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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS ()1\ NIaI{ Bt lL'r:k l)ll.( ,\R,l I l()\
<br />I hcr.hy rflirni trndcr pcnllry i,f p.rury rhf I am crcnrPl irm lhc Conhcl.F l-icctrt Lw for rhc lblb*ntg tren ( S( ?0] l 5
<br />susirc$ Md Prolt$ion C.d.)r Any Ciry or Couniy *hi.h dqui'$ . ncrmir nr con{tu.r. llrcr' inDrcvc. dcnmlth nr RnJt Mt
<br />slrucrurc. priort' ir\ lsiudn.c, ol$.equtcs rh. l,lpli.nm lor such Pcrnil lo lilc r siSncJ slnrcmnr lhar h.or shc n liccn*d Pursurnl
<br />h rhc rrovisions ol rhc Conrachr's Liccnsed ti$ (ChuPtcr 9. Comnrncirs trirh seiion 70() oi Di!isn'' I of rhc Brsi"'s rnd
<br />I,mlcssior CoJc ) or rhd lforshc iscrcrnlr rh.rcrrotu aid rhc bNh lor rh.rlhg.dcxcDPlin Any vidrrionofSccrirn 7011.5 ivonv
<br />npplicr ror r Fnnir suhjNls lic appli.anr r. dcivilpcnaltyol Dor nn,m rh,n livc hu8lrcd dollrs i$5OJ).
<br />-l,0sowncrof'ncpr.p.ny,ornryemplortcqwnhwr!c(usrhctsoleconlxnsdtr,Lqilldoll{$o*,rlrhc(ErEnnrinrcndcd oroflarcd for $lc (Scc 7(!4, Bu\incs.nd P(ntsionsCdc l-hc Conns.i{r\ Liccnt tlw docs tror !p yr.doBncroi
<br />rhc pn,Eny who blildsor i'ryrovs rhcrs.. at *ho dcs such *ork hnnsclfor hcr*lfor rhrou8h his or hcr own.trtPkrvccs.
<br />trovi{j.! rhni such inrl,n,vcn.trh orc ml i'nc8lcd oftcBl f(, sh.li h.\'$cr. rhL huildtrr8or iryrc(nrn! issoldwithinorc Jtd
<br />oicompbrion- rh. ()wns Btrild$ eill hrE rh( tutrlco ol pmving rhd h. or {hc did nn build or nwr^t Ih. pmpcnr lbr rlf NrlnEol
<br />L nsowncrolrhcpropcay. mr.rclu\ilclyconrrocrinSlirh liccn{d c.nticl{nst,.on{nrct rh.IDjtrr (S( 7()4'{. ti!\i't\'
<br />ad lh)rl\\ionCodcr'lhc Conlretois t-iccntc Law d(ts norrnply to an osn.' olrropcny *h. builds or iDlrn,ec\ rhcrcotr.
<br />itrd who conrrrls lor {uch prcJdts wirh o CirnrBckln \) ltdn$d Nnuinr h rhc contmk s Li.cnse l,*)
<br />I rmcrcnrpt unn.r Sccr
<br />D.l.: Osner:
<br />WORKI..Ns--OMPFNS TTON
<br />DEELANAIIQN
<br />I hcrcbyaminu cr pcnallyorrcluryonc olthc loUosi!3 dsl]trarrrs
<br />-l
<br />halc afil will n{inraiD a CedifKnre .r (t'ns lo S.ti:lnsurc i$ wotkcs coqEn\arion. $ pmvidcdforhyScctn,trlT00ofrhc
<br />Ubor Crnc. rd rh. rclfoirMmc ofrhc wolk ror whi.h rhc Pcrnil ir is\ucd
<br />lhr!. rDdriLlmrinrain workfl.omp.ns nnr in\lrrnrd. r\ rcqxncd hy Sccr i.n ]700 of rhc lntxr Gdc. Lr thc |ErLnumc of
<br />rhc Nork n whichlhn pcnnir is nscrl Myeorkcn conD. \rrion nNtrrNccnicr and Nltvtrunrbcrrc
<br />Zur,ch ftm e.:cc^r. Lsv..!,.! t' C.o
<br />I br'ow(oij6q .b9 lo
<br />-lccnily
<br />rhrr i'rrhc |{rlnnMncc oalhc Nork tur wlri.h rhnlcnnil i\ i\\!Lrl.I\hdllror cmpk,y r yNrotr ir anv nunkr
<br />v, ff t, bcc..r subi! ro ltc aorkc^ .onr!.rsdion hsr orC,linmnr. rtrd usrcc rlrr rrl shtrrld h.c.nr suhj.cr fu rh(
<br />nnr pmvniur 6fSc.tiotr 3?00 oflh.lrtxtr Cod..l shill. irrnh*irh coilry Nirh rlvxc Provisions
<br />\{AtNlN(; frilur. t) *.urc r (.vcrrBc i\ utr!rwtul. aod shJll an cmnlorcr rn ainmnlfculrE\ Jtrd
<br />s.u.tr, dsnssc. J{ nrovdcflir rh.riY l firc\ uf !r o r htrtr(lrcLl rh,ni\r d dtll
<br />Sc.ri{nr.l076olrhc lit!tr Coic. i'rr.rr rdd
<br />,r*,_ &- 11''?rrib
<br />IECI,ABAIIO!
<br />I hcEby affirm undc. Icnrhyolp.rjury rhar I ad lien{n undcr lmvhionofChaprcr 9 (comnrminr wnh Sctbn ?fiI)) 'rDivtion 3
<br />of rhc Busims nnd Pmlessionr codc. dd ry liccn$ n in {ull r.r.c lnljlgr
<br />o C t?)
<br />'iIl.'-UtB ,*'*'
<br />CONSTRI]CIXIN LENDIN(; AIiFN(:Y
<br />I hcrchy !flnn undcr F.,lryofpcdury lhd rhcrc is r con{n.ri)n tndinBlscicy lor ihe Frrbrron c.rrhc *otk ftr shi'h rht Fnnil n
<br />i\sucd (Sc. lL9?. Civ. C )
<br />AUI,IIANIDIILAXAIII}N
<br />I lteby rflinnutrd.r pcmlry of p.rjury onc olrhc l(l!n)*i'rg dc.lsirions:
<br />Dcff,!trn,.Pcnnik.Asbc{os N.rifi. nr PidctuI RCEUlt ions(Tirlc'1r). Rm6)
<br />Rcquncd Lcrlcr.i Norifi lari,rr
<br />-l.cnrivrlrarrhoLdcfultc8ulrliotrsr3&li'r!r\lf,ltocrcnn,vrltr'cmra,lr.rhkr.rhi\PRAr'
<br />I ccniry rhd I hnvc r.ad rhi\rppli.rrion d(dclhar kirlo,nrliori\c.rc.! I iStel{,co.,rly$irhrllCilyrn,lCt)rtrry
<br />o'di'rrtr.rs rtrd Stdc Lrwrrcbri'{n, hui d rhrr 7. r.prr\otrrxrnc. !lr[n ( iry r ( tr ]ro.ni$urnirh.
<br />ihavc ncnri,,n.d pn,,tny tur ir -""- ,,,"b'l1-ut!
<br />N $cLrr."/GEL
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Framino
<br />lns u latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\Iaso nry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL Zltllet /1/fi 1 )
<br />Certif icate of Occupancv
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />Shear Wall
<br />T-Bar
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