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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDF]R DILCAiA ION
<br />I hcichy rfiirnr u cr pcDrlry {,r pcrjrry rhar I a cxcnDr rtu rhc cnntrlon l,icensc ks n, rh. roll.qin8 rcdsnl (Scc.?0:r1.5
<br />Bu\ircs\ rfrl Prolcsion (od.) Any Ciry or Con y which r.quirc! ! IFmir t, .onnru.r. rltcr. implovc. dcnxrli\h or kprn inv
<br />n.rurc. |,iorrr irs issu.rcc. llso rcqtrircs rhe apfli.rnr forskh Fnnir ro lilca siSncd (arcmcnr rhd hc or shc is li.cnscd Punurtrl
<br />t, ihc ,ruvisbns or rhc (:tn n.ttr s l-iccncn ljrv lchanrcr ,. Comnrncnr! wirh Sccti,'n 70(x) ot Divnion :l or(|t Busnr{,n
<br />PftnassnnrsCodc)orlhalhco,\hci\crcnflrh(crronandrhcru{i\,'orlhc.llc-qedcxcnrPrbn Anrvn'hri.nofSccrionT0.rr5by{ny
<br />rppli.{nt lnr aJ^rnrirsubjc.h rhc lpplilrnr t, d.rvrlp.mlryoln.r moidhrn fivc hundrcddoll&s (s50o).
<br />-l.x\o*ndofrhcpioNny.,trnrycnrnl,lBswilhwisc\oslhcirvrc.ompcn\dnnr.wrlldolhcworklndlhcn
<br />rur.isnor
<br />noMd.roflarcdforslclS(.7(!,{.Busincrsmdftofcs\idNci)dcrThcGrntractnrl,iccn{lxqll)csnd{Pnlylo!tro$ncrof
<br />ihc pR,tfny qlr) hildsor irnpn)E\ rlEsr. !frjwhrr Jms \u.h ktrk hinrclf.. h.tscll orrhrn'ghlris or hcr oro cn'nloyc$.
<br />lrovidcd rhrrsuch i'lpnrrmnr\md id.ndLld or.liarcd lorsh ll. ho$c\cr. tlktrildinS.t irntovcrEd t $ki wirhi'r uir ,{ir
<br />or.onlt)lcri,n. rhc otrmr Buihc. sill hlvc rhc hurd.n otF,vin! rhd h- Dr\hc did m tlild or i'irpn)vc rh. pmFny for Ih. PurII,$ or
<br />I. sovtrcr.irhcnmnc.ry. trnrcx.lu\ilclyconrncrins sirh li.cns.d cofkn trs tr, dn,{ncr rh. Ptuicd (Scc 70n4. Btrsnc$
<br />!'d lJDlisbnCod.:'rhcConkNkr-sLiccnscL.\_ocsnorit)plyt)an.\nd.fl)lol. ywh. buildsor imPrcrc\ rhcrcotr.
<br />id uho coftncrsIor ruch,nojccrswirhr Ctnntu(tr(n ll.crNcd lurunl lo rhe Contmttr s Li.cnsc hw)
<br />l nN.r utr(l.i S..ri,
<br />n,,t"o(- 2t' /t
<br />DECI,ISAIAN
<br />I hcrchy ain( ondcr !. lryorFrjLtryotrcofihcl.ln,$i 3ncchrrliux
<br />Ihnvr dwillruirlrinaCcrliljcnrcolCon\cnrk,Sclflr\trcft w.rkcrs comDcndn,n. rs l,n,vid.d r(x h) Sc(i{nr:17(x)olrh.
<br />Lahr Codc. tor rhc p.rromrn.. ulrtu ruk tn shich lhc pcrnrir is i\\urd
<br />Ihrvcrndwill rn air workcrr' conrcnsriior i'rumncc. r\ tuqtrircd btSL\lion:l7ll()oirhc liborCod.,luric Pcrti)nnrD.c of
<br />rh. s.rl tur whi.hrhir Nirnir is tsuen My ff*er' snrncnsrrn,n nrurdkc .rnicr .nd p.lky nun,l,.r rr:
<br />('rri.r:
<br />|i,li.t Nun$ci
<br />I()rLlrxll!:u0NrENDAli-trcEl(I
<br />, hcrhy amm undcr rEntrhrofpcrjury rhdr rhcrc s a conslfl.tion lendinE,gcn.y rd th. Pcriornuncc otrhc sork ior shi.h lhis Pcrnrn n
<br />i\ucd (Sc.. 1097. Civ. C )
<br />l.ndcis Ad&.\r:
<br />AIILISANLI)I'CIASAIION
<br />lrxnh) a,l-rnn undcr pcnslr, or,,crjury om oilhc lollorvirB dcclMrion\:
<br />Dcnnrlirion Pcnnirs A\t{sros Norifi..ridr lr.dfidlR.Sulnrion\ (lirlc 40, I,Im6)
<br />S64"q","a r"',", "r ru'n.,i""
<br />SEit,",rtt 'r,,,tr," *a-,t,.sxL"on\ rcsrd,n8 d,hcn.. rc,ru\ar . { ,n!'r*rhr. ro rhh pmirt.
<br />lSEF,-r,, '*,,*'.,-o,n6 0nnrrariotr and ndc rhrhhc atnlc inrdnrion k.oEccr. I aE c ro conery wirh arr cit,lnd counry
<br />dlli'r r.\ r srrr. l rtr\,rlnrii! !i btr l(l n!.f rnnkr, i. rrl h.rcprcscnl!rivc\ ollhh Cirr rnd C:ounrylo cnlct tFrnrhc
<br />0h,rc nrtrrnnrcd nro|rcdy br insn$ri.n purFscs
<br />"",."xx-5zr/ A>;ae4 *,", rQ(1V49
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />S u bf loor/Ve nV lnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Cerlif
<br />FINAL tl n lrn .1A.tol* I6
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />\2'-v''
<br />--,
<br />Erection Pads
<br />rvu,n fiWlhwl)'
<br />-l
<br />ccnify rhri in rhc pcrLrnrm. oirhc sork l'or vhth rhn,rcrmil k trucd. I \h.ll nor cnlloy lny Perv,n in any nrnrcr
<br />$asrob..o'reubj.cltolhcwo.kcn'comnensarionhw\orctrlir(rnin.,l4eli il I rhould h..orR rubj.rt tornc
<br />*.rk.( .onlpcnqh.n pmvisions oI S(rion l7rx) or rhc titr r c.dc. I sh.ll- fonnNirt s'nply Rirh rbsc lmvisions
<br />WARNINC: FnihE ro {.uft wdr.n .oDlEtrsrlio. n'rcr{sc is unh*rul. nnd \hrll suhj.u m cmPlotcr b GimirJl lEnrhts und
<br />ciil incs rp ro or hondr.d rh.us,nd dollds (S,uj.url))- in lddirion tJ rlt c.s olcomDcn\arioo. drturcls Providcil lor rhc
<br />Sccli.,tr.r','hollFc I Jhr G{.. tr cF{ d rkrrcy'\ lccs -&-
<br />t,,... 06-21 - /g no,n,,./_ .-r;%
<br />LTtENsF D ( oNTIIAcrr rR
<br />DECI.AEA.IION
<br />I hcrcby.flno utrdcr Fnolry of p.rjurr rh,r I s'n li$rc]l tM.r Fn'vhtn' ofCh,prcr 9lc.n'ftn.irg wirI Sc.lion Tooo) orDiviriotr I
<br />of rhc Busin.s md Pmlasiors Codc. md myliccnse i\ in lullr.r.cDdcffccl.
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