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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DDR T)EI,CARATIoN
<br />I h.rby amnn Dnd.. p.nalry or r.rjury rh,r I cx.n r fmm rhd C{,nrNroh Li..ns. tiw for rhc iollowin8 rcasn (Sc..70315
<br />ausircsr nM Phfc\sion Codc): Any City or Con y whi.h rcqutc\ r pcirnit r, conslruct. {lls. imFovc. dcmlnh ur rcFn iny
<br />slrudurc. ririor nr ns h$uncc. rlso lcquircsrhc omlic.nr ior such pcrflrir ro ilc o sisned rtarcmnr rd h.or shc i\ li.cns.i puhunnr
<br />to thc pmvhions of rhc Contrr.lofs Licctr$d L1w (Chi!r$ 9. Conrmn.irg pilh Sc.lion ,0(x) .f Divnion I of rh. Bu\in.s nnd
<br />Itofesio.s Codcror lnar h.o,\hc hcrc.,rr rhcrclromand rhc lEsis lor rh. rlkscdcrcmprion A.rvidarionorscdionT0.ll.5byrny
<br />rmli.dnr ror al.nnn srbjd\ rhc aptli.anr loacivilpcnalryorior.xtrdhan riyc hundrcd dollam (S5m).
<br />I. N own.r ofrhe pbFny, or my.Bplorft\ wirh wagcs trs rhcn v,lc c.,nFtrsrrion. willdo rhc Btrk md thc sltrr@ ir,rn
<br />i cfrLd ororcr.dlnls,lc(Scc7(}14.Susinc$andPinrcsionsCodcThcConrricrolsLic.nscLasdocsn.rrptlyr.ano*mrof
<br />rhc rmpcny *lo hoil.ls or inlxrvcs (hcrcn1, roJ etn, dms {ch w)rt hinscllor hc^.lfor rhough his or hcr owtr c.rtloyces,
<br />orovidcd rhd such nnnmlcmntsNmt irrcd.t or.fcEn lnr eL.Il horcvcr rrE trikling o, in{'owEnr is sll *irhinonc F-
<br />of..rpLri.n. rtr Osnfi Buikhr wi[ hrvc r bodcn.fproving rhr h..rshcdn d tuildor iryrorc lhc preFny for rtE fufl.c of
<br />l. rs.wncrotrhc lnD.J(y. Mrcx.lusivclycotrt.rnr8 with li..nscd.ontracrnF h, cntrslnEl l& Irn'rc.r (S( 7(rr.r. Bu\incs
<br />ana lk't$i$Codc Thc Conkrcr{tr s Liccnsc l.a' dm\ nor spplyn) rio*n.rolFJp. y wh{l builds or irnl)rorcs lhcrcoD.
<br />0trd qh. co ri.rsrorsu.hfrcr.tswnhaCu mdo(s) li.ctrscd !tr^unnt IorhcConrrocrois l,tclsc liq)
<br />Ir r.rc'htrridcrS.ctdn .B &P( for rhis rci\rr
<br />lhlr: (r$n.r
<br />ltoRKtjks' c(r\tI)FNs.(l I(rN
<br />Dr:!u-8ar!al
<br />I h.rcbyrllnDtrn(lrrp.nnlrtol|crjLryotuolr)[lnlk$nrB cclxrxrur:
<br />I hxr {d *ill m,inrsin { Ccn ifi.ic ol Con*d (, S.lf li\urc fur {skc( .on{cnsarion, is po! cd for b, Sccrion ]700 of rhc
<br />Lrnor Codc. lor rhc Frfornunccofrh. sork r{rwhi(h rhc pcrnrir ir i\\&d
<br />_lhJ\c iM *il mal rin \u[cr' rotr,tx'slriotr
<br />rhc qurl ri,r shi.h rl; mnnk i\ n{nJ M\ qorL.'
