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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BtIII,DER DEI-CAIdA'I'ION
<br />I hcr.bv rlltm undc. Dcoshy (,f D.rjury ih l !n cx.mfl rtun rhc Conhct'F' t-i.ctrt hs lbr rhc foll.qirS r
<br />Bu\ircss xl Prolc$ion C.dc): Any Cily or Counry whi.h rcrluir$ u PciI ir kr .otrNrucl- rlrcr- i'nPtuvc. dcmoli\li "r tNn n,
<br />nrucrurc. pri'!o i[ issurmc, lho rdqufts rhc tllljconr io \uch Fmir b fi].4 si8trcd nd.nEnr rhd lEo! sht i\ li'ctrscd Pur{u3nr
<br />to ihc F)visn,ns ni in. Cotrrr&ln\ l,iccnsod Law (chnpicr 9. Conrnm.nr! Nil[ Sccrin 7m0 or Divi\ir ] orrh' Busnrs\ and
<br />hotcssi('nsCod.)or rh.r icor\k is cx.mfl lhcrcfronrnn ihc6itri\ aor rhcallcgcd.xtnprion. Anvvi{rlari.n.lSathnT0.ll5lrr"rnv
<br />apflicrtrr ri,r a F-rmir subjc.hrhc rrPlicaor h acililFn,xyol..r morcrhni livc huMr.ddoUar\ (5500).
<br />I. n\ osncr of Ihc Dro|rrly. .r
<br />'ny
<br />.n!role\ *il h w4cs !s rtf, n sh .onrctrsarnn). will do thc sorl lrd rhc sltrh'rc i\ 'vni cidl orofltrcdlorslc(sN704l.ansincslndPnnossnr\C.dc lhcConrx.ktr'sLiccnscl.awdo.stroltrPt'lvhrnormroi
<br />rhc 0mpcny who hdild\ or ilrrovcs lh.ron. ind wh dd\ nkh wolk hnn\clf.r hcrsllor lhroush his orlEr o*n ctrlPloyccs'
<br />n(,vid.d tlrr $rh imro$m!6 m nor i cndd ot oflarBl fi, {L ll h)*tv6- rl{ huitli+ oi nn tulcnrni is wU sirhhom Fd
<br />;con1Plcri,n. rtr OwN auiBcr will&trt rlf, hutlctr oiProving rl'.n lr or \h. dd nor huild or inwovc th. tmF,r Lr rh- rurlrN ol
<br />l. so$Dcrolrhc p'oprny. d cxclNivclyc.nt&riIB sirh lrc$\cd coDrtdr t, con(Ncr rhc P(,iccr (SN 7ln'l Btr\incs
<br />itrd k)ll\\ionCodc: lhc (onk kr's Li.ctr\cLnwlo.\ mr rpfltro ttro\rncr olln,lc vwhonuild\ornnlovcsrhctco
<br />rtrd who .onrftr\fur\uch t)rejccr s eiih I conrm.h I s) liccn\cd Punumr h' lhc (inrrNrn s l-i.cn$ l-{!l
<br />I rfr .\urt,r un,llr Sc.r(nr ' ll ,! P( lnrrhtr rrrtrnl
<br />O*n.r
<br />UIIBKEBILCAMIINIAIIA!
<br />IIECI.AEAUA!
<br />I hcrcby criirm u.dcr pcnahy of pcrjlry on. olft lollowin8 d(lsarionsl
<br />-l
<br />hrlc !d will nminl0in r Ccnifrare .f cone ro Scltlnsur l;r Qorlcr compen\ainn.as Pmvidcd tor bvScclion:1700 orrh'
<br />tihtr Cod.. r(r rhc lcrfornDna of lhc w.rk ror wnich lhc ll.l mir h i\sucd
<br />I havc rtrdwillmrin[in wotk.rl .oorl}cnsolt'n inrur!..c, rs rcquncd hysc.rn,n 3?u)olrhc l-,h.rCodc,lorrhcrcrfonnrneol
<br />fic hrk lor rhichlhG pctnJr is knal. My{oric6 $mt dsarion insumnd.:mi$ and Pli.v nlhb€r ml
<br />C.
