|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDOR DTJLCARATION
<br />I hcrchy afirn und.r Fn,lrt of Frjury lhd I o c&mfl fn,m rhc conttaclom Li(.sc ljw tm rh. followine Rren (Se.7011 5
<br />Bu$n.rs ,.d Prorc$Dn Codc): Any Ciry or Cornry *hich rcqures I lctmir h con{dd, ,lrcr. imllrl)vc. .kelrh 'tr Rlan rv
<br />rd rhc !o!K,ons of th. ContrLrr'r Li..nrcJ Lae (ChaPlcr 9. ComnEn(ing wnh S&rt)n 7txj0 ol Divtn,n .l ol rh. BusiRss ,Irrr
<br />Pn,rassions Colc)orrhrr h. orshc is c$mpl rh.Eriron inJ rhc hari\ td rhc iih8cd c\cnrrlion Anyvn ario.ofScdion ?0.115 hrmy
<br />sml'crnrfttr.lcrnrirsubj.{lsrhc,ttlicanrorcivilp.nalryornolnFrclhrnlivcnrhdrcddollds(5500).
<br />-l.r\o*n$olrhc!tutdy.rtrnrycnuloyc.\wnhwalcrr!rhctrnrc.onllcnslri,)n.willdorhcwortlrlthcsln'
<br />dtoi.r
<br />unmJcJ orotlcrcn tu sk (SN ?044, snsncs atul Pnrc$idrs Cqlc: 1hc c(,nL acrt's Lkctrs.1-a* docs nor aI yhmoq,rcr.l
<br />rlNnn,Fny wlx, htrild\ or mDn)vcs th.s)n, u'l who Jrs $'ch k)ft hinrrclt or lsscli or thooSh his or h.r own cmpbyccs.
<br />F)vidcd I hd su(h i'np$vcmnN e nor Nckhd d oltarcd lbr salc Il. hovcEr, rhc hu'ltitrrg or in{ov.rcnr t soll] wihn onc vtu
<br />ot eon'{lkrir. rh. Owncr Budlcr will lBvc rh. htrrdc. of Osvirr! rllll h. or irc nil rn huill or nil, vc rhc popcny nn thc tturlbt ol
<br />l. as uncr ol rhc l],opliy, am cx.lu vcl! cotrrncrins sith li.enrJ $nkrrtrs h (onnoel rhc PR'jtr (S.L 7044 Bururcs
<br />rnJ [k,L\si Codc: Thc Conrracttr s t-i.c.* Lae Jo.s nDr atply N d owncr ol ln)n d y wtu) hurlds or imr)v.s rhtrcon.
<br />atrJ who.rl,ltnchnJr\uhtnrr..hwdlaci)nrB.ro(s)ltcnscJlunur.rk,rlrai,nt.cntrsl-iccnselr*l
<br />I inc\cnrpr uftl.rSc.rn,n-. B & PC.,i,rrh'\ rcr\rt
<br />IVORKERS' CO]IITENS TION
<br />ACCIABATO!
<br />I lNthy rtlrnr utrltcr p.nxltyol ncruryonc ol rhc n,U(,win8 dc.l&.lnrr\:
<br />-lhavcaniw,llmn
<br />ain r (tnr&arc ol Contnt ro Schlnrurc for workc d,hl'cnsarion. as pbvidcd fot tySern,n]?m oftlE
<br />Ubt, CoJc, lilr rhe !.nomuree of rhe *o lnr which rh. lEmn ( rsucd.
<br />I [dvc lnd *iU nainr.in sorkcis.ontPctrslli(,n imuranuc, as requirJ hySccr!)n ]r(x) ol rhc Lat$r Co{c, ror rhc J'.rfomucc ol
<br />rhc vork nx *hich rhjs Fm Lr Lsu.rl. My *orlcn comrcns, n n
<br />'nsuramc
<br />crar a, PIrcynuntfrm:
<br />l.cnily rhri
<br />'n
<br />rh. p.nnr.rn c olrhc work Inr whi(h rhs ocrmir r (nEd. I shollnor cmll(,y any Pc6on in any m,nmt
<br />$ xs b hccnm Nhjcd to rhc *xk.F on{.nsaodn ldws ol cllinrmu. ,l 4Ec rr'd
<br />'r
<br />l should h..om subjsr h rtf,
<br />wol1lds rompcns!(i,npovisi.nsotS.(rnrlTtUoflhcLalatrO)lc.lshiu.lonhsrlhuonlllywilhrla,Eprovi\bns.
<br />WARNIN(;: Faihrc ro sccurc qorkcr omnctr\dn)n co\tasc is unhwtul. rnJ nd \uticrr an cmtl')ycr lo diminrl lkuh$ rnd
<br />rivil Inr\ ut k, onc hundrcd thouslnJ dolhn ($lm(xxl), in rddfidr to rhc co( ol.omrcnsrrion. d.nra8es.s lrn,vitlrl ntr rl'.
<br />S.crn lI)76 ol rN\ tiborOic, nrcred $l anonty's f.cs
<br />.\DDlnnnr:-
<br />LICENSED CONTTACTORpEC!AB{MN
<br />I hcEbyatrr unJ.r Fn.lry.tpcrjury rhar I am lien*l unJcr Fovision olChaplcr I (dhftN'n8 w,th Ser6n ?000)orOivilnn l
<br />ol rM Burire$ o'l PDfesions codc. iil ny lrccnsc is in tull lod aJrl cficcr
<br />Li.cnsccl!$: l-iccns. N!mb.r:
<br />urr._ conrqlor:
<br />CONSTRUCTION LENDING ACENCI
<br />I hcEby rflnn unJcr Fnrlly of pcrjury rhd rh.o ir a cohstfl.tsn lcn ling .3en.y lnt rh. !.rfonnlNc ol rhe worl for ehich rhls ttmit is
<br />issuc,l (Scc. ]097, Civ. c.).
<br />A[!L&ANLUEC!I8AII9!
<br />I lmby.ltlru .r pcnllry ol pcrjury on ol rhc Lllowh3 dNla6ti{,ns:
<br />Dcnrninr Pcrnih-Asbc(os Nolilic,ii(,n F.Jcgl R.3ukln ts(l lc 4{), Pa16)
<br />R.qurcd l.tlcrol N,nitcrrbn
<br />-l
<br />c.n ify rhar rh. rcdcrd Esul0l ions e8ar,iina ,sh.n.s rlnDval &c nol aptlitlhlc ro rhh pojet.
<br />-l.cnrry
<br />rh.l I h,vc rad lhis lppltarion and furc thar hc abovc inntrrohn is coftc.l. I r8E to mmdy enh aU city anJ Counlv
<br />ordrlRcs.nd Srarc L3ws Ehrins ro bu,ldinS .o.slocli{n, lri hcrct, aldotn. Eplc$nl rrcs ol ihh Cny,!d Counly ro cnlcr uPon rlE
<br />dhvc mdord 0n)pcny lir irspcul
<br />rqApplir'{nl or Ag.nl Si8mluN t'"'"'il/Lo-iL-
<br />Set Backs
<br />Forms/Steel/Holdowns YL t/tl l I L^tltt
<br />Erection Pads
<br />Rool Sheathinq
<br />Shear Wall I
<br />Framinq ll f.o v.lu tq DarBZt3c"\
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL 2-tt'"o
<br />Certiticate of Occupancy
<br />Notes, R m arks, Etc.I
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />l)ara
<br />Pool Fence
<br />LrtrJ.,'" AJI.(
<br />-
<br />lrq I
|