<br />,.,",., llzdtar++ o*
<br />ios!runcc. as Equtcd h, Sccrion.l?00 ofrh. hborO)dc. fn thc pcrlonuncc ol
<br />r'con,pcnerio! in$ran...ari& a'rd poli.y numhn m
<br />tt^<.r.\.\q-
<br />-l
<br />c.nirrhar itr rhc p.dor.umeofrhc work lor whi.hrhis pcrnrir i\ irsucd.l shrll nur cm!,I)y!.ylEnoi ir rnynunocr
<br />$ as tu tr.om subjt.r b rhc workcrJ .onpcnsari()n lrwr or Cnlironn.. .nd a8rcc rhil il I should tf,co'm subjcd n' rtr
<br />workcn omrcns ion pmlisi.ns ofsc.iion 3700 ollhc kh1r Codc.I shrll.lonhwilh dnnnly *irh rkxc pn,vision\.
<br />WARNING r€ibrc ki ccurc workeli co D.nnrlion covcmec is utrh,tul- and \hdll suhl..r in c Dloycr h aiminalFnrlrics and
<br />.i!il fincs up roorc hundrcd lhousann dollas (SIqr-U)o). in addilh r,, rhc cosr or co'nPcnrarion, da.DBcs as proridcd tor rhc
<br />'tsil 1**01S
<br />!lI!.L!8i!-l!AN
<br />I hctobyrlnrmundcr lcMhy of pctury thrr I am li.ctr*idu crnrornimofChnllcr9(connEncin8$irhSccri T(XIO ol Divisiotr:t
<br />ol rhc Brsines rnd Profcsnns Codc.dd nylirrn{ ir in lirll for.c ri ciTc.r
<br />."JUN [T
<br />,-,..*" *-,*,, LrD o n1 $'t,
<br />V-Lu.u--
<br />IAISIAIJSIIONIENIIIN(;1(iIN.CI
<br />I hcnby rfilrnr undor ,)(trilryofncriuryrhrr rhcrc hrcoastndion lc iryogcncylorlheFrfoflrEnccofrhcw.rklarwhichrhi!tcrnriris
<br />issucd (S 1097.Civ C ).
<br />ATILICANLDECI.AAAIION
<br />I h.R.b, nlnm unlcr r.mlrt of p.rlury urc orrhc lnlk,wint dc.lnrardr\
<br />I)rn'lirion I'c!n1i( Arb.sd Norifi.ain,n Ftd.rrl R.SDl i(,Nr'rirl. {(), Pan6)
<br />Rcqrrcd I.rro' ol Norili.xrtrnl
<br />_t:grrrrJ-
<br />di,,u,
<br />rhrr rh! l.,lcrrlrdgulrriox.cgardi',9 r\hcno\ r.fnnrlxi. nol rptl(rh c r, rh \ t)nic.r
<br />I hnlc rdadrhit Uplr.iriofl 0,kl sl0t. th lh. ihnr inf(mdnrn irc.rsr.I !g.e x)
<br />ordinan(!,trdsr c trssshrinS r. buildinS connrud ior t Ciryand C.utrrr_ to cnts up.tr rhc
<br />xlxrc nrtrrkn,cd f(,|rny lnr iN|r.fotr fur Iit,pli(inr or /\x lsi!nitnr ]t
<br />A..v-
<br />dut.i 2018
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />Su bf loor/Ve nt/ ln s u latio n
<br />Rool Sheathing
<br />Shear Wall
<br />Framing 6/z:lttl ..(/r/E iD
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL v'uns lbst
<br />Certilicate ol Occupancy
<br />Notes, Bemarks, Etc
<br />*,",****, 0[NrJwcrtirtcr?a .
<br />-,,.,'",
<br />SLriion 1076 olrlt Lnb.r C.d.. intcrcsr {nd.tlorrcy s fccs
<br />t.,.t,1'. A'iJ'"s
<br />Forms/Steel/Holdowns
<br />SLAB Floor
<br />T-Bar
<br />Flood Zone Certil.
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