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BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE IDiSIG.COMMENTS
<br />Set Backs -rl ^izlForms/Steel/Holdowns +v\lv\'"lr-
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor fl)r?
<br />Roof Shealhinq 9t TrJ Yn
<br />Shear Wall g''t.ilrl I
<br />Framinq rp>,
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath t rN L??'TA "{2
<br />N4asonry tl
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />E'ora*Jat m*- -1-(-l Q l*t
<br />v\\tur'FINAL Lv)
<br />Certilicate ol Occupancy u-rIrl
<br />Notes, Remarks, Etc
<br />oWNTR AUILDER DELCARAI'IoN
<br />I hc[by rlfiirn utrde. pcnalty,n Fryury rhnr l0arcrc rpl lon lhc (inraclor' Liccnsc La$ li'r lhc lblkirJng rc.$n (sc.7l]-ll5
<br />Burin.s nRl PDlc$ion C{xtc): Any Ciry or Couniy which rcquirc\ ( Frm t, coi{ru.r, slrcr, ihprov.. d.mri$ or rcpff rity
<br />{rudurc, lrffro irs nsurmc. l\o rcquirc\ rhc lptlicrnr {.r ru.h Frnir t) lilc d \i8trcd sorcmni rhal hcor shc h liccnscd puGu.nt
<br />x, rhc puvhions ol rhc Conrrucrofs l-iccn{d liw (Chaprcr 9, Conrmcncin8 wirh Sccrioi 7m0 of Divisnr :l orrhc au\nrrs,nd
<br />Prurds\ion\ Code) or rhrr heorshc iscx.mpr rhcrcfromanJ rhcba\i\ r'or rhr illcgcJ crcmtrn,n AnyviohrionofSNrbnT0ll5byrny
<br />rtplic!.r r.r a p.nhr srbj*n rh. rytlicinr to i civil Fn,lry or to nrRrh fivc hufldrcd dollns ($500)
<br />La\o*ncroarhcpn)ncnr.ormychplorcc\sirhwtrgcsrslnensobconrpcnsdion.willdorh.worlrJrlrh.{rudmismr
<br />i c.d.J oroltcr.d lorslc(Se 7(x4. Businc$,nd Pr.fc\snrns C.dc:'I hd C.nt.cror's Li.cn* tiw des nol omlyloono*nqol
<br />rhc rnsFdy wno 6oild!.! iqretc\ rhcNn. ad *h. des sEh Mrt himscltor hcrclfor rhmu8h hn or hcr owncophr..s,
<br />provid.\C rhar such inpmv.mnh m frn inrcnlcJ dlTc l frn eh.l( h)*.w. rhc tEiklin8 or iqmvcnrnr is$kls'lthinotu )es
<br />ofcory)Lrir\ rhc Ownd Boild$ willhnw rh. hurdci of F,viog rhd h. or shc did nor huili or i pn,vc thc pm|Eny ior thc pqnsol
<br />I. aso*ncrofrhc pK,rcny. r crchsiv.lyconkrcrin8 wirh li.cn\cd roftacr.n t,.onnrud rh. pnJj..i rS(. ?014, Bu{tcss
<br />lnd hDfc$ion Codc rhcConrrucu s l-iccnsc l,owdoc( not ipplyro m.$ncr of propcny who buildsor nnproves rh.ruon.
<br />atrd who.o.trrhrorsuchpmjdsuirh.Co mcto(s ) li.cnscd Nsurtrr lo rhc Co racktr s LiccNe Llw )
<br />I o '(\uorDr utrdc, Sccrio
<br />,"," 5/i, lro
<br />I hclch, nrilrnr undcr lcnrlr, oll)crjuryonc olihc n)lhwint dccrtuaridr(i
<br />I h.v. dd will minr . . Cfijfi.dic of Consctrr r. S.li Insrr. foi workcd .otr1p,nq iotr. 0s lovidcd tu by Sccl ion llx) oI rh.
