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BUILDING- INSPECTOB RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNIiR BUILDER DEI-CANATION
<br />I h.rcby aaltnr und.! p€nllry ()a perj!ry rhar I an c*cnrpr fon rhe Conrrucio6 Liccnr lf,* t, rhc n,ln,wir'g Msn (sk 70:ll 5
<br />Busircss .nd Pmlasi.n Cudc) ny Cirt or Cou r, shioh rcluir* , Fnnir n, erNrrucr. Jr$, nhprorc, dcnrlish .r rctlUn Mt
<br />slrucrurc. lrior ro ns hsuincc. also rcqutcs rhcnp,'l,cant ror su.h lfrm lo filc.siSncd slarcm rhd hcorshc n licenscd purs.lr
<br />to rhc pnrvisiDns of rh. G,nudur's Licdn*d be (Chnpri 9. Conmd(in8 wnh Sc.rn,n 70OO of Division I oflhc Businc$ rtrd ,
<br />Pftnt\rions Codc) or thrr lEorshc is cxc rt lhcrcrionHM rfu brsis r'or rtu trllcg.dcrcmprtu. AnyviohlionolScclionT0:ll.5hyany
<br />arplicanl lor!pcrmil suhjsl\ lhc applicanlto rcivill)cnalryol rcr nDrdhan fivc nundrcd dollaB($500).
<br />I. d ormr of rh pn,tEdt, or fy.mplorrcs wirh wrlcs a rlrt !,1. ortcn\ar ion. will do lhc wdk vl thc (flEturc h fln
<br />inrcndcn orn,lcrcdforsolc(Se?Ol4.Busincs.!dProfc$ionsC.dcThcConlrscior'st-iccn!.l-xwdmsnorlpllyhinownur.r
<br />rhc p$I(rry uh. huild\ o. nry,(,vcs rllB)n. arxl wha d,E\ rkh w{l* hn.sclror hcr{lfor rhrough hii orh.ro*n cnloh]ccs,
<br />ttuvidcd rhlr such imrturcrrnh e ml inteMcd oroltarcd hrvb.ll, h)ac!.r.lhc huihiq or im0mvcrEnr i( sld *irhiionc rt{
<br />ot c.trrrlcrbn- rrr Owncr Builcr *ill hnw rhc burdcn of pDlin8 thll hc or she did rel hlil{i or ihltroh lne poFny for rtr pur.$ or
<br />l. xso*TcrolrhcpnDcny. a'ncrclu\ivclyconrrrdtrg *nh li.enscd conrrrtB k, condn'.r rh. prcFd (S( 7(lU.8u$i.\\
<br />lid fi\'ra\lion Cod. ThcCotrtrcroir Lrcr\. Lrw doc\ i.r rrplttr nnosn.r olfl,)tr ) sh hrlkhor impro\c\ ihcr.o .
<br />rn,l who conr,lcrs lar !u.[pniccr\wi'ha (in
<br />'ltr1o1\] ll.cn{d l[nurnrr)rhcC.nrrarkn\ l-i.rnsc lrw)
<br />lxtr,rx.rnruDd.r Sccritm .l] &l'C li)rrhisr.r\in
<br />) o,r" o*nu "*ffi*
<br />I lrrrhyrllnmund.r t^-fulrrorrurlurto col rhclalkNi',F dcclnrrrnnl
<br />Ihrvdddwill Dinrri'r,ccnficrcofConsnrk,sdllltr\urcf(nso'k$ic.nD.trsdnn.aspruvidcdforbySarion.lTO0.fihc
<br />l,Ixr C{dc. tu lnc pcr{ormrcc of I hc *or[ ror which lhc Fnni is nsucd
<br />-lhuvcandwillm.inrdin*orkcs
<br />conrr.ns0rion insuntnce, * icquircd hySalion l7ll0 oflhc ktlo! Codc,lor lhe pcrforoance of
<br />fic *ork lor whkh rhls rcrmir is isscd. My workdC comp.nsdion insuBmc.Mis ond policy numlEr uc:..",", AoU PrEh' 9w*t
<br />utC '04 7o196 75 t A 7-lio/q
<br />Iccn'lyrhrrinrhcpcrftrnu'rcotrhcworklarwhi.hrhispcnnii\n\uc.Inrlltror.mpl()yny|x oninrnynrnncr
<br />$ rs h tl..o f, suhjc.r ro rhc w.rkcrr .onDctr{rlotr lrws ol Crlitrtrir. d Urcc rhrl iil shouu tccom suh}cr k) rll
<br />srrkcrr.orlf,nsdnr!rovisionsolSccrion-1700oIlhcLrhtrC-idc,lsl[]l-hnlhqlrh.om]rlywilhlho€nrrirnntr
<br />\YARNING ljJilurc lo s.nrc *ork n .on,ri.nsrlii,n covcfusc i\ utrLas1tl. rnd ohll \uhj..r Ir c do)tr r, dnniflrlr ilricc rnd
<br />Srr'i rrai.rrh Irh1C, . ir1.iriJi1r'?t'.li..
<br />',,./-LICEISILCONIIACII)B
<br />IIECI.AAA.II!}N
<br />I hcEl'yaflnmundcr ncnaltyofPc.ju,y thal I am licctrrn undcr Dmvisior or Chlprc, 9 (commncinE wiri sc.iiri 7000) orDivisi(,n l
<br />of rhc axsims rnd Ptufcsions Codc. {td nryliccn* is in fullfor.c dld cllLrr.
<br />IOT.{IBUCIIQNIEIDING.AAINCI
<br />I h$cby rfiiro lndcr pcnalry.fFdury rhd rher is r consrtucrion lending,B..cy nn $c p.froflrEna ofthc woik nr *hich lhh pcrmir t
<br />issucd (Scc. 309?. Civ. C.).
<br />APILII]ANIDECIABAUIN
<br />I irrl,hy r,1innundcr pcnrlry.fp(rlury onc ol(hc rollowing dc.l arions:
<br />Dcmlirion Pcmils.Astrsros Norilicarion rcdcral Rcgulrrions ('lirlc40. P6r6)
<br />-Rc{tuircd
<br />L.rlcr oi NolirEltion
<br />I rcnili ihd Ih. lc.lcrrI rcgulariu.: rgrdnrg r\lrnos r( n)! lec nordmli.{hlc !) rhirtron.l
<br />-l
<br />enifyrhd ln0vc rud lhis oppliclliotr ud (olc lh lhc atnvc irloirrution kcoftcl I osrcc lo comply wil,l all Cny rM Counry
<br />ordinakN and sh'c tiws ehlin8 lo buildinC consrru.riotr drl h.r.by,ufitrnc leprcsc otivcsofrhnCn,andCou.ryft,.nr*n,mnrrE
<br />ftovc mnrhned propcdy for inrpccrion puqr*r.
<br />Applienl orAsen( sis,slue E , Dal. ,
<br />),,L
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall tlllrx .<,q {rt ((oqb bv G./,\e.- ., t4 ea-
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />,)
<br />FINAL r/,'O//t .--z W,I)=J^l*b h{?4-fte*
<br />Certificate of Occu nc
<br />Noteg, Remarks,, Etc I
<br />Forms/Steel/Holdowns
<br />Ext./lnt. Lath
<br />-t
<br />tt
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