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BUILDING- INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.OWNIiR BUILDER DEI,CARATTON
<br />I hcrchy rlfifln undcr pcnalry (,r t.iury ihd t on crcflrDr lonr rhc C.nti.ron Liccn{ Lrs ror rhc rollowins rcrs,n (sc..70.11.5
<br />Busir.ss !ftj Pn,rc*n,n cod.l: Any Cily or Counry shrh rcquncs a pcrmir t, .dtrntucl alter. inrp'ov. d.nnrhh o! rcplit rnv
<br />d .ru'r, ri(rrD irs issu0ncc, uho rcrluir.s rhc,ptlicml lor such Pcrmn b iba siSncd naltEnr rhar h.or shc h li.cnscd Nrsu0trl
<br />lo rhc lmrisions.t rri Conr0clols Liccnsd llw (Ch,prcr 9. Co'nmencinE wirh s..ttun ?oft of Dirin,i I oflhc Busincss and
<br />Pmae$nn* Codc) or lhd hc or she is ercnlpr rhdelbn.nd rhc b€sis lor rhc allcgc{t crcflrPrion An}vih(n,nofScdi,n70ll5by,ny
<br />nfrli.,Dr Itr 0 pcnir sufickrhc 4pli..n o acivilpcnrlly,lnor nrmrhrtr live hundrcddolla* (5500).
<br />-1.
<br />N owncrorrhc pmFrly, (r nry c,ht,lort l Nil[ e08cs ar lhen sE c.mpcns0rion. *ill do rhc wdk dtd thc sltrrw i\
<br />im..d.n or ollcrcd lor ek ( Sd 701.1. Busines $d ftofesion\ C{xi. Thc Cotrlru.roi\ Liens tjw docs nor lpplv ro m owmt of
<br />rhc pmF ry who builds or iftporcs rhcrNn. rnd who des su.h sol{ hlm\.ll oi hcr*lf or rhnugn hn or her owtr ctnPnryccs.
<br />plovacd rn r \!ch iryro\t nB e nn i cMcn ot ollcfti r'or elt. la bscr. lhc buillih8 or iqnovcmnr is hld sirhi" onc )ttr
<br />.r.uqhrbn, lbc Owner Buiklcr will haw rrE tdtdcn ol pmviq lhd h. or sh. did nor bui&l ot i.,pt,R rhc tolEnv fo, rh. FUiFM or
<br />-1,
<br />us owncr Drrhc proFny. imcrclusivclyconr,eti[g eirh liccnsd conlrrct'^ k, conslrucl lhc nojccr (sc. 7tr'14. tlu\i"cs
<br />d Pnfssirn Codc: 'fhc Contr.roar Li.cnsc L.w dms nor lptlr ro rtr owncr olproPcn, wh{, builds or imprcvcs rhcr.on.
<br />$d *ho conkach ror ruch l)oiccls snh s Contmtu(s) li.cn*d Puru! b rhc Cont0croi s Liccn{ llwr'
<br />-l
<br />rmexcnrDr undcrs..rio.-. B & P.C lbrrhi\ rcr\m
<br />tlal€ O{n€r
<br />woRx[Rs' Lo lPonisar(!N
<br />DICI.AB{IION
<br />I hcrcby nrfinn undf F_nohyofrcduryonc orrhc rolbqnrS tlcclffrri{,ns:
<br />-l
<br />hlrc nnd will tuinr.in ! CcniliQrc of C.n\cnr ro Scli.lNUrc lor worlcr' dn$cnsdion. os pmvidcd for bY Serion :171D or rhc
<br />tibor Codc. firrhc Frrormncc of lhc work lor ahich rhc rcnnir is issucd.
<br />rh. work ror ahah rhh Dcnnil i\ isluL{ Myw.rkcK'cr i.f iNuratr.r. ricr rxl Ix)licy nrnihcr dc
<br />I ccairilhal rhc Fr,nnndn.c olthc work tlt shi.h rhn Fnnil is is\ucd.I \hrll norcn{l.v rnv pcrson
<br />'n
<br />rn} nrnnc.
<br />$ J\t, hon! ruhE.r ki rhc qorkcrs co'np. \dn r lnws.lcdlihrriJ. xlxlnlt hl( ill should ttconf, subjNl lo rlE
<br />s1trk6 .o lltrn\diotr 0rornionr of Scdtun l7m of rhc bh, (ixlc. I \lx'll. fonhwirh cnmply * irh ih){ povNnrn\
<br />WALNINC Iiinrc x, EC rd *urkcd.o.ltro\uri,,n co gc h trtrl.wnl- md shrll \uhF.r an cnPloycr lo dnninrl lcnrltics ond
<br />.iril fincs up ro om huid,a{ rhous trd dollir (3100.i. addirio. h the co( of.oop.ns.tiotr. &escs n{ lrovidcd to. rtE
<br />Sc.r( lo76.lrhd I rIxtr(inl.. 'nrcr.q rklinorAplte
<br />DES,AAAITON
<br />I hcdy afllrn undcr lcnohy oi pcrjfiy rhar l.m li(n*.d undcr Pmvhi.n ofchiprcr 9 (comnrn.ine lirh ssrion 7(xI)) orD'vi\i'n l
<br />or
<br />'hc
<br />Ermss&rfcs ions Codc. aid ny lic.nc B in lull forcc ord c[.cr
<br />e C
<br />CANIIBIJ:IIONIDIiD.ING.IAENCI
<br />I hcrchy dflnn und.r lEMllyol pcrjury rlN rhcrc k ! conshcri)n lcndi B iScncr li)r ihc P.rrannrN. otrhc srrk nn which rht ncflnil ir
<br />i\sucdlsc. :1097. Civ C.)
<br />Lrnds 1 Atldr.*
<br />AITUCANLDECI,AM.IIO!
<br />I l!rcby nlnn undcr rcn0lry olprrju!, om orrhc r(rlownr8 d.llnrtrli(,n\
<br />Dcm)lirion P.rmirs sbc(os Noliicltion FddcrrlRcgularions (lirlc.10- Pnn6)
<br />Rcqxn d krrcrof Norilicari,n
<br />l.cnilirhrrl hn\c tud rhi\ r i,nr !ftln rrlhI rh.itr,vc irnirmali( i\ronc.r.I l3ren)conrply{irh rll(iryand C.unry
<br />ildins condtucrio..,i hcrchyrurhort! rq,rc\cnurivcs.lrht Ciry ntul counrvu ctrrcr uF,n rlEdiili'xnrcs strd Starc Ii*r rcl.lin! ro
<br />xlbvr rcilidrd flol[nylar i'l
<br />ADDli.nnl or A8cnl Signolu
<br />Irennile nrnE(prinl)l
<br />*7tE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framincl B.P{l4l
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />1-fi-t{
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Erection Pads
<br />x-x-tr
<br />/A
<br />FINAL k-\4.ru
<br />I ccnililhallttr rcdcful .cgularions rcSardirs !\h.{os r n,v,l c nolrPPlicrblcro rhislmicl
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