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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS O\!NER DU ILDER DEt,CA RATX)N
<br />I hcrchy rffii!! undc, pcnalry (,r Frjury rhar ! an crcdpt ln,n rhc G)ntrkB Li.dn* bw for lhc li,lloqin3 c.$n (Ss.70] 1 5
<br />Busnrss nnl PoLrsion Cdlc)r Any Cir! or Counry Rhih rcqunc\ a ttnnir ro .otrnrucr, !ll.r. imp.ovc. d.frni\h o' qat rtry
<br />srrucrurc. Irrhrro irs h\uamc, aho rcqdncs rhc aplli.rnl lor such IEnnir ro litc ! sigicd sarc'* i rhd h.or sh. h licctr\cd punuint
<br />lo lhc I'nivtiors of rh. Conlmctols l-iccnsd tiw (ahoplcr 9. Conmcncin[ +irh Sccrn,n 7qI) o, Divnn,n :] or rlt Bu\i,rcs\ ,nd
<br />Pnfesi{i.sCodc)orrharheor\hctercrprrtercriomMdrhehlrnforrncrlhgedcr.mflion.Anyviohrn)nolS(ti{?0ll5byrtry
<br />rypli.ani f(trrlcrmn subjc.rerhc iprli.rnr (o r.iviltcnalryolnornxftthrn fivc hundrcd dolla^ ($500)
<br />_l- a\ ownc, oa r hc popcny. or nr, cmpk,)ecs sirh slScs !\ r hcir $lc .o,npcnsr i(,h. sill do rh. work arl (h nf,E1E ir nol t
<br />inrc,iGi or ofcrcd rd qlc I SLr 7t!.L Busircss .nd Porcssons Cntc l hc Coot0crols LiccnE Lrw dcs nor appl, h ,n owndr ot
<br />rheF)pcdy *b ti{ilds o, itrtItroks rhcmn. dd rto dms sEh wo,l hims.llor h*sclfor rhftulh hi\ or ho o*n.mployccs.
<br />nrovidcd rhrt su.h iNnro!€nEnts m nol irl.n6 or ollcE'd lor slc.l( ho$cvry. rbc huilling or iqmv.mnr issll]wirhinonc ]td
<br />ofcoml,Lri[ rtr Owtrd BuiU.r wiu h3rc rh h[d.D ol JrovinS rh! lI or shc di:l mr huild or in{'mw lhc Impcny aor rhr lnlpoe of
<br />-l.,sowncrof
<br />rhc ror.ny. ! cxclusivclyconri.rinS wirh liccnscd cotrrrncroF lo con(rucr rhc pojc.r (s( ?0,14. Brnncs
<br />md l\.tcsionCodc-theConknctr'sLi..nsck$doc\norrpplyron.o*ncrofpro|).dywhobuildsornnprcvcsrhcrcon.
<br />rtrd who onrn.h ror such pmirls wnh a C!nhcb(9 li.cnscd pusurtrr b rhc On Bctoi s l-iccn\c Lrs )
<br />llat€ OEn€r
<br />woRKrR-s' coruPFNSA rrcN
<br />DlclrlSarto!
<br />I hc.cby affirnrtndrr Fnalr, ofPcrjtryorc ofrhd folk,*ing dcclrrrrion\:
<br />Irtxn Culc. i{r rhc Frformrncc olrhc sork fushi.h rhc pcirnir n n\kd
<br />Ihrlclndwillm,n ai,r workcrl comNnsatiotr insur.ncc, as rcquncd by Scction]?Ulnflhc Lahor OJde. trtr lhc P$r'onmncc of
<br />rhc work tu which this pcflnit is tsEd M y sorkcn coml.nsrion iNuruncc caricr ud policy ntnlbcr d.'
<br />I ccnily rhar in ric pcrl{rnur. ofrhc work ld which rhi\ pcrnn is hsrd, I shrll.or cntLy ony r.6on in any mnmr
<br />s is to h.com suhJccr ro rhc *oltcs co u.nslrion rrwsofculirbrni0. lnd !3rce rhd irI shonld h...ft 3ubicl ro ttr
<br />*orkcn'co,rpctrsolionpmvnionsofSc.iin3?fi)ofrhcL,borC.dc-ldEll.ronhwirhd,mplywith'ho{Polnions.
<br />W RNING: FJlurc b s!r. *orkc^ .on{rn\art,n .ov.tu!. ir unlawful. and shlll subj.rl nn cmplortr ro dimiotl Fnalas rtrd
<br />civil fincsxt ioon. hrndrd rhousand dulles (S100.00O), in sddnn tu rhc con oi.omp.ns0rion, iarug€x di Ptolidcd for rh.
<br />sc.rion 1076 ofrhc tlbor q e. inr.rcs Md brmyrrr.\.
<br />D.rc: Appliml:
<br />| (IFNSLI C-llrNrnA(rfi |R
<br />DFCLARATrcN
<br />I hcEhy alfi n und.r ri{.alry oI ri.rjury rh, I nm lienql und., Eovi\ion oI C}aOd 9 (.onnmocin8 *ilh Salion 70Oo) or Divisbn :l
<br />of lhe lrusinc$ md Pmfc$ions Code. ud my liccnr n in lull lore and c(ccr
<br />IOISIBIJCIII]N.LENDINC.IGENCI
<br />I hcr.by rfltnund.r lBn,lry olrcrjury thd lhcrc h r con rucrtrrlcndinsrscmyrornrcpc'rornEn.corrhcNo*forwhichlhisocrmin
<br />ir\ucd (S{c. 1097, Civ. C )
<br />AIfLIEANLII:CIABA]IQN
<br />llmty linnundd p.trrlry olpcrjury otrc o, rhc hlloqirS dcclmriors:
<br />Drm,lirion Pcnnir\ Ashcdos Norifi.artun I:ed$nl R.8nhrtun\ lTirlc 40.lhn6)
<br />Rcquncd Lc(cr of Nontiori,n
<br />-l
<br />ccnilylhd lhc ltdcrrl r.[lLri,nr rrgrlin8 rllx(ol r.trx,vrl rro ior rfi,lic.h[ h this pro]ccr
<br />_l ccniayrhJr I hrvc rc rhnDppli.xri,[ iil rcrhnrrh. x,vc intunhri.i it.omd.I !8re rriconDly wnhlllCiryridCounry
<br />o i,anc$n StarcIlsarcldrin!rDhuildi'lg.oi{turi,D$dh.rdhyiulhorizcrclrcscnhrivcsoflhnCilyandCoonryro.nlduF,'llE
<br />$vc mninnlld lropcny for irspcction purlx)ss
<br />]\l)I)li..nl.r .\8etrl Si8nslu.e
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVasonry
<br />T-Bar
<br />Handicap Req.l lullg,-{//qE/f4
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL 7il?(tl ,,u&Em
<br />Certi ticate ol Occupancy
<br />Notes, Remarks, Etc
<br />Pool Fence
<br />Flood Zone Certil.
<br />-l
<br />aDcrc,npl ! .r Scdn'n-- B. & P C forlhi\rcoson
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