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BUILDING- INSPECTOR RECOBD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BTIII,DER DEI,CARATIoN
<br />I herchy alfinn udcr p.nalry in Frju.y rhnr I d cicmpr fn,nr rhc Conra.tus' Li.c.{ tjw ior lh. follosin8 rclstr (S(.1r.rl 5
<br />ansinc\s and Pr6rc$i(in Codc): Any Ciry or Cruirt shi.h roquirci r lf,nnir to .otr{dd. rllc.. irlf.ove. dcmltn o! rpan ony
<br />{ru.rurc. prior r) irs nsunncc. aho rcquircs
<br />'h.
<br />amli.n.( ror \uchFirnn ro filca siSncd srireorcnl rhlr hc6!rh. t lic.nicJ turuani
<br />lo rhc pnvhions oi rnc ConrEcrols l.i.enEd tiw lcnaplcr g, Comfrctu'ii8 wirh sc.rion 7u)o ol Divni(r :l oi rhc Busincs and
<br />Pn)f.snn* Codc)orrh.r h.orshc iscxctrrf rhcrcho rard rhc &rns tu lhc rllc3cd cxcnrplion Anyviobrn,nofsc.rn T0ll5by.ny
<br />rDplicrnt lor o Fnnil suhjc.h lhc l|Dlicant lo!civilNnaltyofnol nuc rhu fivc hundrd d.llaml$5u)4a-
<br />,9.r\',*trcrolrhcF,ncd)..rn'ycn'fn)cc\whwr8c\3slhcirsolccoinpcn\dnnr,hlldolh.wo*idilriMrEirnor
<br />i0rcn Ld oroficrcd f{r {lc (Sm 7OJ4. Bu\iics\.nd Pn,f.r\n'is Codc Th.Conrncrois,-iccn\cl-,*d€rnordP,llyb!n.wNrol
<br />0r Fn'tMy wk' tdilds or imrr)rcs lhcfr,n. sxl sho d{rs su(h so hnns.lforhc6clfo!rhDughhhorhcrosncnlPluytcs,
<br />pmridcd rhrr such inrpnmnr.rr m , iircnLd n oficr.{ r(, slc. lr. howcvcr. rhc huildnr8 or impmtmnl is sld sirhin om ,u
<br />or.o.!,hlion. rh. OwE auiBcr *illhaw rlf budmoffmvirS rhd hc or shc dnl not huild or inu,ovc rhc pn,Fny tu ft. puqb$ or
<br />-r.
<br />r{owncr.ilnc |r,pcny. !ncrlusivclyconlncri'rs wirn iic.n\cd contrctn t,.uinturr rh poiccr (Scc. ?(]'ll. Bu.inc*
<br />rnd Pn,fc$in Codc: Th. clnnrnctr'! Liccn\. Lrw d(B mr apr ly ro m ou ncr ol p!'|rn y sh buil,hor nnpov.srh.r.on.
<br />u d wlb .onrmclr ld such t'nilccls qirh r c(, mcro(r liLrnsci Du6u nr ro rhc Co uktr\ t-i..n{ t-rw )
<br />Ihcr.hy Jlirnun cr DcNlry olp.rturyon. oirhc f{nkiqi
<br />-l
<br />harc ml Nill minrain a CcnilEure of Con*nr ro Scli l.\trrc ft, sork.rs {Npctrs,tio., rs providcd tu by Sccrid .17(x) ol rh.
<br />tjh.r a'odc. rbr thc pcrlbrmhcc ofihc $ork lor qhiih rhc ndn n hsued.
<br />_l hrvc itrd will mlinrain worlcF compcnsrri{'n i'runicc. tr! r.qurdd b! scdn,n.l7(ro oflhc L!ho. C{nlc. i,n rrf, |trtuntu,tc or
<br />itu *ork li)r whichrhi\ lcrnir is hsucd My*orkcr: (o'np.n\di.tr nsnrrrcccffiicr ( r,licynun,ncrrc
<br />PolicyNumhcr:-
<br />*irE niryrhr in rh. Nrronflncc or rhc wor* rd {hi.h rhis p.rnrir k issucd.l snallnol cmnloyany pcs.n in.ny.k.ncr
<br />s, s'o hcconE rublNr to thc *ortc6 c.nDcnsutio. laqs oiCllilornii. und,8ft. rhar ill shotrld h...nr suhr.l ro rh.
<br />{orkqs conr!.nsarnnr lmvhn,ns oiSccrion:lTtDolrhc bhn Grdc,I \hrll. tunhwnh.omfly wirh lhos prclhions
<br />RNIN(:: |ril$c h Rrtr'. sork i1rtrl wtul. Md {hull un.{r rn.nllllo)$ rd dinnnrl
<br />k) o . htridrud rlrou\rtrd dollnr\ (lllx).(Xx)r. ir] dirr n, rh. .orr .I ..n,p(tr\rrn,n, drnrgcs
<br />::::w;;ttr *,r .1-)
<br />I hcEhy ofltflrundcr penllryotrc.jurr rhal l.m liccnaaj ldner pmi\n,n or Ch{rLr 9l.onrmncir8 wnn Sdion 7001)) orDivhn,n.l
<br />of rh. ausircss md Pmfcssions Gdc. md nry liccosc is tulllbreo cltccr
<br />CANSIIIEIIONI.IINIIIXG.d{jENCI
<br />I hcEby nmfln un,lcr Ilcillry l p..jury rhil rhcrc i\ a { sltodi(i lcndin8 ,cctr.y ror thc rcnonrEmc ol lhc wort lor *hich rhn |rmr n
<br />issucd (Scc.1097.Civ C ).
<br />tJ "lc''. NJr.
<br />AITIICAITDICLAAAUON
<br />I hcrchy dlinn un.ler rnalryolFrju,, oN or drc fdlouins dNluarn n\
<br />otnkrnion Pcnnirs A\hc(os Norificlrion lrdcral Rcgultri,,n( ('l irl.4)- P r6)
<br />Rc!un n lxrlcrol Norilicari,,n
<br />Icc ifyrhrrrhcl.dcrrlrrAtrlrtrn\r!d'di'igashDi,'s'crrxlxr.forrt0licnhlcl{rrhi\nn'tcct
<br />fiGiryrh,r I h*".odrhk olplicarionud (rrcrhar hc !b!c irromurnn' hcotr c' I io.r/y qnh rll Ciryanl Counl,
<br />his ciry d d Coxflyro cntcr urr rhcordiMn.cs rnd sr.rc t]Rs rcLrlitrE ro tuiklirE .onsrru.rnrn. rtrd
<br />xhrv. nrrnrirnr.d nr)lrrr\ ktr iN
<br />,\pIli.onl or lg.nt Si8nnn,ru
<br />U""rr"" "-r.,Unr,,K
<br />. OE
<br />YtrFAtl -E1a+.
<br />><c
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Sheathino I ?//r//P ,in*zr+/6>,
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\rlaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />I,ilulfrTt 2v
<br />Certificate ol Occu n
<br />Notes, Remarks, Etc
<br />+
<br />Dore ' O
<br />a,
<br />'i. '
<br />Liccnsc chss:-Li.cnr. Nunrrr:
<br />Drt. C:onlmclor:
<br />Set Backs
<br />Flood Zone Certil.
<br />FINAL
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