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BUILDING- INSPECTOA RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNDII DU ILDER DELCA I{A'T'!oN
<br />lhcrchytrltunundcri)cnrllyofrrjwyrharlanrcxcnDlfroflrrhcContr,.ktrrLiccnrcliwforthciollosinsrcdrn(Scc70lll5.
<br />Bu\inr$ Jnd Protc$i.n Code) AnyCiryorCi trry whi.h rcqrnct r pcnnil ro.otrdnd,.lrcr. irProvc. dcnDl$h rtr Elt'n rn)
<br />ntucruc, priJr ro ir\ nsuamc, aho (_quncs rh. llpltMr l'o. !u(h ttln,ir ki filD n sigrcd slnlcm.r rhrr h. or shc i\ lic.n{,| fr{ n ' I
<br />ro rhc pn,vi\n,ns ol rhc Co kaci{tr \ I-i$trscd lrw (Chalrcr 9. CotrmrncinA uirh Sccrion lfiX) oI Division :1 ofrhr tlhrn+s xn,l ,i
<br />ProlassiotrsCodc)orihnrlLorshcircrcnUrhcrcii.m0MthchAi\lorrhc!lLc8cdckf,prnni.Aryviolrri,)nolSe.riotr1l)l15hyrn,
<br />amlicrnlhrarEnnilsuhj(lslhcrpt'liclnlrorcivilI'enrhyofnoru,mrhril,v.hurdrcddolh^(S50$)
<br />I.a\owftrofrhrpmpcny,ornryr'npk,rtrswirhsrA.\a\Ihrnuncconrpcn\irion.willdorh.sorknftlhc(er!fti.n
<br />inie ql or.itrcd n srlc (SE.?UU, ausincss dnd Pmfcssions Cqb 'rhc C{rnkttt s LiaNc I i* doc\ nor +fly r. 0n owNr ot
<br />rlrpn'Fny who tnrildsor inuowsrhctun[nM who rlocs su.h w.rt himscll or hcr{lforrhn)uth his or hcr owtrcnlhyccs.
<br />pi(,!iJd rhrr such i'npn,rotu s d tor imcnd.d or ofis.d f(tr srh ll h.qso. rh: huildina or i'r{FrcnEnr is sld rirhin oi. ,tr
<br />ol<trryhlion. rhc (rNr Buius $illhrrcrh.h cnolpn'vins rhxrh.otshc dil R! huiHari.Drovc tlr ptuFiy tulhcPurrM.r
<br />I.Nowncrofrh.!rencny.otrrcxclu\ivclyconrrtrcritrg*irhlicctr\cd.onk.i)^bcoNruclllEpojNr(scc7{111.Burncs
<br />and hDlbsbn Codc Th.Conta.roi s Licensc L0u docs nor qrplyro rtroaicr ofnropcny*ho huilds.r nnpovcs rhclc.tr.
<br />dtrd who .o.tr ll f(tr ruch pn*rkwirhq Conrracron\r licctr*d pununnt kilhcConr,lct, s Lic.n{ Liw).
<br />I amcr.mpr undcr Scclion-
<br />D.r. ()*mr:
<br />}lAf,KEESlg}ltSEN$.rlaN
<br />DICLAAAIION
<br />I hcr.by rflnm undcr pcnllry oipciry onc ofrhc n,lkr$ing dcrl&rri(ntr:
<br />-l
<br />harc ud will roinrli! a Cenillc{c of Con\enr rd s.lf.lnsurc for workcr' cotnpcnqrion, rr Fovid.d Inrbysccrion lTOJofrhc
<br />tihor C.dc. lor Ihe Dcrformncc ofrhc {qt n, *hich rhi p.mir n issucd.
