|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILI)ER DELCARATIoN
<br />I hcrrhy alfinn u cr prmlry ,n' I.rjury I hlr l onctnrpi ronr lhc Conk rois Licctr{ Law ror thc followins rqon lscc70.ll5
<br />tlu\incss ud Prntssion C{xl.): Any Ciry or CoL y shich rcqon$ , tf,nnn h .on{n'cl. alrcr. jflprcvc. ded,lkh r rcr'n rn,
<br />{fl.rurc, pri(trro ir\ (iurn.r.oho rcqut s rhc,pll.mr for \uch Frnil ro rilcr sirned srarcmnl rh nfo. sh. i\ li.cnscd luruMr
<br />ro lhc pmvision\ oi the Conrractois l.iccn\.d h* (Chlplcr 9. Commctui'rs airh sc.tnnr 7fix) of Division ] .t rht Busincs and
<br />Proacsi{)nsCodc)orrn hcor\h. isckmpr rhfcrrohnnd rhc hrsir rd dc rllc8cd cxcnltriotr. Any\iohrn,iofsi.rk,n?0,11 5hynny
<br />rpph.rnrr(tr,r.rmirsubjmbth.apnli.rnriorcivill[rltyornorn,c'hantiuhunJreddollr\($5u)
<br />l- rs owncr ol rhc propcny. or mr cnDk,r€cs *irh wuscs !\ rhcir $rc orl).n\arion. *ill do rh. solk 0nd lhc slrrE n tr
<br />i' cndcd .rollcrcd ior slc (SLt TOl4, tluiiic\\ and ttorcrsiis Cdc:'Ihc Co.lr0crois Liccnr l-ou docs ooi lpplr k, &ovncr or
<br />rhc F)t'.dy st(, hilds or inpr.rB rhcN[ and wh, des such w* hin$cllor h.Eclfor rhmu8h hi\ o. h.r osncDplotc.s.
<br />lmvidcd rhrr such i'npmvcmnrs m nor inrcndcd or off.rcd fir salc. Ili ho$.rcr. rh- hildirt or iq,rcvcrrcnr is sold wirhin onc tr r
<br />ol coDulcti{nr. lhc O*rc! Buildo ,ill hrt !h. hnrdcn ol pmving rhrr tr or +c dil mr hoiLl o nFn)rc rhc pmpcay tor rhe porpoq ol
<br />\t- -n*n. ui,t" p'up"ny.,ncrclusilclyc.ita.ri'rs *irn li.cn\.d conkkrors ro con{ru.r lhc fn]ccl (Scc. 7OJ4. Blnn.s
<br />dnd thfs(i Codc: Thc (.nkkr.lr Li.ctrsc Law dN( nol.t'!ly lo 0n owmr ol propcny wio build\ oi nnprolcs rlErcon.
<br />rnd who contmch ntr such Fojcch wirh r Conknct(, liccn\.d nuNuinr u rhc conkftoi s Licctrr L!w)
<br />I hcrchtrlli'mrndcr lrctrtrLryf l ]rurjuyrncrl rhc r,,ll,'*i',g,l.cIrrrintr
<br />-lhuvcutrd$illnminr!tu!Ccni&lrcofc.n*nrxrsclllnsu!.rarwork^.onD.nnion.aslrovidedio,hySs_rionl70oorrhcL$or Codc, lnr lhc p.rfonMrcc ofrhc work rbr *hicn th. pcnnil h h\ucd
<br />rhc sork tu *hi.h lht p.iinil i\ i\sunl Nl) *orkcn con,p!n\rri(in i'ruBtr.(.nricr ud Filicy nunrh.r .rc:
<br />PolicyNumbcr:-
<br />Qc!.sriri rhd o rhd trr foflrfln.c olrh. \ork ntr rvhi.h rhn ltnnir i\ k{u.d. I shxll nor cmploy rny p.r\otr h uy ndnncr
<br />h rsbbc.orE \uhjNr t'rhe workcri .o nrrcnur ion h$sol Crlifornir. rnd l8to{rl ill \houkl hccoaE sh].fl brhc
<br />sorkc^ Rnnpcnsrri.nprtJvisn,nsofS(rn :l7(xl of rh. I-ntrr C,xlc. I rhrll. Lnhsirh coq)ly q'irh rho\c l)nr i\nrN
<br />Wr\RNING l'diluru to surc workcn' conDcnrdion ovrroB.ic.r nn cDploycr ro dminal penrhis and
<br />.ivil fircstr,)Iootrchu lrcd rhou\rnd dollrrs rsllxl.(lD). in id tr n, rl'...{ ol ft rr).n\nr.f iitrnA!\ r\ n(\ (ldd ftr rhr
<br />Scdnr 3l)76 of rhc Lrhtr Onlc. i' cr( rnd xrkrhy r ltc\
<br />I h.'.hy r,lnr rDrl.r |rr lrr_,'r t)drttr t rhxr I rnr li..dwl trJ., t,',1 isi( oiCl[nrcr I (cnDnmocira *irh Sccrim 7(XX)).fDivisi( l
<br />(IONSTRT](:T(TN I ENI)IN(i AGENCY
<br />I hcrby nflrn un'l$,xtulryol Jrrjuy thar rhcrc i\ i con(rudn,n bndilrg rE. .y ror rhc Filarntrn.c ofrhc sork io. *hi.h rhn pcnnir n
<br />n\urd (Sc. 1097. Civ C )
<br />AIIUCANLIECLIEAIION
<br />I h.rcby oninn undcr rEnalry oI ncrju.y ore ofrhe lollo$inF d(hrxrn,ni
<br />D.mlirion P.rmirs^sb.rlos Nolificnlb. lidcr.l Rqullrio.s (Tilt,r0. Pan6)
<br />_Rcq!icd lxncr of M,lifi .dk,n
<br />I.cnrlirh rhc fcdcr.lrcsul0liotrs rc! rlirg x\h.no\ rcNivrl r'. noi lpl'.ihl.rorhr\t'mtccr.
<br />ntrd (rrcrhxr rhcrb\c nlortrr ior i\.or..r lr8ren).onlrt(ih llCnyrftlCounly
<br />,nsruclotr,.nd hcrchy.ulioizc rcnrcscnrarivcs oflhisCiry d coxnrv ro cnrcr upon th.
<br />/\|)|)li.inl or Aacnl SInalure
<br />r'"""ir".r-,"tp;,,rr, {Zff 9d
<br />,.,. sfu{,"
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venti lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u lation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif
<br />FINAL t--7- tq ../)a{e-t-E )
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />fl$e
<br />of rhc Busincss lnn PmtsionsCodc. and nryli(cnsc n ir tull nn.c anl clfc.r
<br />l-ncn{ C r$ l-(rn.c Nnorl\1
<br />Ir. .
<br />Ic J,," JJ,. r
<br />=
<br />I
|