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BUILDING. INSPECTOB RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BT'ILDER DELCARiTION
<br />, hcrchy !finn undcr pcnllry ol pcrjuiy rhar I m.r.ntnr rmrn rh. Conrrados l-icens Iiw fu rh. n,lbsih8 rcdr)n (S..?0ll5
<br />Bu\i'rcs trdl Prottsion C,xl.): Any Cny or Coutrty Bhich rcquircs a llcrnir b .on{rucr, allcr, nnpruvc, dcmolish or rcpM ,ny
<br />{ru.rurc. plntrk, ir\ ku.ncc. alw rcquncs rhc afpliclnr Lr such pclmn ro nbrsi!rcd (dcnf, th tE.r shc i\ liccnsod Pusuani
<br />lo lhc nrovnions o, thc Conrrac(tr s Li.cnsd uw (ch,pr$ 9. Coln.rncins si(h ft.rion 7fix).r Divisi.n 3 ollhc Blsinc* and
<br />Pn,r.rsi('ns Code) dr rhr h. or lh. t cr.mnl lh.rctomalld lh. t{sis ntr rhc dkr.d ct mptiotr. Anyriol.lion ofSccrion 70115 by,ny
<br />lpllic r tor. lcirnir subjccrsrhc oppli$n! r.,.ivilpcnalryotn.r morc rhan tuc hundrcddollars lS5@)
<br />-1.
<br />rs osncr orrhr tr.lfny. or mycmplorrs wilh w,scs 3s lhcir slc con{i..sanon. wrll do tlE work d]d thc dod!ft L n.r
<br />iNcelcd or ofictod li, $lc (Ss 70a,4- B!\inc$ lnd Profc$ions C{xle Ttr conrrucloas Liccnsc Llw does nor lPlly r. M owncr of
<br />rhcpmrcny *ho huilds or in{reB rh6n,,rxl who &rs ruch woll hinsclf.r hcrrllor lhnugh his.r hcr own cmtloyccs.
<br />ptuvidrd rhrr :u.h inDn)Enrnrs m ml i,rrcMcd or ofcrcd ntr uh lt hosrcr, rtr h ilding or invmk'ftnr h $ld wirhin.m )trr
<br />ofco,rrldi,n. rh. owrcr Builds will h!rc rnc no.dctr of rrarirs rh,l hc or shc dit nor blild ot itr{Jhvu tu pftFiy fot rhc l]uqre of
<br />l. r!ovnd oirhc protcny. nmcrclusivelycoikrcring eirh lic.n\cd .o nt 0.bF b.otr\|ru.1lhc pr+cr lS.. ?o4-4, Bnrnc$
<br />ud Ptrncssioo Codc ThcC.ntad.r'\ Li.cnrc Las docs i.r rppl!ro ino*ncr oiprrFny*ho hrild\or nnPflrvcs ihcrcon.
<br />rtrd who .onr*r\ f(r su.h pr'lccl s wilh ! Conlacror I n liccn\cd pu.sla n,rhcClonrn rtr's Liccnsc l-!w)
<br />I rncrrm0 o'!&r s(.otr-.11 & l'C litrrhiicrnn
<br />(rencr:
<br />!uraKi&!19-uElis IIQN
<br />DtsclAAAIlON
<br />I hcrchy!llirnrundcr nctrrlryorrrcrioryontof rhc lalha rE dc.larnrtun!
<br />-l
<br />h0!c md will roinrain a Cenificdc orcon*nr ro srlf.Ir\urc rr $orkcc con{EN{ ion- rs proviitcd t byS.crio..1700ofrhc
<br />titx1r Carlc. for rhc pnloirurcc olrhc *o for whth fic pcrm ii nsu.d.
<br />-l luE rndwillnEinrii n ni{rnN.. N tulun.d hy Sc.lidr.r7(xrolrlt l. hor (i c.lhi rhc FrlnnnrD.c.l
<br />.rrirxrl T)li.l nr n{r nrc*_,,tr:r,lur."
<br />*a' "1 n, rtu con ol c.nrNnsnriqr. ni mgcs !r piovid.d for lh.
<br />I hceby atlim undd r.nahy ol t'.rjury lhnt I am [ensd undcr Imvhion olch.pt.r 9 (conmrcncing wirh S(lion 7fix]) ofDivhbn l
<br />of lhc Busircssnnd tmfcssn,nsCod., dnd ny ltcnk is h tulltbnc orxl cflccr
<br />cqvE c
<br />))
<br />I I'crchtnfinnu dcr tctr t
<br />nsucJ rscc 1097 Civ C: i
<br />I pcrltryrhrr rhcrc i\ a.{,n(ru.ri(r lr
<br />A.ITLICANTDIII,II3A.IIAB
<br />I hdrt,nnmlndd p.ndhy orp.rFr, otre otrhc t('llowins d"d- nr!
<br />Dcnnnition Ptrmits Asbcsos Notifi.ari.n [cdcral Rc3lkrn,nr Onb40. Prn6)
<br />_Rcqxncd tlrtc. of NotifE.tion
<br />I.cn'ryrhdlhclidcrrlrcruhln,n\(g Jin!J\hdo\.1 $nlrrc tror dt'tlicxh[ ri] rhi\ nn,arr
<br />*lccniiyth l hrvc rcud rhis,ptli.rrion,rn ar. rhlt thc otrrc i.fornulion is.oft.r l aSc ro.omdy wilh oll Cnr {nd (
<br />ordinunccs md Srarc tiwi rclaringt, buiHin8.onstruclion. ad hcrchy rurhorizc rctrcsnhlncs oithh Cily and
<br />,bvc nf,di(trrd pft,Nny in
<br />,\r,pli$nl or ,\*cnl Sign lum
<br />Pcnnil$ ntrnr lp.inl ):
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq LlzG IrB .A.4.ttD lblA to P( ttt< . G*.+c S al fu*,
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL -/ln lty ,{,(l( 7 r tq)
<br />Certif icate of Occupancy tl
<br />Noles, Remarks, Etc.
<br />Ext./lnt. Lath
<br />l.cnilrrh,r in rhcrcrlo nccoflhe wort I'or whichrht p(flnil is i\\u.d.l drll not cmtloyonyPc6on in riylndncr
<br />n, rsroh.roNsuh]c.thrhc"1 cn.on1p.n! i,,tr lrws or cnliromii. nrr!8rc hll ifI \hould hcd,m subjNt l.ItE
<br />sorkcrJ omrcnslrion prorhions oI sc.r i(,n :1700 of rhc tjh.r aic, I shdl. fonhwirh comply e irh rho* pn tirions
<br />IVARNINC, Failorc h *cur. trorkcr' compcnrdion corrrrgc is unlawiul. rnd drall rubJ.cr rn cnrrloler ro rinriml lrBlri.c and
<br />tr'nJur ' AJ,lrc$
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