \ , p.nnn k, .on{ru.r. ,lrcr. imphvc. dcnmhh or rnrn ry
<br />nrudurc. pri)fro irs ilsu{rf,{,.h. rcqutcsrhcappli.,nr ror \u.hr.rfril Io lilcr siSncd stalcnrnl lhd hcorshc n liccnscd lunulnr
<br />ro rhc pmvisionr ofrtr Conrra.rois Liccnscd Liw (Chlprcr 9. Commncins wirh Sccrion 7rD0 ot Divnion.l orrh. 8u\incs rnd
<br />Irulaslons C.d.)orrhar lrorshc ncftn9r thcr.fromnnd rhe hasi\ for rh. rllcg.dd.nfrion AnyvnrrionofscclionT0-ll5hyany
<br />atpli..d ,nr . ptnnit subj(c rhc apt,licanr ro r .i!il pcnan y df nor mrc rlun livc hlndrcd dolhr (Ss(tr )
<br />l.nso$ncrofihcpn,pcdy-orfrycrpk,rtcswirh*rgc\asrhctn,lc.on,pcnsridn.willdorh.workdxlthcsltrturci"\trol
<br />inlcrn n or oficrcd for elc (Ss 7(}14. Busircs md Polasions Cod. Thc Contr..lor's Liccns Lrq docs tror lnrly ro an o*ncr o,
<br />rhcftup.nt *h hnildi or i.lpots rh.rsn. rxl wtr docs s.h w,* iinsclfor h.r*lror lhflrgh tis 6r hcr owncnployc.s,
<br />prcvidcd rh3r \u(h nnlrorcm.rs m txn i c cn or off.rcd rrtr kL. Il h)Mvn, Ihc buikliq .i irry$rcnrnt i* sll wi6in .ff )adr
<br />ol omfhrion. tlE Owncr Buildq will h.rc rhc bnilctr of rtuvnB rMr lr or shc dil tror hnikl or inpmvc rh. pmFiy h hc NrIr$ ol
<br />I. x\ own.r olrh. t()pcnv. r'ncxclusiv.ly.otrtr.rirg *irh li.cr\c(l coDr'rcr.^ b.onnni.r rhc prU!cr rScc 7(!"1. Boni.lr
<br />kl |Nli:$iflCo. ThcCoir'n(tr's Lrcf\r l-nw (hc\ norrrnlyti nno*trs.ffr.tr yqho huild\.r i'nt)nrts nrrc tr.
<br />xn *ho c.nr.k(in\u.hpnlccrs*irhx(inrcro(nl.cDs.(ltu\urirr)rhcCi)lrr.l{tr\l.i..ns.l- )
<br />I arcrcorpl undcrSccli,rn
<br />]10xtr0&uarItENsa.lroN
<br />TICI.A.BAIION
<br />I hcrchydlTr r und.r pcnrhyolrcrjDryo.c olrhc tulk,wi'rg dccl&in,ns
<br />lhaveoxt*illnuinrlinsCcnifKnrcofCoiscnr(,Scllltr\urciorworkc^c.n{,cn\di{n,.srtnvid.dforbrScdlonl7(x)olrhc
<br />Llbor Codc- lor lhc I'clfoirrorcc olth. *ork tu s[ic[ rhc Nnnn ( Fsucd
<br />rl'(r.,kh1vJ.l'l 'u iri.n.u,J M!{f'1.1..1{ aa. it,ir\.tr,tr',-.r'.i..tr'Jt.li )trutr.hlr,(rr.lwrar Ceow *\r.
<br />0,,,,"r",,,*. RNu'0 co ,? <,o?rc, c.p;- l. \ ,\4'
<br />-lccnily
<br />lh0r in rhc pcriorroncc oarhc work for whi.h rhis rcnnir h n$cd- I shlll nor cmploy rny pcrstr in rny runncr
<br />s ns ro b..om subjd io rhc solkftJ .omr.nsrr k,. law! of CalirixiL dtul rtrc. rlur ifl shuld bc.om subjccl tu tlE
<br />sorkcn .unll.ns nrn pdvisions olSelion:]7(nofrhc Ltrhtr Cod..l shrll. 6nh*irlr .ornply wilh lhosc Uovnions.
<br />WARNINC ljtrilurc to $curc rorteF .ompcns.li{,n .orcm8c ir unbwrul rn,l \hall suhjccl !tr cnrpkrrcr b dili'[lpcMhi.\ nnd
<br />lo onc hund,cd lhnu\and dolk(s (Slrx).{Do). ir nddil ro lhc cosl olo tr,txf\iri{n,.lhn Ec\ r\ I'otdLrl l(tr rhc
<br />Sc.ri,)n:10?6olrhc tihtr (ixlc. i'rrcrc{ a'nl rnonEyi,!cs1.(,.[B
<br />, hcrchrrfikmun,lcrt,crrlryoincrjurylh l rm undcr prcvtion olChaprcr 9 (omnErcina eirh Sdi,n 7m0) otDivnnJ..l
<br />ol rhc Bu\iM\strnd PmicssnnxCodc. anl my lic.nsc is ilr frlla,trcc udcrlccr
<br />(2-
<br />L.ctr.c ttJ., t4 'ofl1q1
<br />o,," q.(9.i%Wb,t-
<br />(AN!:If,IIIITNIEND,INCIjJENCI
<br />I h.rby afihr uMcr FD"llyorFcrjuryrhal rhcrc h 0 consltu lion lcndirc r8cncy for lhc Frformincc ofrhc rork ror *tich rhn pcmir n
<br />isucdls( :1097. civ c )
<br />AITJ,I(ANLDLCLIAAUOIi
<br />I trR$, nflim uid.r ll(nak, orp.riury o.d ofrhr f()lloqin! dc.hhrbns
<br />Dcnr,lirtr,n Pci,nik A\h.{o\ Norifi.rrioi F.ddrrl Rdgrhrn,ns ('I'irlcJ0, Pan6)
<br />Rrquncd l!rrrrof Noriliuro
<br />ly['rr.mltr l.dcnl', ru dr'n\ r.r,rJtr r .'!t\'r.\ 'r'i,-:.li'r ! r.' 't. tr.'1,1"'. rl'r. 0r',tc!
<br />217"n,', 'n, ,t'.,..r,n^ rffrh.ri,!,,trx1{rc,h. rhc) r r!rL{r)r. iriysihrr Lryitrd Lotr*y
<br />onlinrmc\ andSrrrc lf,s\nlditrE b brikln,E con(rurrnn!. rnd hcrchy sc ni v.\ orrhn ( nr r dCiunrvr,ctrrc,!J!rirhc
<br />xhovc n{nri,nNl |n.t)crly nn tr(
<br />AnDlienl or AIenl SigmiIPp*
<br />q.C. /a,)
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloorivent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Qeputy Final Report
<br />En ineer Final Re ort
<br />Flood Zone Certif
<br />FINAL ftllilic t\trx
<br />Cerlif icate of Occu pancy
<br />I
<br />Set Backs
<br />UFER Ground
<br />Brown Coat
<br />Notes, Remarks, Etc.
<br />I.Bn1'\ ,l.t'. -
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