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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE rD/srG.COMMENTS owNER AUtLD!:R DUt_( AnAltON
<br />I hnch, amnn u.d6 Fnllr, oa tEjury rh l dn ercmrt li(rm rhe G'0traclo6' Licdse Lar ror th. follo\in! rqs'n (S( 70ll 5
<br />Itusin6s and Profesion (id.) Any ( ily or Counry shich r.qur6 a pmir ro corsrrucr. alt6. improrc. dfr.lish or rqatr any
<br />rtruclure prnyro its istrMc., also r.qrnd $. dptlicdt for su(h pcn'r ro 6lc a ssn.{ srarqcnr rhd h. or sh. ir licosdl N'itrafl ,
<br />ro rh. pNvtnJ.s ofih! Co ra.to.s l-icos.d Las (Chapld 9. Conrm.ncinr wirh Sccrion ?000 olDnisionI orlh. D6i0css ond
<br />Preressions Codc) or lh.l h.or sh. is €t.hpr rher.6o6 Md rh. hair ror rh. all+.d ridprion Any vi.larnr.olsdrion 70r15 b any
<br />al)pli.a lor a pdnir subj..rs rh. applicant lo acivilpenaltyofnot morethan fir€ hundrcddollars($504).
<br />LdosnsollheFopen'.ornryctrDlor6Nnh\as6arh.irsn..ortnsarbn.$illdorh.(.rkmdrhcslMu.is or
<br />i.16(H or olTd.d tu slc ( s< 704,1, Busm6s and |rof6sions Codc I hc ('onlm.tor's l.icos ! is dos nol .pply to an o\ n6 oi
<br />Ih. FmFny * h) hlilds or in!r.v6 rh.@n. od sho (i)6 s!.h \rrk hms.lf .. hcmlf or rhrough hh or hd o$n cmplo!.6.
<br />prtn'id.d thar str.h i,npN\ un6 s e mr i[od.d or oflad fttr sl. ll hos 6 -. rhc hildiru or unprovdndr r $ki $ i(h'n r n. _\.r
<br />oacompldiotr fi. (xntr Buildf sillha( rhc burd6 orproviry rhd hc or shc did mt trild or impro\c thc pmpaty lorlhc E rpls. of
<br />l.soNn6oithcIropsly.{nerclusiv.l)..nta.rinrsirhlr6s.dconnncbBh.onsn'.tth.trejNr(S..7Ol4,Busmcs
<br />and P,sfsin (.dc: Th.c{nrraclr's I ic€nsc Larv do6 nol applyro.n o$nd ofpropdy\ho builds or nnpro!6 rhssn.
<br />and sho onrads lor such Fudrs wnh a (i.r,cro(s) licflFd pu6u l lo rhe Conlrldois l.(ose I !\r)
<br />l.m eronpl undd s(rbn
<br />lrrre Orner
<br />wonl{Ft{s, c1r\t i[Ns,.rnoN
<br />Drcl4&\.ItoN
<br />I h€rcby rmrinund.r Fn,l(yolpdiuryon. ollle rolhsins dataralionsr
<br />Iha\c dd sillmai ain a Cdrificar. orConrt lo s.la-l6ure for trorkGs' co,npasalion. as pm\idedaorbyS..lion!700ofrhc
<br />tjb.r cod., lu rh. p-fonnamc ofth. {o* for *hich th. pmil is isu.d
<br />lJrf and Nill mainlain $ork6 co,npflsalnrn l.stranc., s rcrldrdl hr sdr mn I 700 o I lh. Lahor (tdc. hr lh. Faom.n.e oi
<br />rh. $ork tu tr hich lhis pcmil is i$usl. My work6 comp.er io. iNurmc. ce iB md p.licy nunhd &.:
<br />,","6f" {-, C AN
<br />folic\ Nu[br /-7 t/s//0
<br />I ..niayrhat in rhc psrornrancc orlhe \ork for Lvhich this pfl nrn is isstred. I sh.ll nor cmploy an!, person in an, mann6
<br />$ slo h..o,ne $bi(l lo th. \o,{ds conp.nsrio.lass or( ahfom'!. and a[rr thit ifI.hould h<ome subr(t rorh.
<br />\ ork6 comt€nsation lror isioN ol Sd io. ]7m oarh. Lahr CoiL. l rhlll, lifih$ h c. llly Nth rh.r pNvis'.6
<br />wARi\lNC: Failur.lo s.cure rvorkm compsalion co\cr4c is mh$ful. and shall subjel M dnployd to oi,ninal p€nah6 ind
<br />crlil fin.i up t! on. hundr.d lhouend dollaB11100.000). in tion lo the cosl ofcornp.Nalion. dan:at6 is [ovided for rh.
<br />s.tritr, rn1,,,lrhr lihtr( 'du. tr(\rr,Jtr,,.,( ro//t l/7 ,,,
<br />AECI.AAAITQT
<br />I hrcbyomnnundd pmahy ol tsrury rhal I @ lr.nstd utuj6 pmsion o t Chrprs 9 {codmociis *irh serion 7000)olDivsrn:1
<br />of lh. Busin6s dd Pror6sons Cod., md my lftnsc is in tull forc€ md efi(t.
<br />,,"r,r"" C,27*- lol/t //J ;;4 ^.""^",, ?A,-zct 7 /
<br />I hmby 08irm und6 p.nally ol pdj!ry lh.l lhd. i. a snslruclion lddin!
<br />isu.d (sf 1097, civ c.)
<br />h.l)Lrn[nxnr!fllhrsf'l lnr\\l'khrhAtrrn l rs
<br />AIIL!(INLDECI,ABAI]O!
<br />I@amnnu trFnahyorrrdjuryoncorrhcfollosinsd(lararions
<br />D. hh tun Pdmlts^sb6los Nol ificar ion ljcd(.| R.8trhibns ('I n le 40. Pan6 )
<br />Rcqurcd llIls ol N.lilicalion
<br />l.dlll!rh.r rhrled.nn,.!trl.to s r.!rdn{ *hcrtx'e'novrl r nor aml'crhl.n,rhis piot$r
<br />I .61i1_v rhd I ha\e rc.drl,is rmli.arn,n ed rhillhuatF\e,naoflnalnni\corecl Ialrel.c.n,nlr_\rlhnll(,llrndCounr\
<br />ordinanc6 a.d Slar.l-issr.litin! ro huikl ru.rion- el hereh! rh.ru c rcp.dnrirs o f rhis('itr_and Cotrnr!h.nlr qFnthc
<br />abo\c trmrnnled opdly tur
<br />,\l,pli$nt o.,\But Sipn{nrrc to/t,/lz
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation -q-ld.l7"l)Y.VfiA ,qtJ\ /Erl .
<br />Shear Wall
<br />Framing
<br />ln s u lation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />De ut Final Re ort
<br />Engineer Final Report
<br />Flood Zone Certif
<br />/r'.r-\,
<br />FINAL /d-lt-Jl v.vl"I{,t\
<br />Certificate of Occu nc
<br />Noleg, Remarks, Etc7t/
<br />Roof Sheathino
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