<br />ttrb.r Crxl., f.r rbc Ffoilm. of rh. eoR ror which rh. pcrdn is i\sxcd
<br />,l hrrc.nd{ill 0iNrin *orkcrr compcns intr iNurlncc. is rcqunL{byScclionlTO0.rrhcLihorC..b-nnihcponnrrnccor
<br />lhc work for whichthh pcnnit i\ hsEd ltry workcrs conrpcnsarion insururcc caricr nftl p.lic, ntrmbcr@
<br />P.li.yNu rbcr: Expncs:
<br />I ccdiiyihlr inrhcrcrrornsn&ofthc worl for $hichrhh nrroir i\ is\trcd.l shrllnor c.!r.yany p.6on in.nynuorcr
<br />vr m Io h..orm suhnrrro lhc *()ricrs coryEnsnrion laws ol (hlifomnr. and !8rec rh ifI should hccom tut'jm' brk
<br />aolkcn'comlcnsolionnmlnionsolScclionl?(Ilotrhclj6.rCodc.lsh!11-lonh*irhcohplywnhrhoepbvisions.
<br />WARNIN(;: Frilurc I. surc Boikes conDcnsalio. covcnrac ir utrl.wful. !.d shau suhr.l M cmpk'ycr ro lrini.nl lrnalris atul
<br />civil fincs xt' ro oR h.drcd rhousand doll0ts (SI00,u)0). in addn ro the co{ ol conEnsarion. d!ruge\ as prcvidcd fd rhc
<br />Scc..n :1076 ofrh. hhr Codc. inrcr.sr md dhrrcy s ltcs
<br />*", s l:tl@
<br />I hcrcbynrlnn uDdcr Pcn0lryolEriuly rhd I an licctrton u r nrovlsion .I Ch!prcr 9lcoomrm i'U wirh Sccrioi 7{Xx)) olDivisidr 3
<br />ul rhc aurncs rd Ptufc$ionsOdc. dt myli.ctrsc is intullforucr clINt.
<br />AITLIIANLDEIIAAAIION
<br />I ncdy alin lndcr pcnlh, ot lcrjury oie ofrnc rollowin8 dr-^l!r!rionsl
<br />t)cmlirnrPcrn h'Ashc(os Nolincationfidcr0l RcEulllionslTnt40- Pan6)
<br />-Rcquncd
<br />L.tl.rof NorfE i)n
<br />I rcniryrhrrrl[ rcd.rx] rcguhrtrntr r.grdi',Ar\b.{o\ rnn^rLxrc Dor tpllehlr ki rhr\ tn!c.r
<br />I ccnilirhnrI h.vc rcod lhaslptlicrrio. xliat.th{rhcrtsr.innxnuio.is.on6..t.l.gretocomtly$nhallCnrrndCo!trry
<br />ordiMn..s nnd Srarc hw\ rcl,ti,re b huildint .onstru.rion.iurh)rir rcnrcsenldivcs oirhh Cilylnd Cotnryt, toi6 $on
<br />'hcrhovc mnit,ncd pmDcny Ior in
<br />D,,", tf
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<br />I PApplicrntorAEe Slans(
<br />Pemir€e mn'€ (pnno:
<br />-?
<br />t
<br />-^ll,l
<br />,
<br />r. , tl \.,?
<br />Sublloor/VenVl nsulation
<br />d?|lt'r?'
<br />Brown Coat 1l atl t*'
<br />tdeltg T
<br />Lienscchs: LiccnscNln$cr:
<br />D.l.: ('onlmctor
<br />II}NSIBICIIIJNIENIIIUG3TiINSI
<br />I hcrhy ,ffinn nnd$ Fmlly of F.jury thot r hcrc is . onnndion Lnding oecncy l'or lhc pcrforrorce of rhc wort ror *hkh rhis p.lnft is
<br />i{s&d (Sn.. .1m7. Civ C )
<br />Irrdcr's Nrmc
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