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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER AUTLDDR DET-C RN'IION
<br />I hcrcby rfirn undcr pcnrlry (,f pcrjuy lhar I am cxcnTr frn'n rhc Conrrlcr.n Li.cnsc trq ror rlB f{nk,sin! rcNm (S4.7o.115
<br />BusnE\ nnd Pn,fci\n r Cdc): Any Ciry .r ConNy shK h rcqu rc\ r F r[ h, ! oN n'.r. alr.r
<br />'mniovc.
<br />d.rmlhh or ftlJn dv
<br />{fl.nrc. |,iorlo ir\ n\rdcc. rl$ r.quircs rhc amliclnr lnr \u.hF.,rnnr n, filc d nsnrd virc xnl rhrr }rf,r\he tr l'.lnscd puBuur
<br />n, thc ,$visions of rhc Conlracnn s Liccn*d Low (Chinrct 9- Connncn ir8 wilh Sc.rn,i 7fin of Divistr :l .r rh' Bn(in'( ind
<br />Profc$iotrsCodc)orrh h.orsh. iscxcmpl lhcrcfronand rhch,si! rbtlhc dlcgcd.r.ntr6n. AnvviolarioiofSarionT0ll 5hva',
<br />rprlicrnl iora pemir subj&hrhc q'tliclnrloacililpdhlxyotnorff,crhrfiwhundrcddollrr($500)
<br />-1.
<br />r\ o*n r or Ih. 0 olEny, or n,y dmtlolBs wirh snscs os lh.t w,lt co 'Fn\diotr.
<br />g ill do rh. vurk ond lhc {Mrm t tur
<br />i' .ftIi .r o{lced lor elc ( s( 7(x4. susincs and Pnfc$ion\ Co cr Tnc An rtr.t, s l-i.cnsc Lnw do.s nor nmlv lo !n osNr or
<br />rhepmp.ny sho huilds or im[ovcs rtcmtr.,Jd wh(, docs ruch *o* htnsclr or h.rclfor lhmlsh his ui hcr own cnfk,v..s.
<br />Ftuvnhdrhar slch inlProxnr.( tre n inrcndd oroftcc\l t,t $k lf. ho(crrr rlt l,rildiry or inpovcmnl is q,kl wirhironc$r
<br />.f cumthrirl. lhc ONtrcr Boild$willhtrvc rhc hrrdcn of Proviq rhd hcorsh.did 0orI ildor ifrEolt drc Pmlicnv lor rh. ntrry)* ol
<br />Lisos.crorlhcp('|Enr.rrcxctusnclycotrlrncriaswirhlicco\.d.onttulor\ro..isln!.lllEpmicl{sec?o!l.Bu\inc$
<br />utrd Pmlirshn Codr: Th. Cotrtslols l-icensc lls dkl nor .Prrly lo rn owns ol lnrDcnv wtr) t rild\ or i$pro\ts rhdrc'i.
<br />and who conhcrs io sucl t$Fch wilh !CoDractn(s)licc \cd Pursuanr rorhcConkd.ktr s t,icctrt lis)
<br />l.mcEnrln u crSccrn)
<br />l)st€ Osn.r
<br />WORKEITii'iONIPFNSA r('N
<br />DE1:I.ANIIIQ!
<br />I hcr.nyilljrtrrdn tr|ttrrlryoiF-rtD'yoncorlhchlk)$trrl..hnri{trr\
<br />-l
<br />hlvc afllwill minrain ! Cenific eorco.sc ro Scli lnuE ft, workcts <,mpensri.n. d providcd for $v sNnon 1?0(' nr rhc
<br />Luhrr C{xlc. turn. Frrornunccollhc *6rt ror*hi.hrhc p.flnil is kslcd
<br />-t
<br />h!v. n'il will nrinlain *o*.s .omp.nlrri.n i$uroncc. !r ,.quied tt Ssl ion -l7cn ol thc tibor Codt ror I hc Pcrrortu'c ur
<br />rhc work for which lhis ncrnil i! itlxcd. Mywo cN crmpen\srion insu.{iccciris u.d Fli.y nunrl,c, m:
<br />-Er|n
<br />\r
<br />-
<br />, ccailylhnl in lhcFrfonumcol lh. *nrk f,tr whi.hrhn |xnnir is i\\!cd.l shrll nor cnUL)!any,.rson ir snvmtutur
<br />e !c ro bclanm \uhjccl t(, lhc vnicr' co lp.tr{riotr hus .f Crliaornir, aM rB
<br />Fr ro crinin,l lrtr,lti:s ann
<br />rfl{scs nr prolidcn lbr lh.
<br />*orkr( mn\Ensdriotr pn,vision\ ofSc.rion l7(x)ol rhc l,rF- n
<br />W,\RN,N(; rrllLtr. r, \.(r'c {orkc'\
<br />(nil ll A trt, r,' otro hrtrrdrr(l lliin\:{!l dfllr';:;""^[/;;/"i-
<br />iwl utrdc. [ovirionofchdflcr 9 (.ommndi're wth Se-^rt,n 7(xm, .f Divisbn :]I lr,.hynllnnrund.rpcnxlr,rlr,criuyrli. l xn,
<br />06d
<br />7o /
<br />Ih.r.hy rrft r trrdcr rDrllyorprrjuryrhir
<br />irni.J rS.. :1097 Ci! C- j
<br />srto.rk,n kMin8 r8cncy for rhc ltrfoirurct olrlt w.rk lor uhich rhi\ Fnnir i\
<br />AITLICA fDLELASAIION
<br />llmhyifimundcr p(trrlry ol nctjty onc ofrhc ttllosin8 dcclaBrion\
<br />Dc xniliotr Pcflnir\ Asif,n.\ Noriricrrion ljcderrlR.sllrhois Ilirlc40. Plda,
<br />RrqundL L.llcr oI Norillcdri(rr
<br />I rSre ro comdy snh,ll Ciryrnd Cornry
<br />r J
<br />'':,'_':";b),
<br />Set Backs
<br />Erection Pads
<br />UFER Ground //8 /%"t-,rlt2'SLAB Floor
<br />S u bf loor/Ve nt/ln su lat ion
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />alb,z A,./ 1UJ*//// -44 d L 5c-*/
<br />FINAL //-? tB z '-*z-7)
<br />Certif icate ot Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />or rhc Busirc$ itrd ltot$n tr Codc. .ft1 nry liccnsc is in full nr.c rxl ctii.r
<br />tlnoc' " ddrc'.:
<br />-
<br />Forms/Steel/Holdowns
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