|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER BU!LDER I,OLCAR-ATION
<br />I h..cby amrn undcr !.nalry or ncdury rhar I m cxcmpl riom rhc ConrracloF l-icenrc Las rhrric lollowins rc,n,n (s.(?0.115
<br />Busircss anl Prof.\n.n Codc) Any Ciry or C.tnr, which rcqlirc\ I ,cdir b .onntucl dlrd, im0i.vc. dcmli\h.r rcnrn Jny
<br />slrucrun. prhr ro ns issu!rcc. alv' to\tui.s rh. ippli.rm t{ \uch pcroi' ro fik r \iBmd {ar.mnr rhd h. or shc ic li.ensd pusunnl
<br />k, rh. pn,vhions of rhc Conr.acktr\ Liccnsd lju lchlprcr 9. ConrmNin8 *ih Sccrion ?0q) ol l)i!ht,n.l orrh. au\in.rl end
<br />Pmlcsi.nsaodc)orrhnrh.orshckcenlprlhcrcfto$.ndrhctrsirlrtrrhcrllcgcdcxc,rytion.AnyurlatiotrofSstion?0.115tiyony
<br />lppliconr tor ! pcnnir suucch lnc llplicanr ro acivilI1cnlllyofn.r nFnln.n fivc iundrcddollon 1S500).
<br />l. $ owmrofrhr pmFdy. or ry.nDloto.\ wnh wrger a\ rhct $k coBncn\dion. *illdo rhc sdrk lrxl rtE (Muc ii h
<br />irreRlc{ or.lt'crcn lnr slc (Sa ?Or4. Busi'rcs! rnn Pror'c$i,nF cqlc: Thc (tnrocn, s l,i.cnsc,r* docs nor apply b rtr owicrol
<br />rhc pmFny who buiLs or nnpo\rr rh.Nn. a't *hn des su.h $.* himscll or h.^clfor rhough his or hc. oqnc'npkJyccs.
<br />nrovid.rl thd su.h nnFohnrnh m nor inrc Lrl or .lT.Ed ftn srlc ll ho*.vLy. rlE huildinS or i,rn oKnrnl n sld wiriin nnc
<br />'rrorconpbtion. rhc O*rcr Buiklcr willhatr thc huKlcn ol povint rhd hc or shc dn ll()t huild.r inrpruvc lhc tmpcny r{n rh. !urt,{ or
<br />l.x\own.rotrhcpmli.nt.a'ncrclusivclvconkacrirgsiriliccnsc{t.otrtrcr{n\k,cof(turrrhcpmjccr(S..7(x-{,Bn\irr((
<br />aniPNli.sion(ndc:rhcCotrtrcktrsl-icc.scl,rwdo.sn.rrptlyk)ino$ncrofpropcny*h.huilso,jnlnnmsrhcr.otr.
<br />rnd tho conknct\ fr such InJcci\ wirh rConhctin Liccns.rl pu$!a brhcC{,nt&ktr's l-i.ctr{ tjsr
<br />I rrrxcnrpr u dorsddnrr . B & I'C lnrrhi{r. (rr
<br />Dole Osn€r:
<br />wonxpns' trrnrprrrslrr0x
<br />DtrCI.ABAUA!
<br />I hcr.hy,iltn ull,]cr pjnally.rl'crjuryom orrhc rollowine dc.ldrari(,n\:
<br />lihtrCodr. lnrrhc ncriornEnceofthc rort f(trshi.h rhc ncnnir il i\\!cd
<br />.\. tr.rl i{ trl,n \ r['. Flrnr '. r-u.d IIt tr rl.'.'.,,{1r1. ' .".'ilt.l!)n'nhr,r..
<br />(,nc ll'tlr*/o+- Cas^ r'nr.
<br />r:r^l a 1. r . \".-
<br />l.cnily rhnr in lhc penhrronce olrhc *ork lor $hich Ihn Frnir is issu.d. I fiall nor cmn[,y rny Ilch.n i'r rny main r
<br />so astu trcom subF.r iJ rh. s.rkcr' drnFn\xrion hw\ ufC,lift,ni,, .iJ aercc rh.r rfl \hould b..onr {tbiccr ro rhc
<br />workcrI .onr!.nsdrn fr ovisions of Sccr i(in l7(Xl .l rl[ l-rktr C( c,I shall. Lnhsirhonlnl, sih ttne fovisions
<br />WARNINC Failurc h rcurc work. c.n!^-nsdrion cov.ngc ir unla$tu|. md {rrll \ubj.rr an.nDk,tcr t, dirnir$l0cmlriN aM
<br />.iril fincs u! ro onc hutrddd rhou{rd doll!^ ($lm,flX)). i'r lddiri,,n ro ih..o{ .f.oflp.hsdriotr. d.nr8cs rs Dn^idcd for thc
<br />uiiit'luu":l)htL\ll\Il(,!
<br />I h.rchy ifirmundcr Fn.lty of perJu.y rhar I am liccnrn undcr tmvhion olChulcr 9(conrmncinB *irh s*iiotr 70fi)) ofDivisbn:t
<br />of rhc Busilrcsssnd Pmfc$ion\ Codc. dmyli.ctreisiinnrn'n.i rrtrrr
<br />o,trrTttn
<br />1n 1q conrr{cror Fa:{rrgJUN frru-"
<br />TANSIBIJCIION.LINDINC.AQINI:.I
<br />I hcrchy 0f,irar undcr lcnaltyofncrlry rh rhcrc n r snsrrucr htr lcndiry aBcncy lor lic pc.iomncc ol rhc *ork for shich lhis pcmi is
<br />is\ucd (Sc. 1097.Civ. C ).
<br />AIIIIIjANLOECIAAAIIQ!
<br />I ltrr-by ohn u cr rn.lly or'Dcrjury onc or lic fo]loRirB d(lararions:
<br />Dcnmlirrn Prnnik-Ash.fos Norifl.ahotr Ijcdcrnl Rcguhriotr\ (Tirl. Llo. Pan6r
<br />Rcqun.d rrii.r of Nolilicarinr
<br />-l
<br />ccnitirhu rhclcdcalEguloriotrsrcsadin8 0sbcsos rcnnrnlarc mt 0pllicoblc ro rhis pre]ecl
<br />!-l dili ihd I hu,. ,",,1 rhh apnli.ari.r .nl ntrrc rhar rhc rh,vc n'Iorm,r idr t con.d I 08re ro comtl, wirh all ciry snd couni,
<br />onlinnn.os Md Star. bw. rclxrinS b buildin8 conslru.rion, &d hcrcbyaulbrizc rctrcscnhrivcs ofrhh Cii, !trd Counry ro cms rl)on rh.
<br />ah,vc nrtrriqE,lpr)runy ftn ir\jb-^'riD !urrx){s
<br />'\tplicrnl or tcnl Signalu
<br />.9r,t
<br />I !N ilI t]1n
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing b/ t?/s > fJ a'(
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />ltrlason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL i/3/b 4nEsK
<br />Certilicate ol Occu pancy
<br />COMMENTS
<br />UFER Ground
<br />Notes, Remarks, Etc.
<br />(,/ a^',
<br />-r------
<br />I
|