|
BU'T.DING- INSPECTOR RECORD
<br />I hE.by armn undo pcnrht of pdtury rh.r I m .!dnl, aro rlrc Conllaclo6 l-ic.N L,N ror lhc lollo\ring rtuon {S(.70]l s
<br />Businss ,nd Profsiotr Cod.) Afly City or Counlj_ \'hich .€qun6 a p@ir ro codrucl. tli6. inp!or.. do.olish , r rcpsn any
<br />sirucluc, Fior ro il' isudcc. also ruqun6 Ih. appli.d aar such pdmil io file . silned slalodl rh h. or $. ! li.ds.d poreuont
<br />lo thc p.orEions of lh. C6nr6.roas l.ic.ns.d lrN (chal,d 9. (onnncncins Nth Salioo 7000 of oivision I of rhc aosins ed
<br />Pr.a.sions Cod.) or rhat h. or shc is crcmpl lhq.hom md lh. bsis for lhc allecd ddFion Ary viulari.n of Sdion 7011.5 by any
<br />opplicanllorapsmitsubjdslhcapplicanlloacivilp.nallyof,orBor.rhmnehuMreddolles(!500)
<br />l- d oNnE olrh.pnrp.nt, oi my c.lPloy€ silh NryB as th.t $l.conDosrion. Niu &! rh. $orl dd '. $nrclu. b nol
<br />i{aded o. oII6€d aor slc (56.?0,1.1. Busin* tnd Prolssions Code Thc (inta.rois Lic6$ t.aN do6 nol arrly lo an o\r.r ol
<br />rhe rturEry Nho boil&.r in'prc\ 6 thson. ..d who do6 sucn sorl hinsclfor hclrorrhrcush his or hd oM cmplotcc.
<br />prcvid.d rhar such inPlovdMrs e. mr i.rdd.d or oratn aor ele I[ no\ 6'6. rhe trildins or imprevmr iq $ld wirhin on. ta
<br />oacomplerion. the OMs tluitlq sill na\ c rh. hrdo ol tfrrinB rh,l hc or sh. did not tarild or irpror c thc rmpdy tu rh. ttulre oa
<br />l. nsownsoarhcIIorolv, tur.rcl"sir.ly.ont..rinr snh li.cnsedco mft6 h coNlrud lhc rmjccr (sd 704.1, Busins
<br />ind hrftssbn Codc:1hc Conrrrcrois l-iccnsc l,a\v do6 lor lpplt ro d.\'n$ olprotdly \vho btrilds or improv.s lhrsn-
<br />and $h. conradslorsuchpmjNlssir[.(olll,atu4s)]iccnsc! pureuanr k,lhe(ont,ckr s l-i..dsc t-ar)
<br />I in erdnpt trndd selion
<br />!oat(!j&5:(a!!fE!sa!lol
<br />DI,CIdBAI!(}I
<br />lhcrcby amfln und6 pdalr) ofpsjury orc orlh. following d(ldari.N:
<br />I hare od $ill maiorain a Cdificarc of Con$I lo sclt l6uE for sork6 conrpos.tion, s Folid.d lor by sdlio. 3700 dflh.
<br />kbo. codi fo. lhc pdfonnmcc o f thc wort tor $ hi.h lh. p€trril is issued
<br />I haveand\ill nrainrc \orkers' .ouri:nsarbn 'n.uratr.r. is rl\rtrircd b! Sd ion ]71J0 or rhe I ah.r (nd€- fir rh. pdfofrre&. r
<br />rhc so.k lor {hi.h rhis p.mit is isu.n M, \ork6s' ompmarlon iNtrrance.ams a lrlh.r_ u rbcr at
<br />I.cnifr thar ii fi. po loiinancc ollhc $ork lor \hich this !.n!ir is issu Islrllnrl cndo, rn! N,!rr i!r ri\ frMn.r
<br />so nsnr lxco'nesubjccr brhcso,l6imnllnrisarNr hNs o l (-.lilnnria.Ihd illshould trcoN s'hic.r h rh.
<br />\0116' compdsaiinptuvisio.s.rselnnr1700olrhcI-at r(
<br />WARNINC |aihtrc to snrc tro'[c6 cotr1peBalion coNralc
<br />nhNilh (o'nply silh lho{ p(,lisnrns
<br />shallsubrdr 0n dnrn)yc.lo crir.i.al pdrahi6 and
<br />civil fires uI) ro oa€ fiundreJ thousatul dollars ($100.000)of.onrFnsilion. dmrascs d provided tor lhc
<br />srri.tr 1076 olrhe I ahn r'ode inr
<br />"^,.,2/z
<br />!l!rl L!!! !! !!l
<br />lh.rcb) afirn utuu lfnihr'olpdjr)ar I0 li,..En$n ulder lrorision orchaprr I (co'nmoring \rnh sNlion 1000) ofDnision l
<br />,2c//
<br />"::^::,"'-
<br />/>/,//r 2o-frzoE-
<br />I heEby amm undq penalry ol rqu' r_ thil
<br />issud (Ss 309?. Civ C.)
<br />oBtu.lbn lndirs asfl.y for lhcrEtr m..orrhcsork aor\hichthi, Ff,nn is
<br />a-tlLl(lNl.ul]ct B{Ua!
<br />I hd!t, arnn tr.d.r p.nalt, olpojry one olnrc aollolvint delanlions:
<br />Dem.liiion Permirs Asbcros Norinca(ion F.dcral Rqtulations ir nle,10. Pa16)
<br />Rcqrt d Lr(d.rNorilicothr
<br />-!::''[ '2d'm r"a'"r
<br />1,.\,r, 'l,n^",*,,'n,m,ritr c\iy'd \rc r^s Erir
<br />rh^c m.nyrnd nn,p61 rur ,
<br />idno\.larc nol aDplicabl€ lo lhis prot.d
<br />rld drc ai[v€ n,romattun 6 .ond I ag d to conplr" wir h 0ll Cily and Counly
<br />ion. and hcrchy aurhor;rrctir*nkrnc oflhG cil, d Couitr_ lo ols upon lh!
<br />Appli.rnl or Apdrt 9ipn.lu
<br />SITE-WORK OATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lalion/Enerqy
<br />Drpvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />--<-\FINAL I I tt-prr.r+,
<br />Cdrtificate of Occupancy q'\. r-7
<br />Notes, Remarks, Etc
<br />luruil
<br />^)'D-./
<br />ol rh. B6ine md Potdiorts(odc, mdnrylirdrsr is h lull fo,.c md eftd
<br />,,-," ,"/rr/rr
|