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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS o}VN ER BU II,D'R DEL('ARA TloN
<br />I hq.by am.m u.d6 p€nahy ol p..jury lhai I an crc,nrl lrcm ihc Co r.clo6 Lic.M l nN for lhc nn[Nins r.a$n !S{ 70.1 1 .5
<br />Businds Md ProlBnon Code): Any Cry or C.unry {hich r.aun6 a pEni lo .otuirurr, ahd, ina(vq d.nolnh .r rLp'i, anr
<br />struclrc. prior to ns isud.c. abo r.rlui6 rhc appli.d f.r su.hFmn ro fil. a sirn€d st.t.md thol hcorsh. is licens.d prmanr
<br />tr lh. provisions oirh. Cont.cru's t.iccn*d I aN lChapr( 9. Co'nm.ncing rirh S.dinn 70rn of Onilion 1 of rhe Busin.s .nd
<br />Prclcsions Cod.)or thal hcorsh. is cxcmpt rhcr.6om dd rh. hnjt for th. dllq.d.xmplion Any \lolation ofScclion 7011.5 bvany
<br />,!pl,.ant for!p.m subl(Brhc apphclnrto acivilpcnahyoan.l mor€lhm fiv.hundrcd dollrs(5t00)
<br />L ds .wnr orlhc Inrp.ny. or nry .nrploy6 sirh \vatB s lhcir sle conllBMr ion. q d,rrhc\rortedrh.nruclu.snor
<br />inradcd or ofid.n ror sl. (s& 7044. Busin*r and Proldsions Cdc Thc Codrador's Li..nk lrs do6 nor applt r. .n o(n.r oi
<br />rh.Imptiy s,ho hqilds.r n{rv6lhs(n. drehodGsuchrorlhi,ns€lforh6dlorlhroughhhorhsoNT.npk,tc.s,
<br />nro\ i.lcd lhd such nnrovffnrs s. no' inlfld€d or oildd nn eE Ie hos66. fie hrildinr o. impo o'or is mllj \rihin of,c )er
<br />ofcon ldion. rh. (nvnd Buildd will hart rh. lnrdft ofr6\ is rha h. or sh. dij n.r build .r iqro!. fi. tmpdy aor rh. puqb* of
<br />l. 6 ovne of lhe lnopd]. m.i.lusiv.ly.ont tinr*nhh.os.d({ md.h r. .oBrrud rhc prerd (ss 7cr.l1.ltusins.id h.La\on Code rheCont l(n s, ic.nsc l.s!vdos not appl)- to ano*,n6ofpropenrsho huilds or imptuvarhsdii.
<br />and *ho conlracts for strcn ltrojets $irh a ('onta.kJds) li.oscd ru6u,nr k] rh€ (-ontr.crors l,!.cns.l-atr)
<br />I ame\eorpl undcr Seclion , B & PC rorlhis r..sn
<br />l!!.8\!Bl1!flIE!.!!-l!A-L
<br />Dt,t( t,aR,rtlo:"
<br />I lrcrcby amnn undd Fnrl(t .l ldNd on. ol rh. lnll(*\ mS d.\lihhon\
<br />I ha\! dd $ ll mamhin a Cdilicat€ of Consdllo S€li- lnsurc for *!rk6i compqsalFn. s pro\ idei lo. h] s(hon 1700 ol ihc
<br />l{bor (ndc. fo! lh. pqfomanc. oflhe No lorwhichth.ptmn is isu.d
<br />I harcand*ill mtimam \eorkEi.ompcnsahoi insuranc..6 reqnn.d bySsrion3700ofrh.l-,h.rCodq aorrh.Flome..ol
<br />rhc \ork aor which rh6 p.nnn L isual My s o.kd .omDdern'n imure.. .Mid dd Flicy 6umbd d.:
<br />c"-., {r,4+.,-J Co5'1 -rr^i.
<br />o"r"'",.t. 'lb OEAQI4SIIF n*n* S. \. \e.
<br />I clniryrhal inthcp(formanccofthewort for qhichthis p6'nt is issEd- I shau not mployanyp€6on in anymanns
<br />$ a ro h.om. sulj.r ro rh. s.rk6' com!.nqion la*s orcaliromia. dd a{ft rh{ ,a l should lE om. rubjd ro rh.
<br />$orLm conpasriontmvisions ofserion:r700 ofrh.Irtbr Co&,I shall, lodhsnh.omply $irh lho* porisi..s
<br />W RNINC failur.lo surc yo*6 comp€ns.tio. cor.rarc is unlawfll. and sholl subjd an mploytr lo .nmml rFalr6 and
<br />civil fin6 up to onc hundrcd thousand dolla ($100.000). in.ddition to lhc cosl ofcomp€nsation. dlmas6 as prcridcd rnr rhc
<br />Srhon 11076 of rh.lxtrr C.d. inrdd.nd droftv i ld
<br />,ll ti;
<br />I hscby afinn und6 p.nallyolpsjurylh.l I am licenscd und6 prorision olchapls I (commcncin! \ilh Scclsn 7000) oiDivisnrn l
<br />ol lhc lrusinNand ProassionsCodc. a.d nry licos. is h full for.. a .iIrr
<br />a twcv
<br />'ffiAtl* --u+,J l-
<br />CA.NSIAUCI.I()N.LEIDUC-AGENCY
<br />I h6by aftrm und.r D.nlxy oa pcrjury rhar rhdc ii r co.slrucrrn lidins ag6cy lor rh. pdfomd.. . f rh. $ ork lor s'hi.h rhis Fmn L1
<br />issu€d (S(.l097. Civ C ).
<br />AIILI(IITLDICIABAIIAN
<br />I hdrb, amnnundd t6a1r, olpfjui, o,. ollhc follo*ins ddldar n3
<br />D.hol'rion Pqnis^sb6rosNolincarion Fcdral Resularions(l'irlc.l0. Pan6)
<br />Rcqurcd lnlqor Nolifi calion
<br />I c6liD thor th. t dfrl rcEuldioN r.ardinS arbGros rohoval . nor appli.abl. ro rhis pmjd
<br />B(1-,t ,n, , t' . ,*u
<br />'
<br />n* anphcauon ud $i,. , hd rhe aboL c inronnarion is cotr.cr r asrE ro cotr,pry s.nh arr ciry and (i unry
<br />(ndinanc6an,jSrarcI!trsElanngrnhuildin!coElrudinn. d h6c!l Nrhorizc EF6olarn6 olrhis C y ud Counry r. dro uBrn rhc
<br />alrv. mcnriorcd p.op€ny lor insp€.rion
<br />lpt,li.N ( o' ,lscnl Sisndur ?11
<br />Qr".',:c-l f,"i-<^
<br />il,/r*i OJ
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing --4 ,/ig 9-'>p trjy 7t(
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />FINAL q9 lrs \ iE qfrfl€x
<br />Certificate of Occu pancy
<br />lVasonrV
<br />T-Bar
<br />Notes, Remarks, Etc.
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