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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />sRoof Sheathin tut\61 Gev.L 1*ts k"*,.-
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />De puty Final Report
<br />Engineer Final Report
<br />I
<br />I ,
<br />FINAL 4/tr/ly I
<br />Certificate ol Occu an
<br />Notes, Remarks, Etc
<br />OWNER BTIII,DER DELCAR IloN
<br />I hft.byafir undcr r.nahy.f p.rjury rhdr I d crcmpr lio rhc C.nkr.ros l-iccisc tle fM rlr folk,w,ng rcason (Se70ll.5
<br />Businc$ ind Prolcssiotr Codc) Ant Ciry or Orunr! shi.h roquncs a Fanir Io connrucl. rllcr. improvc. dcmohh or rcFn !try
<br />srtucru.c. rior ro irs n\uancc- aho rcqutcs thc opplicmr lorsuctIrrmit ro [hu si8rcd shlcftnr rhlr heo, shc n I.cnr.al llsu,nr
<br />ro rhc rnvkio,Ls orltE Conracrors Li.c.rd tjw lclqrrcr L ConDrncinS wirh Scclnrn 7sD ol Divnion 3 oI rhc Businc$ ond
<br />Polt$ionsCodc)orfi.rhcorshc h cxcmpi lh.rctu)mand rn basis ior lhc allceed crcnrprion Any viol.tion ol Serbn 7Ol I 5 6, uy
<br />anplicanr ln a pcrnit sut'Jcch rhc lprlicanr lo acivilDcnoltyofmr mlc thu fivc huNlrcd dolhs (S5{D)
<br />-1.
<br />!s owner of thc pmticny. o! my cmtbyccs wnh w0e.s m rhcir nnc conrlr.sarion- will do rhc work old lhc nrlr ir
<br />inicnd.d or ofleEd lor slc (sec.7r,4t. Busincsr lml holc$iotrs Cdc: Thc Conrncrors Liccn\c liw docc nor aprly tu M own$ .r
<br />rfu tmFny who builds or inDoB rhcmn. axl wtrr de\ such soik hnns.lfor h.trclior rhmu8h his or hcr owtr.mployccs.
<br />pi(*idcd rhar \uch inDmrmih fr ior i, cnd8l or o,lcrcd n, sE lt lx,*cru, 11* huikling or imptuhnrir h sld r hh onc )qr
<br />oicomnlcrion. rhc Owrcr suildcr willhqve thc tntrdc. ofproving rhnr hc or she dil mr huild or iq,mw lhc IntrPcny for rhc roqn{ or
<br />Lrsos.erofrhcIn)prdy.rrq.lusiv.lyconka.ri'r!wirhli.c.scd.onta.k,^bconnrucrrh.ftulc.r(Sc..70,14.Ausir'c$
<br />aRl Pn)fc$irn Codc: Thc Co.lrlclols Liccnsc trlw do.s not q,,rly ro.nowncr ninnpcny sho builds or impmvr rhcr..n.
<br />,nd vho .dntach for ruch p6l.ch wirh rConr.r.t,h)li..n\cd pu^urtrr iorhcCoftn ror's l,iccnr tjw)
<br />Ir rcrcmfl uIldd sNridr .B &Pc nrrhirrcr\otr
<br />l)alc: O*nc.
<br />rvotxtrtisi Lortnrrs,rrrttx
<br />DICLAAAIION
<br />I hc'rhyrflnhu d..p.nrlryof tf,rjurtoncofrhclolL,tr\trrgdccJ arnns
<br />I hnvc rfilwill rmi.r.i,r rCcnlfi.atcofConsc bSclf-lnsuruforwDrks'compcn{rion.asImvidcdlorbySecrion]70Oofrh.
<br />hlttr Codc. for rh. p&tormaN. of lhc uor* fttr *hich ihc p.rnrir is irsu.d.
<br />-l
<br />hivc ind will mninkir workcn comncnsarl.n nrur.tuc. as rcqutcdhySecri.n:lTu,olrhcljhorCodc.f$rhcrerronM'troI
<br />ihc workt)r whichlhistcnnit is isucn My wor[crs conrFnsrlion in\unncc !_rdcr !i,l B,licytrun$cr dc:
<br />o^", ob lz o /td
<br />Ihcrciy rllnmundcr p.tr.lryollctury rh rhcrcis.conslflcrion hndine agcncy iorrhc pcrfrrarDcc ofrh.work frtr whi.hrhn Fnnn
<br />r!\u.d (s( 1097. ci!. c.)
<br />IITLICANLDEILANAIIOX
<br />I hcNbyrlllnundcr l,ctralry or l].rjMy onc oithc n'lhwirS dc.linriotrs
<br />l)c nniri,,tr Pdnnirs Ash.s.s Nollli.rrnr FcdcrilR.EUlnrloi\ (lirlc,l0. P.tr16)
<br />Rcquircd t-cxcr of Nor[icdiotr
<br />l.cdiryrhr rh.ltJ.rrlrc!xlxri,ias '.tflli'rg r\h((.\r.nxi!xl r. n.rrflr i.$1. n, rhn pnr(r
<br />-l
<br />ccnilirba' lhavcrcad rhh lppLicarnrnud illrcrhar rhcatnvc inlonto io t.oft..r LCra r. coryl, wnh all Cny ind County
<br />orliranccs d Srorc Laws rcl,rins ro huildins connrucrnnl and hc,cbyaubonrc rcpE\cnrdilcs orrhis Ciry e counryto cnrc! upontlE
<br />abrc trEtrrioncd flop.ny for in.|tclion puqrss
<br />^ppu.m,
<br />or As.n, skMrtrF A rydff-
<br />P.mrre Mherprrnu:.-. -..._ '/ --
<br />-,,o\l Z-ol )L
<br />ru'_ir$l
<br />Set Backs
<br />UFER Ground
<br />Flood Zone Certif .
<br />I c.nifyrn ii rh.F foflEnc.orrhc work ror whichrht pcrnn is i\\ocd,I sh.U nor .nplUy ,ny Frsotr itr lnynranrcr
<br />$ s lo hcom subjccr to thc wortsl cohpcnsdirn l.ws ol Glifor.i.. ond asr.c rhnl if I should bcconr rubJc.r io rrt
<br />workcrs conrpcnsarion provhionsofSalion 3?mof lhc tibot Codc.l shall. Io,lhwirh omply wirh rbt pmvhidE.
<br />WARNINC: FailDrc ro su* wortcs .omp.n\art,n FleEsc is unlnstul. a.d sh6ll suhj$r . ploycr ro aiminal ncrulis and
<br />.ivil n.ci up b oE hundrcd lhouend dollm ($loo.(xlo), in rddin ro rh. .on or.omp.nsalion, d0nEBcs as lrovidcd lor rhc
<br />S,\rtr'n.tr)?6urr\r bh C,dc, irrcm{ rnl r tumy'.fm\
<br />,,",ublzo ltz eoor*,.L(1laa.fu
<br />LreENiU, coNTRAc{4R
<br />DEII8AIIO\
<br />I hcrcby afirnrundcr pcnllry oi tcrjury rhlr I om liccna.d unds nm\i\Fn nr'Chrnrcr c (c,,n'mEn! * hsftinn 70(xr) olDivisionl
<br />ol rhc Busirc$.nd ProfcsionsCodc. rnd lnylicctrr n in iull hr.c ardcrrccl
<br />IriJcr\ Addr.{
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