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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDiSIG.COMMENTS OWNER BUILDER DEI-CAR-ATION
<br />I hcrchy nfirn u.d$ Fn,lry or p.rjDry lh,l I m crcnpr ronr lhc Cont.cloN Li.cn* t w fo! rhc lollowin8 rcaon lsec 7011.5
<br />Businc$ ad Profcsion Codci: Any Ciry or Counry unich rcquncs a [Ernil ro on{ru.'. allcr i'iPo!c, dcmlish r tNn M,
<br />srtucrur., ,ritr ro n\ isruancc, al$ .cqlirs lhe applicanr fo, \och pemir h lile a \iged {d.mn' rhar h. o. lhc i\ lianscd puNa.r
<br />ro lhc prcvtions of th. Conrractols Lienscd t * (Ch!/cr 9. GnnrrcNins * irh Sc.rt,. 7{xlo of Divhh! .1 or $. ausin.s\ and r
<br />L'rolc(io6 Corlc) or rhlt hcor!h. tcrcmfl rhcrclro $d rhc h!si\ iirr rhc alk8.d .rcnprion. Anyviol.rionotS!.rion7011.5byony
<br />aptlic. rornpcflnirsuhjc.hrh.,mli.a.rro.c,vilpnakyornornrrcrhanr,vchundrcddolh^(3500).
<br />I. r\ osicrolrhc pmFn}. or nycnplo)s: wirh srlcs a\ rhcn s,h conrpcnsrion. silld. rlE $od( n thcrnEtuhEn
<br />irlcDdcd orollircdlirs c(S.r.7044.Busincsnndl'roltssion\CodclhcCotrlra.tofsLiccnscLrrdocsnor$plyr.aiowmrdf
<br />rhc prclrny who hui[k or inlpn,*s thcmn. rlabdocr$ch*()rkhinNc]rorhcn.li.rrhi.ughhi\orhoowncnDloycc\-
<br />nmvidcdrharsuch i'lporcmnh m mr i'lcndcd or ollircd nx strh ll k){.!cr rhc buildin8 or inrrovcftm h$ld wirhinoN r!{
<br />olconDldion.lhl osm! Builds will havc thc burdc..r rovirr rhd ,tr o, shc did ft'l txiB or improvc tu pn,Friy r.r rlI putr* or
<br />l.r\owncrolrhcpmpcny,an,crclu\ilclrconta.ri'rgwirhlicctr*dconrrctEt,ronrudrh.l,(!&r(Scc7044.an$rcs
<br />lnd Prsf6sir.Codc: Thc Co rr.rois Liccnsc tjw do4 nor qrnly!) !nowncroflmpcny*ho huildsor impro\c\ rheron.
<br />and who conhcrs tu luch po].d s wnh a 6nrE nn(r) liccnrd pur\ra brb.Conkr.ttr\ L{cn* tj*)
<br />I mcxcnr untlcr Sdidr .lr & r'C n,rhjs rcr$n
<br />rQBxlBlLg)ufENnuIaN
<br />DESANAIION
<br />I hcrchy a[nm uDdcr ncnllry.l pciuryoN.trhc nnb,irE ncchrari,,ni
<br />_l h& and will minrain 3 CcnilEarc or C6n{nr ro Scla tnslrc lor work.( compcns,rion. $ pmvtcd lor by Scclion l?OO of lnc
<br />Litor Codc. for thc pcrfornEne oflhc srt lor *hich lhc tE rit i issucd
<br />[r r,,* , t *, rr --r-" " *lrcB .nmll.n\d
<br />'on
<br />,n<ursn.c. r\ r.quircd b, s(iion ]7tro ot rh. Lrhr codc, ror lte perfomftc or
<br />rh. work a.r which rhll pcmn is hs.d. My workuC omp.nldn in*ur{ncc canicr .Ild policy nuntE uc:
<br />f
<br />t
<br />-,
<br />ccnilylh in rhcrrcrlormlnccoflhc worl lor whicnlhis pcfl,il is i{!ucd,I shdl nor.nitloydny l)c s.n in0ny'nanncr
<br />s, nrb b..oft sxbl..r b rh. aork6 compcB i.n laws ofcrlirumi4 daBrccttut iil should lrroft slhFt rorhc
<br />*orkc^ conD.nsarion piovtions ors.crion lT0ooilhc bb.r Cdl.,l shall. fonhuith conrdy wilhlhos provnions
<br />WARNINC: a{ilurc ro surc workcr onqx.slion covca8c is unlowftrl. .nd shdl u},rccr an cnrl.yd t, oimi.,l lEnrxts anJ
<br />civil fincs up ro om hundrcn rhousnd dollss ($lm.ur). ir addnn'n lo rhc cosr o, c.npc{\rrnnr, d,tugcs rs p.ovidcd lor rhc
<br />Sarion 1076olrh. ljtrr Conc. intc,c{ otrd artomy's K
<br />U(ENIEII.CI}NIIACIAB
<br />DECI-A RAT(TN
<br />I h.rcby!flirn un{lcr p.nalryolpcrjury rhd I dm liccisl rnder pmvisi{,. .r Ch,prd 9lconrnErcing wilh Scclion 7000) ofDietn,n.l
<br />of lhc Busim$ 0n Pml'csiols Code- lnd myliccnsc h in tull forecsdcffecr
<br />0.t 0t
<br />,"'. ClI C1tt'tot[ .-,..*K
<br />I hcEby atfifln utrdcr lEnohyoftcrjurythat lhcrc isr onnrudion hndins ascmy for rh. pdfotnoNc or(hc work fo! whichlhis !'.rnrir k
<br />issucd (se 1097. civ c.)
<br />A8&ICANLII}i,CIABA.IION
<br />I hd.6y anhn u.dcr pdnrlry utp.iluryrnc ofrhc iirlloNinE dc.llntrions:
<br />rxmolirion Pcrdir\ Ash.ros Norin arion F.dcdlRclIhrhni (Tirlc,l0. Pad6)
<br />R.quhd lltrn of Notifrdrion
<br />-l
<br />eni{y r hlr rh. redcnl rcplarions rcgardirs aitEdor rcnrlal src nor jtplic,bl. ro rhis pmj.{r
<br />tllccn'ry ft lhx\c fud rhn,rnhcnr'on sd {rcrh,r rhc atx,h infdnuriln is corccr I Jsrc ro.omply virh trll Ciry,nd counry
<br />.rdnrrc.sandshrclf,ssiclditrErohuildinecon{fl.tion. klhcrcbytrtr rcrrcscnrarirs olrhis Ciry md Counry k, c cr urDtr r}[
<br />JIx'vc rrcnri{)nctl t(,pcny 1,)r i',\*cr
<br />Applionl or Ag.nr Si,tnnrtrr.
<br />$rH t{C,
<br />o1(o l I "Er(8
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonr v
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .,A
<br />t"tubw lolha y-zl-tY *"tJtt)A
<br />FINAL y-zt-/l v-tz/h)t' \_7Certilicale of Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Subf loor/VenVlnsulation
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