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UILDING- INSPECTOR RECORD
<br />COMMENTSSITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/Vent/lnsulation
<br />R ool Sheathing
<br />Shear Wall
<br />Frami ng pqi'i.€ L 5Ofr
<br />En*rr-lnsulation/Energy 0/7t/rk't -r/
<br />Drywall .1/ZW D
<br />Ext./lnt. Lalh 1j tol 'zrlc? G "408-Brown Coat
<br />lVason ty
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Beport
<br />Flood Zone Certif
<br />FINAL rua47 I )
<br />Certilicate of Occupancy T
<br />N otes, Remarks, Etc
<br />(}WNER BUN,DER DE!-C,{RA'TloN
<br />I hcrcby afiirD undcr !.niliy of pcrjury rhll I am cxctrrp' fronr thc ContrucroN l-iccnsc Lrw aor rhc followin8 rav,n l*L70315
<br />Bnsincs nd Prof.sion Cdic) Any Ciry or Coutrry which ..qunc\ a Fnni! k' c.nnd.r, 0lrc.. rmrrcrr. dcmlhh "r rclun uny
<br />rrrucrurc. priorlo its hsuoncc- alw rcquncs rhc ilplic r lor suchpcrmir lo lilco sisncd sr0remcnt rhd hc.r she i\ liccnscd punur
<br />ro rh. trcvisn,ns.fdr Conlh.etr s Liccnscd Ltrw (Ch!pr.r 9. A,nnrn.nrC *ith Sc.rion 7{mO ot DivhioD I oi lhc Bu{incss lnd
<br />l'mlcssions arlc) or lh{t hc orsh. h cxcmpl rhcrcironr and lhc basis aor rhc alh8cd cxcmption. Any rioldionofS.crinr ?0.r1.5 by,ny
<br />ip,rli.r fd aFrmir !trbJ.chrh. dppli.anr b rcivilpcnblryolnoi morerhan fivc hu ndrcd dollar ($5m).
<br />-1.
<br />!s owmr ol rh. polcny. or my cmplorcs wirh wracs {s rhcn $b compcnslrion. u iU do rte mrt ond rh nMm n mr
<br />i, cnd.J or olrcrcd tor sle 1Sd.7(}44. Bu{iftss and PFtessioo\ Codc fic Contrctn r Li..isc Ltrw doc} nor apply lo atr ornq of
<br />rhcpmpeny who builds or inrprors lh@n. ad who d€r suh sork hinnclf or hc^cli or lhnuBh hh or hcr own cn'pk,!c.s.
<br />Fovidcd rh su.h impn'vdrnh d mr imorldl or ollcR{ fd slc Il lr,w.vcr. rhc boikiing or inDtuhmnr is $U within onc rs
<br />of coDplcri{,n- ihc Osncr Builder *ill hat llt hudcn of prnrin8 $ar tr or snc dil mr lDild or i,r$r,w thc pmrdy ror rh. luqr,s or
<br />l. a\o*ncrotrhc prol}cny. urcxclu\ilclvconk!.ring wirh liccnsci conrrron to conntu.r rhc pmtc.r is.c 7t).,-1,3u!h*1\
<br />rtrd thrrision codc: rhc conlri.ror's Liccnsc L.w d.$ .or rt)dy b dtr .wncr ol pmFny who hu ilds ijr iDpror\ rhcrm .
<br />rDrl wh. .onr d \ tur \rh t)n,j..h wirh n C.nkacki n liccn\cd pu'suir h lhc (-'n rNntr's Li.cnsc lrs )
<br />I n rcx.tr1tr uiddr Scrrn,
<br />l)sl. (r*n..
<br />naatr[Bs-lr)llruNsflox
<br />D,IiILIAAIIO!
<br />I h.r.hy riir undd t^trrlryotDclur) oN.lrhc fi,llosi'ig dc.lxnriu)\:
<br />-lhavca
<br />willmiinrrhaccnlficarcofCons.nrrosclf-Insuruf.rworkcfcom|ENation.0stmlidcdlirbyScrn,n:l7u)ofrh.
<br />hln Codc. frr rh. lcrf(mhccof fi. work lorwhi.h rhc F rnir is issucd
<br />-lhavc
<br />and *illnraintuh *ortc6 comncn\nn,n insurrn.c. !\ rcquircd 6yS(ron.l7fi)ofrhc IIxr a)dc. for rhc pcrfoiinrmc ol
<br />rh. *o,k nn *hi.hrhis ncflnir is i\\ucd My workcrr .o nrplnsr I i, r iNrrrD.ccri..a Poli.t tru'nb.r dr.
<br />Policy NuDbcr
<br />-lixnircY
<br />I c.nifyrhrr in rhc pcrfu,tunccofrhc sork nr shi.h rhisFrmn i\ i\nrd,I \hrll nor cnrdoy rtrytrr{ in rnymmncr
<br />$ {\ to $com subjd h rlrc wortc( conrN.sarion hss ofcrliio,nii. rn{t rarc. rhxr irl shrtrld h.coft suhj.rr n, rlE
<br />*or[c6' conrFn$lion nrcvhions of SCIion 3?00 of lhc ({c. I shall.lbnhtrirhd,mply wirhrh.$ nmvh
<br />WARNINO: tjxilurc t, {tor. wo'k * ..nIrnsrrnn.ovc chrll subj.rr ni cmplolcr lo
<br />.Nil lnr! !p r, oN hrndrcd ihou:rr dolh (Sl(X).o{ ni.omncnsdion. drmasc
<br />Sc.loi 1076 ol rlrc lrhtr (ndc. i crc( md orrcv'
<br />\ E ^*,,-',,1- <.
<br />I hcrby rfirmunde! pcnrhyofpLrjury rhar I nlnan$dtrndcr irion ofChpr$ 9 (.onnmNirg sirh SLrtion 7O0O) ofDilisi(,n l
<br />of lh€ Businc$and PmicssiorsCodc. od nryliccnsc is in lull inr.c. cficcr
<br />1-l I
<br />cl]NsrxlJcrlQNtENllllc-tra[Nlf,
<br />I h.rb, amrm utulcr Fnllryoapfijury rhar rh.rc i\ a.onsro.rion lcodin! r8.o.y ror rhc Frlbrntrcc orlh. work l'or snich rht ltnnii iq
<br />hsued (S( 1097.Civ. C )
<br />AIII.II]INLDIICLTSAIIIIN
<br />I tf,nt y rmmr rndcr pcnxhy ofpcrjrr) otu ofrh. folk,win! dcclirrrionr
<br />Dcnxnirion Pernrlh A\hc{or Norificdn,n Frcdcral Rcsuhn,ns fl'irlc40. Prn6r
<br />Rcqutcd Irtrcr of Mrifi cari,n
<br />-l.cni,
<br />lhoi rhe l.dcfl l rcsuhrior Jrlirg r\6!ro\ r.m,v lirc n.r:'|)Ini.rhl. r) rhn t)',urri
<br />-lccniryrhol
<br />I hrvc rcod rhtlnPltal i nnmri,)n iscomd Ir!a$t)conrlyqrhrllcilrdtrdCotrnry
<br />odimnucs an(l Storc tiwr rclal iry l(y rurho'iz. Epr.sctrrrrivu\.lrhi\ Cny rnd Courryro cnrq nII)n rhc
<br />nk'vc nr iotud rmFny r(r
<br />ADIrli.nnl or AA.nl Si*nnlurc
<br />Cocr-tB6ol
<br />r: lL
<br />SLAB Floor
<br />v1t ltc)
<br />@r
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