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BUILDING- INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG COMMENTS oWNFJR BUII,DER DELCARATloN
<br />I hcdb, rmrd undcrycnrky or |).rjMy rh,r I nn .tcnrpl ilanr lhc C.nri.lo6 Liccn* l,,s rq rhr r,nhqing rcnstr (Ss.7011.5
<br />Btrsncss a*l Pr.tcssiotr CdcJ Any Ciry o, Counly *hich rcquirc\ r p.rmir k, con{ru.r. rlr.r. improvc. lkNlhn or {nr r inl
<br />nruclurc. |nior ro ils hsuancc- ako rcquircs rhc applicanr forsuch frrmir o fiLd si!trcd earcmnr rh0r heot shc h li.cn\cd PUBU,nr
<br />b lhc pmvNnff .f ilt Contncktr\ Liccnrd tnw lchnplcr 9. Comnrrcing wirh Sc.rn ?fin ol Division I ot rhc Bu\incs lnd
<br />Poltsions Codc ) or th.r lE or shc Gcxcmpl thcrcli.'nund lhcbosir ntrrhc tllcgcdcxcm iotr AnyvioltrriotrofSNrtnrTl).115byrny
<br />rrplicrnrt)ra Dcnnir suhj(hrhc arplic,ni ro acivilpcnalrtornor nxmrh,n iivc hundrcd dollan ls5m)
<br />l. a\ own.rofrhc pn,|rdy. or myenpn,yccs wirh wagcs rhctr c,lccotrrDctrliriotr. willdo rhc *ort trnd rhc $unrrc n Nr
<br />idcfthit oroflc.cd tu qlc(Sc.7(!4. Buim$lnn ftoic\sions ('odc:1hc Cl rd.rolsLEneLjwdo.s.orarPIyhr.otrtrcrol
<br />rhcrr,trdy uho buikk or nqrovcs rhcrn- ud wkl doc\ \uch wt,k hi' \clforhcrsclf.rthoughhi\orhcro*nc lt)hyc.\.
<br />prcvidcd rhrr skh inJrdrmnh m .or i, cnd.d o. ofi.rcd for !d. ll. ho$crcr, rhc buikli',8 or i'nfnNt'mnr is sold s irhin onc
<br />'cirrlonrhridl ilEo*trd Buiucr will h.vc rtE burdcn oilrft,vin8 rh,r hc or nrc dil n tlild .r trhpr.tt lhc pmF{, tor rhc purlnB nl
<br />l. Noamrollh! UiiJrny. anrcxclNivcly cofircr ll,lcrr rS..')l)l.l 11u!nc\
<br />ad lh,rs\i C(trI. Thc Coiticktr s Li.cnr. L.w
<br />and who onrNrs for such trcj$ls q irh a conh
<br />) hrrld\r' trnDflr.\ rh.rcn'.
<br />;'":w tr
<br />I h.n hy xlllrf, trtrtl.r Brrlry.l t)uirtryotrd ollh. nn o\ int,l..lrnr($
<br />-l
<br />hxvc urlNill rnrinrrin rCcnili.i.ofC.n\rtrr k,S.lllr$rc fttrsorkcn conrpcnsllion- a\ px,vidcdforbyScclnrlTl)Ooilh.
<br />L{l'or C*lc. lor lnc pcrfonrn.c .l rhc sort (n shich rhc pcnir n kxcd
<br />I harrrM will r tr . ir *ork$\' compcnsnr iinr insu.arcc. N rcquirud b,Sccrion l7mof rhc Lzbor (-odc. iot rhc l.rfonu'rc of
<br />rnc$dkntrwhichrhntEnniri\is{,cdMysorkcnconpcnsrrii)nnNuran.c.rtricrtrrdlbltrnumhcrsc,
<br />-l.cnilyrhrr
<br />in thc pcrn)inDRtofrhc *ork lar whirh rhi\ ncnni n i!$.d. t {hrll nor cnrflo,x v |f,rsof n: aiy.rtrnc'
<br />v, rsk, bccln c suhjc.r t)rhc *.rkcr\.onDctrldnr hws.leilitrnir. xlrtrccrl rifl\h.uklhd. r srhlar rorlE
<br />trorkc'\ (nnt{tr\xrtr{ pn,r \irin\ "l Seeri,{:t7lx,!l rhc lrt(tr (
<br />WARNIN(;: l.ril,tr. nr \o.ur. wnrkr'\ o t{ \iritri .,)vrrxlc
<br />.o rIly \rirh'h.rp0visinn\
<br />I suncd rn cmlloycr h crintinrllrnillics rtril
<br />**
<br />.l con,J,.trrxri,u. ,hnrxgc\ tr\ t,oLi,lcd lnr 1[r
<br /><)
<br />I hcnhy rrltm utrdcr tcndry of pcljurr lnol I m liccn{t undcr povision or Chaprr 9 (o nturcin8 wirh S..lion 7(xxD or r )ieilini l
<br />or rhc Bu\incssa ,, Pnnassiors Cod...d mv ltcnr is in tullturennd.lncr
<br />qJNEIA]]SJANIENDINC.AGINr.Y
<br />I hcrcn, alli uidcr p.trilry ofFrjury rh th.rcn.connrudionlc.din8ascft,iorrhcp.rtumratuc.rrhcworkl'ortrhichrhi\IEflnilir
<br />i\{'c(llS.. .ro97. ( ir {' I
<br />lccnil'_vlh rlrc lcdcrnlrcsul l \rlrr. m( xtltlnrllc () rh^ t)niIer
<br />l('ilfv rhrr I hrkrci rhi\ a
<br />onli'irm.\ rnd Srrr. l. {\ rulnri'rg I
<br />rtxtrc tr'ctrli{,r,| ror.n} lbr insp.r
<br />AU,licnnl r Axcnl Sisniltr
<br />I,ernrilc€ ntrnr I prinl)l
<br />'{\L a 10
<br />;::': I itr"I;:t1l ;J'(':1,:,'i1:fl :::H" ", ^,.n\?xl n
<br />. Y\eqgt^,dfi-
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsu lation
<br />Roof Sheathing 8[1,tB ./,<alrr?fuko ,o"u
<br />^af a pit ( t4t P,o)
<br />Shear Wall Do *of lt4.
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/aso nry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 4 flb-vt ldD-
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Yq'// z
<br />ult(]il]\l.!!)!
<br />I iL!tr\c Clnss
<br />-Li..n\c
<br />Nurh.r
<br />Dnre: conlr"cior
<br />APPLICANT DT'CLAR TI(IN
<br />I ltE6, afim lndcr rcnalry or!.rjrry onc.rrhc a.lnrwint dc.lanrn,ns:
<br />Dcn$lition Pc nih-Asbc(os Norific.rion ltder!l Rcstrlariors ('l'irlc 40. P,dO
<br />-Rcquircd
<br />llncr ol' Norilicxrion
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