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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcEby aili,n undcr ncn,lly,)l t'.rjury rhd I ah.ichtt fr.m rhc Conkrknr Liccnsc tjq |d thc rolblns Eanrn (Se.7oll5
<br />Burincss anJ Polc$i{,n Codc): Atry Cny or counry which lcquircs ! lcrmil l. con(nEr. llrcr. imtn,v.. dcmolish or rqDir any
<br />slrucruro, prtr, b ih rruancc, uho rqNrcs thcapplrMr Lr ruch Fmn h fiL r siencJ drrcmnr rhd hcor \hc n liccnsd pusu!
<br />tJ rhc ln,rhnrns of lhc Conrrn lmr LrccnkJ Lnq (chrfl.r 9. Commcncins *irh Sedion ?0(lO ol Divntun I ofih{ Bulrc\s dd
<br />Itolc$ions CirJc) dr thal l{ or she h crcql rhcrdnnn and rhr h,si\ tu rh. dll.c.d .r.hflnnl Any vi,'hrn'n 01 Srlbn 701 L5 by ry.mled ror n p.mir subJ.cB rn. rmlunr lo i .ivn ncn,lry or nor hxtr rhM lilc hunJr.d Jolhrs ($500)
<br />-l,
<br />r! own.rollhc l]l)!(ny. (tr nry cn{loy&i wirh ws8cs rs rh.i nnc conr|rcnslri,'n. will do lhc wo* lnd rlt {nEhm N ur
<br />(fcndcd dr nlt rcJ for sk (Sr 7011, Burincs\ an,.l Pr]f.ssnns Cclc I lr (i r!c(r'\ Liccn\. Law d€r nnr anrlv n, rn o*ncr ol
<br />rh. |['Bdy *,rhu ls or inlPnr(\ rhcNr, o*l who drs skh work him\.ll .r hcrrll .r rhun,Sh hr or hd .$n cn[l.yccs,
<br />pnivn,L:t rltu such inDovcnrn* e mr intcfrlcd d oficrcd Lr s .lt, hi,q.vcr, rlr huiunrl or ihnnr.tunr i $l'l wirhinore ycr
<br />ol cotrll)Lrion. rhc Owmr Bnild.r wdl hx\r rhc htrr,Ln ol poving rharlE or slrc lrl N bu l,trr{revc $.ptuFry ld ih. puqxr* ol
<br />_1. ro$ncrolrhcnn)pcny. !ncrchnNclyconkrcrh! wih ll..nr,l conk.rkr^kr.ondnr.nlr |[rj(cl (scc 7(114, BuqrE\\
<br />rnl Pnra$ n.i r: lhcCl,ntknn'\ l.icc.te Law locs frn lt)plyh.trow,rcrof[op..ywho h$ldsor inrt'ovcs rhcrcon.
<br />h'l who.onrru.rsntrsuch|$jccr$wirlrConka('(s)liccnsc,lpruldbtlE(nra.usLienscLrw).
<br />I I'ncxcmpr trnJcr Sc.rir
<br />ltoRKERS. CONIf UNSATTON
<br />lEg,lndusN
<br />I h.rby rllirnun,l.r F-nllryol l.riuryo . ol rh. ralk,winL Jc.lrrrr0n\:
<br />-l
<br />hr!. rJ wnlm trranr aCtniiulrcrlc.nscnrn' Scll lnnrc tur workc 'omtctrstoq r pn,iJcd nxbvSc.rl'n.l? )olthc
<br />Ijtrtr CoJ..l,tr rhc pdnmun.c oirhe work tur wh(h rhc Fftn i\ ts&,1.
<br />I hrvc.nd w,llmlnrrin workcrr conrp.n\ali(r insuhD.c. r\ r.quircrl by s(r n,n l7n of rhc Lrbor Gr'lc, ntr rhc Frfomrkc .l
<br />rhc w.rk ntr whrh lh,\ Iirn, i\ n{'.J My (omn ns iur r!$in...dnicr rl nr(ynun$(s.
<br />-ExpiEs:
<br />l..n'ly rl,ri in rh. Nnormrn(c olrlr t Lr whichrhr |rlnit is r\sucJ,I rhall nnr cnllt,vanyrc6o[ 'n ] mrnncr(, .s b b(on* rulicct ro rh. ai'rk.^ conFni&on law\ oi(.alitumia, atrd nsrcc llml 1f I druld h.com subjc.r k' rhc
<br />wort.n conrti.n\nthn lno l\r
<br />cmnloycr n' crinrinll F-ullEs rn
<br />ion, 'hmr3cs $ poviicl br rhc
<br />llALNIN(;: Frilurc n, *.urc wolkcs' conlrnlnr
<br />crvrl lircs ut tu onc hrnn'cd rlnns n &)lhtr
<br />Sculknr 1076 ol nr Lhtr (i,ti. inr.r.(Tc-70
<br />IECId8AIIA!
<br />I h.rcty arllm oftler FnalryolFrjury rhar I rm lknr.d undcr lrotnn,n ol Cnaptcr I (.lmmNins * hS.ction7000)orDrvr$nloi rhc Busincs .nd Pofesion! coJ., ald m, lic.n{ n in tull l','rc e, eflirr.
<br />CONSTRUCTON I FNDINC AGENCY
<br />I hcrby,flnn und.r Fn,lr!ol p.ijoryrh,t rh.rc is !.onsrru.ron Lndr8 a!.n!y ror rh. n normtuc ol rhc wo litr which rhi\ pcmir N
<br />ssuctl (s.. .ltr97. Civ. C )
<br /> PPT.ICANT DECLAR TION
<br />I lrNby.ltnn trn,l.r pcnahy oipcrjury onc ollhc f.lbwin8 Jcrlrdrbnsl
<br />Dcdolirion Pcrmirl^shc(os NorlMli.n Fcdcral R.strldlnN (l'irlc 4r). Plnh)
<br />-Requncd
<br />bttc! ol Norificaridr
<br />I ecndirhrrrhc li{crrlr.luhrions m3rnus rsh.{dsrcnu,rl^r. n.r dlld'.rlrc b rh'\ I'r)r..r
<br />I ccniltrhir I hrvcrcr,l thr ippl
<br />onln.ncc\ iftl srdrc trwsrldmg k,
<br />th.ih)lc n,lornBnon N..rc.r I rsren,.onDly wirhrll c yrrlc.! y
<br />nkfmdrirc\ d rhtr ciry rndcoutrrvrrcnrcruBrrlE
<br />dlinvc r.rrrnul f,otEry l,
<br />,\t,plnxnt dr,\,r.nl Si!nirtr A.ZD
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sr-rbf loor/Vent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall I
<br />Framing //t</zo -7wA
<br />lnsulation/Ene
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />l\4ason ry
<br />Pool Fence
<br />T-Bar
<br />D ut Final R ort
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL
<br />Certiticate of Occu anc
<br />Notes Remarks Etc.
<br />Drywall
<br />Handicap Req.
<br />'-t /tr / -ir'1 ,aL&,,l\
<br />l)nr._
<br />t^t" ' /-6.?,0
<br />tJr'1.' . JJr!:
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