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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathi ng Pla)-
<br />Shear Wall A
<br />sFramin l-J-t1 V)LtA
<br />lnsulation/Energy t- l5-11 CelL/b.6. '
<br />Drywall PP4f
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />uty Final Report
<br />Engineer Final Report
<br />FINAL G*z-o-t\X^WL
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />I-J-llr Hlzrz-[0ry- q=,4
<br />-ld-t1 i 0 t,JA{,4- lel A.O P t/)l,lJ ,v
<br />.J
<br />OWNER BUIL'ER DELCARATION
<br />I hceby altm lddd p.ndry of Fjury lh, I m cxdnpr Fon lh€ Co radoa Liccnsc L.w for rhc lollowi.s rcMn (Sd 7011 5 .
<br />Business and Prol6sion Code): An, ( ily or couly which requiE a psnn ro coinru.t. alr6. imp,o!r, donoliih or (pntr dy
<br />studu( rior lo its issuucc. sls. rcqunB th. applicmt for sucn Ff,nn b fii. . siSncd st,ldd lh.l h. or slE i, licdsJ p6umt
<br />ro rh€ prorisio.s ofth. Conrrrclois Lic.n$d bw (Chafler 9, Cohn..cios wih S6tion 7000 of Division I oflhc B8in.s dd'
<br />Pror*i.ns Codc) or lhat h. or sh. is cr.mpi lhscfto,n md rh. b6is aor rhc alLgcd .rmption. An, rioLrion of Sdion 701 I 5 by y
<br />appli.anr loi a r...il subjsls rlE applicanlloacililpcnaltyol.ormorelhmfiv.hun&.ddollm(!500).
<br />_1. 6 oMq ofrhc FoFrly, or my mployd wilh wag6 6 fiet ele codF.!dio..
<br />"iU
<br />do fic "ort ai rh. ende i! nol
<br />nnodad or olldcd tor elc (Sc 7044. Bsin6 d PmlsioG Cod. Tt. Conlrocld\ Lic@ t w (l)8 not apply ro e o*rd of
<br />lhc Frp.ny qh. hilds o. impro!6 $6-.. 6rd vho db6 sh w* hirucla or h@lf or rhrcugh hh or h< oM dployG,
<br />prcvid.d rhar su.h inl,o{deftercr i,[qd.dorotra.d loret. li tow6. rh. hiUins or irptDr,6.r'r is eB vnhh oN )@
<br />ofconphbn th.ol d Auilta will lErc tlE htrd6 ofFtrvi.e !h, t orsn€ did nor hrildor ibFo\r th. F.F{y forthc Fnlosof
<br />-1.
<br />ao*ndof thc tropgry, oncxcllsiv€lyodraclin8 wilh licd.d codrdos ro odrud rh. pmi..1(Se. 1041. A6ir6
<br />aod t}trftsion Cod.r Tfi.Contrcroa! Li..6. Law do6.or applyro d osnd oapop.n, who buil& o. idprovG rhdon.,nd *ho contrers lorsuch Irojcds wnh a Conlado(s) lictr.d prB@r lo rh. Corrractoas LiccN t,w).
<br />_l d.xcnpr od6 Scrion_. B. & P.C. for rnis r6on
<br />Drl€: Onn.r:
<br />.rlaKEalt(orlEErs^IlQ!
<br />D!C!A-E{!jA!
<br />I ltrb! drlnDr utrder rctrallyolrqrulyone ollhc lollo\yinr dn..laalioN
<br />_lhavcdd\yillmainiain0Ccnilicar€oacomfllrosell-laur.aorMrk€rs'conrp.nlarion.alovid.dforhySarionlT00oarh.
<br />I nbor Codc, lor lhc pdlommcc ofrh. wort aor snich nrc lsnn ! isu.d
<br />I halc atul *ill mainrain wo ers' cod!.Eaion i6uraoc€.6 ,.quired by S€dion 1700 ohhc l-abo, Cod.. fu rhe p6,imdc€ of
<br />lhc wo.k aor whi.h rhi. t€nnn is ir$q1 My wortdi conposal,on iBurecc.di6 dnd loli.y nunbd a.:
<br />1'are T<.<ttp
<br />tlLl a s q - 7-o\S -ol -2,o
<br />I cdiay lhat in fi. Ffoll@.c olrhc wort lor which rhis p6hn ir nsu.( I shall nor dploy &y ps$n in dy @rd
<br />$ a lo bcod. suhict to lh. {0*6' onpdsarion las ofc.lifomi& ed aaE th.l ia l slbuld baom. sobjdl lo th.
<br />wor[6 coop.tualion ploviliore otsElion 3700 oflh. titor Code I slBll. lontwith comply with tbos pmlisions.
<br />l,vARNlNC: Ir.ilur. ro ss. wort6' omp€Mion .ov6ag. n dbwtuL ed shal subjd d dplorq to dinin Fd'i6 and
<br />.ivil fioB up to oE hundrcd lhousd dollm (1100.000). in addilion b ln cos ot compastioD. d,mg6 s provid.d for th.
<br />S<t'on 30"6 ol rh. Llbor Co.le mr6d Md stlomey's f€
<br />tt-1t51.*14 ,.t< J*to To'c
<br />ucrft!o_caNr&!!]4-B
<br />Dr.r't \R,l r toN
<br />I n.rcbt eftm undd p.nahy ol pojury lh6l I m liccns€d und6 provision olchaplq 9 (conrmdcins wnh S€cli{ 7000) of Division 3
<br />ol lh€ Buins d PotsioB Codc. ed my licd. is in full forc. md .iId.
<br />1e214$wlo lo-o 1c1.,."",,^",", * Auut l^__
<br />CO!fl4!CIIO}LTEN!I!C.ACINC.Y
<br />I hs.by amnn und6 pcnalty ol psjury lhal thrc is . co.sltu tion knding aedcy lor thc Ffomanc. olrhc \orl tor shich thir psrnn is
<br />hsucd (Sa.1097. Civ. C.).
<br />AEITICA.NfDICLAAAIION
<br />I @y amm unds peoalty oI Frjury one oa lhe follo$ i.B delear ions:
<br />D.rDohion Pamirs-Asbdos Notificario. F.ndal R.subtnJns (Tnle 40. Pd6)
<br />-Requi.d
<br />t rtrorNoinc.tion
<br />I cdily lhrt rh. Iinqd r€EulsrioB r€sEdins sb6tos rmolal e ror applicabl€ lo lhie p.oj<l.
<br />ql Glia, lhar I h.!. rqd fii5 appliorio. ed $,t. iha tn€ abov. i.tornaion n cord. I Eg,d ro corply wnh ![ Cny dd Coum,
<br />ordinancB dd Star. b$ r.lating ro buildioe .oturrudio.. &d hd.by aurhortc r9i*naliv6 o I tht Ciry dd Cou.t, lo o16 upon rhc
<br />abo!. maniorcd p6pdy for iBp.crio. purpos6
<br /> Dplicant or Agctrl Signrlure *," r ('r- f tt
<br />Aq
<br />'b
<br />I- arl
<br />Subfloor/VenUlnsulation
<br />k"l!-M
<br />Flood Zone Certif.
<br />"v
<br />I:15-N
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