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BUILDING. INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Sheathinq l/[o/L
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certit.
<br />FINAL tt0\/(t 5Aift
<br />Certificate of Occupancy I
<br />Notes, Remarks, Etc
<br />7,
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<br />OWNI]R BUILDER DNI,CARATIoN
<br />I hcrcb, umn undcr ,. rlry of lrcrjury rhat I m crcnrPl ircm rhc c.ntu.k'N Li(cns ljr r{- rhe idloqin8 rcasn is( 70ll 5,
<br />Bu\incss Md Pnrtssiotr Codc) Any Cirt or Counry whi.h rcqui.\ ! Pcrnril k' cotr( .t. rltcr, inProvc. dcmNh r rntrn rtr,
<br />nrucrurc, Dior ro irs i\sunc., trlso rcquncs drapplica itr such Fcnrir i' lllca 1i8trcd dllcnEnl rhlr hcor\hc t liccnscd l)llrr'3!r
<br />k) rhr nn)lisons or f Cotrtrs.lor'l Liccrqi Law (Chrflft t). cunnncrcin-s wilh S.crn,n 7uD oi Divisiotr:l ofrh. Btr(nr\\ rRl
<br />Pn,fcsri,,ns Codd) orrhd h.orshc iscrcnpr lhrrcfionrnid rhc brsn totlhc rllcgcd crcnlJ)rdr' Anyviohtn'nofSslionT0:tl 5 by rn)
<br />dppli.a lbr d p.irnii suhjslslhc rprri., k,,.ivil Nnilry or nol flDre rhu fivd hundr&l dollah ($50)
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<br />0s owmr ofihc pn,lcny. or my cnlloyccs *irh {agcs E\ rhct $L .!mD.nerion. *i!l do rh. wolt ond rtE srulr i1 i.'
<br />id.nd.d or olttrcd lor slc (S( 7l}14, Busiftss anrt PflJlcssions Codc:-fhc G,ntacror's Liccns ll* do* nur.nplv to 0n osncr of
<br />rhc pnlrdy wk, hdilds or iDpr.vcs rhc't,n. turd who d@s su.h wnt hi'nrcllor h.rsclfor rhouah hk o' hc, owncmplovcc\.
<br />providcd rh|r skh i'nptuvcnEns ffe mr inrcDdc,l or olTcftd fd s L ll ho$cvcr. rhc buildi'r8 or iDlrot,mnl is *,H wiihi'r o c F{
<br />or coq,hrion. lhc (){ nc. Brildd will hrv. th. burdcn of rovinB thll h. o' $c dil m! noik or iqtrov hc Popcny for thc I)!{b( of
<br />-1.asow.eroalhcp'.ndy.,mcrclusilclycont,uclirgwirhliccn*d.onrntosloconsrtu.rrrrrn,jN(Se7L!t'1
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<br />and E lssbncodc:ThcConlrocroirl-ic.ns.trwdocstrorqrplytootrosncr.rrn'pc ywho huiklsor i'nltuvcs thcrcon-
<br />ud who conracls ft, ruch Imj(h with i G'.rruclo( o liccnrd p!^und ro rhc Conrrack,\ Li.crsc hw).
<br />liNcxcm|l utrdcrS.cri{rr-- l} & PC ttrrhi\rcnn
<br />}IABtr]i&):(AMIINSA]ION
<br />D&CLABAIIO
<br />I hcr$y nl'itDundcr pcnrlrrofp(rjrryotrc olihc tulb* inr .lcrhrd trrs
<br />-lhrvcudaillmidindccnilicnlcolConsclllr.s.lalrsurcrorworkcr'dnnP.nsdnnr.asflovn[dforbvscction]700oitbeIjhor Codc. forlhcpcrformnccorrhc sort lor shichthe lqnir n issuld.
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<br />harc and will mnimrin wrr*cs compcns ion insnrrk.. rr r.quircd $ysr-'rion l70O.fth. bh.! Cod. f rhc [tcrfonurce of
<br />rhc wort t r whichrhhr.irnir is isqcd Myworkds .otrDcns,tion bsu.!rcccMidr tuxltolicynunbs dc:
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<br />thLt cti.r.tt in,
<br />N,,,.,1, (wt717q7 - t0o I 0l tl
<br />l.cnrry rhrr in tlE l)crfoounrc ofrlt work for which rhh Fnnir i\ i\sucd. I drll trol cmploy any l.rsotr in rnv manner
<br />$ as ro hcqnm su$Jccr t,rhc sork cis' co mrcnsd ion U*solCxlif(mir, rtrd nlNc rixril I \hould tEcoflE ruhjccr b lhc
<br />$ortcts conrpcnslri{)n povnions ofScctiotr l70O ofrhc utxr C{xlc.l sh.ll. tonh*irh RnnPlv sirh tlbsc Pmvin,n\
<br />WARNING Frilurc lo Burc sorkc* com!.nsnr$n ovcnr. is utrl!*tuI. nnd shill suhid rn cmpk'ycr l. ctininrlp.nrlrics rid
<br />L 'l lN\ un t' nrc hundrcll rh,,u\Jftl d
<br />l ,sc.rn r ru7n.l rh. t hr Cn'lc. inr.rc{ r d
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<br />r! rhc .on ol conDcn\Jrion, d0.u8cs as Povidd r(r rlE
<br />I hcrhy rllnnr dc' N alrl.l tkrjury rl r I m li.r {d u dcr uhn,nolChqrrcr9i.otrnmn.irs trilhSccriid r0ur) oiDivi\ion.l
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<br />Ihcr.ty !firnxidcr p.tr ryolPcriuryrhd$crcisrconsrru.riunLndingnaccyrorrhct'cilonun.cofrhtsorkluwhthrhi\Frnriri\
<br />tsucd (Scc.3l)r?. Civ C ).
<br />A.PTLICANI.DIILIXAII!}N
<br />I hcnny alnm nnds p.n.xy olF jury om ofthc n,lk,wiog d.cld,rhns:
<br />D.nolition Pcnnik'Asbc(os Norin.arion Fcncml Rc8uhlhns (Tillc 10, Pd6)
<br />-Requircd
<br />L€llq of Norir,&rioi
<br />_l..n,ry rhd rh. fcdcral lcEularions
<br />I co'ri,r rh lhr\.rc (lr I rgK rocomrly sirh rll Cityx.tl Coonry
<br />flr.rivcs ofrhh Ciry,nd Coutrlyto cnrcr DFn' rhc
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<br />of rhc BusircssaM Profc\sionrCod., dd nry li.cnsc is in lullfitrrudcffc.r.
<br />Lndcis Nam'-
<br />onl' n .cs d Srnrc hws
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