<br />,1,r\No,r\(, B|\rUV Cr,1. \ . t'..
<br />-l
<br />ccnili rhI in rhc Pcllomtrmc.frhc *ork lor shich rhis pcnnir il issucrl. I \hrll ior cmPl.v !n) Pc^on h anv nnnncr
<br />\o rsro hc.onrc suhjcd t, rhc vorkcn compcnsriioi hss orcrlihrnir r d l8nt lh0r ii I sh.uld b..orc suhj.cr n'rhc
<br />w.a.r c.nrpcns.ri,,n F)visi('ns olssrion:lTtloofrh. Litx code.l \hrll. lonhuilh onnPly *irh rho{ Provisions
<br />WARNINC: rlihd lo sccur. lor[cB conrpctrs rnnr colcrrsc i\ unlastu]. nnd shlll srhjd rn cnDb]"cr ro 'riminr P'mlric\ rtrd
<br />civil ,ine\ up b on. hundrcd Ihousand dollr( (51m.(D0). in rJdnioi ro rhc.o{ ofco'nFisdio.- drruEc\ as Provid'd l'r rhc
<br />Sccri(r .11176 ol rh.libor Corlc. irrr.rc( rnd oary'\ lics
<br />4. L.r.:-.
<br />I hcmby rllirD undcr pcndryorF.juiy ihal I !m liLti$d undcr lnrnn,n of Chll,q 9 (comtun.in8 wirh Scclion 7000) 'fDivtirnr:3
<br />of rh. BusimssaM ttoicssn,n\ Codc. arxl my liccn\c t in llllLrcc J cll'rcl
<br />Br,
<br />,,, {;U, P"
<br />(IoNSTRUCIION t FNDTN(; r\CtrNCY
<br />Ihcruh!rlUrNtrndcrFnalryorp.rruryrh rlrcrc t a con{tu.rbn kndi!! a8.Ny f(tr rhc Enhlrnanc. of rhc sork lor Nhkh rhis lE ril i\
<br />i\\ucd (Src. l097.Civ. C )
<br />Lc ci\Nr r
<br />-
<br />Lc .lcr's Atldrcs\:
<br />l.oriyrl rrhclctl.nlrrsuldi(irsr'!',1i,,!irE\jos!tr,!tlrrcnirfl,rxlrlet)rhi\n'ol.rr
<br />O*ri r ,h:' lh . rcrlrh,' rnnrrJtr{ ,l
<br />,lilr .$r,,,1skrr Lrv. (riri',r r' htr'ldtr'!!l
<br />tr. iDhnMtor \.oirccr Irgrcchc.trrPlywirIrllCilyrtrJ(inrn,
<br />hcrcbrrtrrh.rn. rc[.\c rnrivcs(,1lh]\Cir, rid C.unrytr, rircr ulit Irhc
<br />rhor. Dr.nli,) r,l p'ot,.'rv r,i irf..ri,trr |u
<br />Applic.nt or nxtnl SiAtr.luro 4.---
<br />t. q. ro,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Framinq th3t?5D?S
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputv Final Report
<br />Enoineer Final Report
<br />FINAL lo/"1lc 1d94
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />l"+t-
<br />APPLICANT I'F(:t {RATiON
<br />I nnbylmmhdcr p.n,lty oipcrjtry otu.rrhc r.rb*in8 dr--larari.nsl
<br />DcnFlirn,n P.rn,iB AslEsosNorificnrionFcdcBl Rc8ul4lionsllirlc,l1). P.n6)
<br />_Rcquircd hiicr of Norificdion
<br />9.
<br />Set Backs
<br />Shear Wall
<br />Flood Zone Certif .
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