<br />Ihctrorknl'rlrichrlrirfrnnrisrsrdMyw.rk.(..nrDcDrrronnNtrrrnccrx cr rDd frli.y ntrnhd rc
<br />J..-
<br />lttlolL- )ot)
<br />-e*pr'*,'
<br />6 2 -
<br />l.crtilr rhat in rh. E-nnrinrnce.frl[ $orL lnr whi.h rhi\ fcnnir it inEd. I shrll nor.nlPl,,, ant l.Bon in iny nunNr
<br />{, ^ r, tiotu {hird t, rhc *orkcn compcn\lrn,n hss oiCrlili,rnir. and 4rc rh ifl sMulJ bccom lubJ.cr rrih-
<br />w.rkcr\.oDcn\nrnil)fovtsionsolScdion-]7lX)olrhcl,rtr,r(i,Jc,lshrll.frrlhsirhconrlly*irhrho*n(,vnidns
<br />W,IRNINC Eilurclo sccuE sorlc^.ofrpcn\ n)n..vcfulc is trtrI.$iul. rn,lshtrll lubjccr dI cnrflolcr lo criminrl|.mhic\ ind
<br />civil inN un ro oDc hundrcd lhorsrid dolli^ lSlfi).UD). nr,klditi(r lo lhc con.f.onllrnsariotr. d.nugcs !s pnrviildd lnr rhc
<br />Sccrion J076ofrhc lnhn C.xlc. inrcrcnnnd oirf,y\{
<br />/' 8-tL-"ll
<br />I h.nby fftrm undcr rcnrhyoipcrjury rh,r I a,n lidn$d und.r 8)visionoi(hrprcr 9 (ontuting eirh sccrion 70drr oiDivili.n.l
<br />or rhr Bu\in s nnd Pofissions Codc. and ny li.cn* n in anll tffd gljff..r
<br />Licctr{c (-lN\ '9?f olf
<br />r'ga (r aOL c.,--
<br />CONSIBUCIIONTENDI!!.{AINS
<br />I icrcby rflllnr undcr pcmhyur|ljt]ury rh3t rhcrc i\ { co.srrucli('n lcndins as.ncy ntr rhc Pcdotnuncc otrhc *ork tut lhich
<br />'hn |Enni n
<br />nsucd (Scc. 30r)7. Civ C )t l1dcfs Ntrmc
<br />-
<br />AITLICANLDICI.AEAIIAN
<br />I hcrebyrfinnudcr l.hnlr, orpdjury onc ofrhc followinB dshr ionrl
<br />Dcmhiotr Pcrnrik Asbcsros Norinclrn,n Fcdchl Rlluhtio.s I ritt.10, Ptrn6)
<br />-RL.qut(l
<br />l!lcr of Mni[Eari,n
<br />Set Backs /z'-t
<br />g-21'11,,V,WJC)t prsr)a2\i(*3
<br />Ereclion Pads otrztJ-n9lwl{b
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Roof Shealhing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/lasonry
<br />T-Bar {-2r4Y Y,W'6)
<br />Handicap Req u
<br />Deputy Final Report
<br />Engineer Final Report
<br />/^
<br />FINAL IL-LI-lt:Y x-WJil
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />Forms/Steel/Holdowns
<br />Pool Fence
<br />Flood Zone Certif .
<br />Lcnd.a.
<br />^J,lc$
<br />I .dili rhar lhc ltdcrrl rcsullrioos rts:rdi'rs !sb.slos 6m.vrl orc nol flmlicuhlc ro rhis pi(,j.cr'
<br />-l
<br />ccnify rhar I hale rcld
<br />'his
<br />rrpli.,rion sJt slalc thar thc atDvc inarmurion is.otrml. I tr8te locomdy snh,U cny and 6unlv
<br />odin,n.sdtrdSrarcLarsEhrinsIohlilding.o.{rucrion.orldhcfthyNlhorizercItrccniariv.r.rlhisCilynndG,lnryrocnr.ruponlh.
<br />hh+r nrflr trrl r",p.rl f.r rnr.nnn ryfrlh{s
<br />n"",,,",",n*",o,-'"*/ (- 4 **'l:1(:1t.r
<br />Pemil* nom. { prinl ): z
<br />rt
<br />I
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