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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS O1'INiJR BIJILDI]R DELCARA IION
<br />I hcrchy rfirnr uRlcr ncnulry ol p.rjury lhrr l o. cxcDpt frorn lhc o)ntrrlor' l,iccnsc lu$ rhr rhc n,llowins rc v (sc.'70115
<br />Bu\int\\ Md Prof.\\i{,! Codc): Any Ciry o. Couniy rhich rcquircs r lcnnir h .on{tu.r. rh.r, nnln,v.. dcntolith or rcl[n y
<br />{fl.rurc. liitr ro ir\ isurftc. rl\o rcqui6\ rh.4rlicrnr tr\urh p.rnit b nld r ri8trcd {nrcnf, r rh.i h.ot nr i( li.ctr\.d pu^urtrr
<br />b Ih. F)!isi,,n\ of rlt Conrra.tr\ t.i.c {d l-aq (Chrprcr 9. Co mrminB {irh Sccri{nr 7(XX) of Divisnnr :l ofrhc Bunrcss.id
<br />lrofc$i.nr(odc) or lhrlhcorshc iscxcnrpl lhcrcfrontrtrd
<br />'hc
<br />hr{n tur rlrc illc8ci cxcnrpliotr. Anyri.llri olS('ion?0.1l5byany
<br />rtplica tur u pfmir srhjccr\ rh. rttlicrnr b rciviltculryolDor nxrcrh3n nlc hxndrdddollr\($50O)
<br />-1.
<br />os otr rcr ol rhc pnipcny, or nry cmployccs sith *,ecs $ rhctr $L ompctrr{rio.. * ill do rhc *dk iftj ltl (nnm i\ nor
<br />inlcft,& or offcrcd r'or elc ( Se 7044. Busincs akl ttobsn,ns Conc ahc An nrroi Liccn{ I /w d@i nor arply b an .wNr .r
<br />rhc ,nrllny who huikls .r irporcs rhdsn. illd wlr 'l.s nEh sor* h msclf or hcncll'or rhrcu8h hk or hcr own cmpbycc\,
<br />ptuviJcd t hnr ruch inll)R,lcnr.k m mr ii mdrd or oflcml for srk If. hrw.ru. rh buildnB .r inrtuvcnrnr is bld wnhin onc y!a,
<br />orc.nrlcri,n. rhc owncr Buildcr sillhrE rhc t[dcn oi[ovin8 rhd h. or sbc di.] ai huild or nnF)vc rhc rn,Fny tur rh. lU{b{ or
<br />I. r\ owtrc' olrhc tir) ny.nnr.rclusivrlyrotrtxdnB$irhlicr'sc,l.otrtr((tr\r).oiinr.rrlrt('{rrSccT(A'l,llbir'!\\
<br />ntul h.ri\sionConc |hcConrrrnnsl-iccrsclnsrnJc\trorr0rlvl,,rrosnc.oluorcnv$hohuilds.riDDi,,ve\rhrrcon.
<br />r J who co Rd\r \u.hpntcr\* hrContr.kinliccfscdlursuanrt,rhcContxckn'\l-'ccnscU*)
<br />lrfrrrrn:tr utr .r Sorri,r .8 &PC ntr{hn(r!nr
<br />]laatrE&!-!;Qu8ENtAIr0N
<br />DI'CLA.BIIIOX
<br />I h.r.hynlln r urdcr pcnrlry.fp.rjurtotrc ofrhc tul[,*i"! d..itr'rrtrtrs:
<br />-Ihrvc
<br />d tr ill mid.ir a Ccnili..rc of (ttr*.r b Scll.lNur. Lr xukciq convrnsariotr, !s previicdlorh,Sc.rt,n:l7Ulofrhc
<br />tihor C.dc. ld rh. p.ifomun c ol rhc work for rhi.h rhc p.nnir ir irsucd
<br />_l h!v. lnl s'ill nnirrdin $orkcri coDlEtrrarion iNunD.c. ar rcqnircd hySccri{n,.17(xJolrhc lrborCodc. r(tr rhc l(rronrDcc .r
<br />rhc work li)r which lhi\I)(nniris i$u.d My \ukrr\' .otrrpcDsari{nr insuraNcraricr nd F)liry drnrhd n(
<br />Policy Numbcr:-
<br />l..rrlyrh rh. Frfo un.c of rhc \ok tu uhi.h thi\ pcrrnir ir is{icd. I \l[ll tror cn ., iny pcr$n h xn:" nr trncr
<br />vi r\ tr) lr(oE \uhtc.i t' rh! workc^ .onpcnsrrion lrss oiCJlilooir. rnd rgrc rhrr ifl \hould h...rtu {rhl..r ro rhc
<br />$orkrn .ompcnur on ln,vi\ions or SNri.n :IT()O ol rhr l;fin ( ,ic. l shlLl. ,nn hN ih .. iplt n irI rht lnr isiox.
<br />l!ARNIN(; r.ilu'c k, \ccurc {orkch strrpci{rnnr ..v.Egc is trilnwlu!. rDd \hrll subtccr flr cnrtlorr t) crinri',rl n r'lri.s and
<br />SNrid, 1076 otrhc l-rhtr C,xL, ir rrcn did rn.n{t s tu \
<br />Drlr: Appllonr:
<br />LX:FNSrr) CONT&{CIOR
<br />DECI.AXA.IIA!
<br />I hcrcby!fiirm undcr pcnlhyofrE jlry rhrr I an liccn{n under prcvnnrn ofChrfl.r 9 (.onftncing wnh Sc.rion 7o(xr) oiDivi\ion 3
<br />o, lhc arsinc${t Prorc$ions Codc. un mylicctrs is in lull nJm jtuclld
<br />CONSIf,I]CIIONIEIDI}C.&GENII
<br />I hcrcbyrllir uidcrFtrrlryofFrluryrhdrhcrci\r.otrd.ri,riLid,nea8cn.ylhrrhcl]crhnunccoithc$ortfor*hihrhnrdmiri\
<br />i\skd lsr :1097. Cir (' I
<br />Lndeas Adnrcss
<br />-
<br />APIUIANLDESAXAUqN
<br />I hr(bydljnnuodcr pcnrlry of pcrjury.nc of rh. lalk)*ing {lr--hrri{,r\:
<br />I).moLiri,nr ltirnils Ash.sros Norii.!ri{ rtdcrrlRcEtrhlnns (l'nlc 40. Pxn6)
<br />krlltrnr(l lrrr.r or N.rill.xli(tr)
<br />l.r'1rli1ltu rhc lcd.'rlr.!rl !,N tlnnltr! r(ii$r. trrrln'r trorit)pl(rh]l h rlr \ O,!..r
<br />I.cnilyrhlrlhanrcrdrhisrpplicrri,)n Jn rcrhri rhcrhnc itrlannriion n$rc.r l rgrL\ ro .omply vn h nll Ciry nd (i)unry
<br />oil,nrnc.\ind Srrrc lf,qsrbriry b huilding connflcrnnr rnd hcrcl'yrurhfiz. rctr.\c.rdrivc\ ol rhis Cily d Counry lo cnr.r u|hn lhc
<br />ibvc mntnnul prop.ny ntr ir
<br />Lhaus<
<br />,-," 7-3-lo
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulalion/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handic ap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />7-o3-rB '.D..Cy-'4Tr)
<br />Certificate ol Occu pancy
<br />Erection Pads
<br />T-Bar
<br />FINAL
<br />Notes, Remarks, Etc.
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<br />IL
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