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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG,COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />WRoof SheathinqT-l/ O l*U7n 112J4 <'a >7.rJ
<br />Shear Wall
<br />Framin g
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL h//r'rf >.1 7)
<br />Cert iticate of Occupincy -7
<br />Notes Remarks, Etc
<br />OWNEN BUILDER DELC,!RATION
<br />I hcrci'r,innr lNlcr pcnall, ol pcrjurr rhat I m excnrfl 6onr thc Contraclom'Lknsc t w lor lhc iollovirB rclen lscc.70]1.5
<br />Busirc\s nnd Pi(nassi,)n Cod.): Any Ciry or Co! , which rcquircs I I.rmit lo on\lrucr. altcl iqrrcvc, dcmlisn or rcI]on lny
<br />srrucl!,c- Fior ro ilr hsuarcc. aho rcquncslhc applic0trr ro! such Fi'nir lo filc r signcd slar.nrnr rhar t[or shc is h.cn$d t'UHUnnr
<br />ro lhc pmvisions.rrtr Conkr.rors Li.cnsM L!* (Chlllrer 9. Comrcncins sirh Sccrion ro(n of Division I of the Bu\inc\s lnd
<br />Pmr'csions codc) or rh,r rr or shc h.rcmpr rh.r.rroo Md rhc tEsi\ lor rhc allcs.n dcmplion. Anyviolaiio.ofSucrionT0.ll5hyan,
<br />ffi ffiilffi;-=#;;;;ffiffi ,*,**i,*,**.,,
<br />rhc fn,Frly wh' builds or i.pnrws rh.Nn. ud who dNs sch srk himscll or h.^e ll or rhmtrCh hi\ or her o*n cmpkrycc\.
<br />,nrvid.d rhrr such inrmEnnh aflx, inrrndcJ or ofieEt ior sh ll h.scrcr. rlE hoildins or in{,orcmd is eld vilhin onc ){u
<br />o,con{,kli,n. rhc Owmr Buit+r will hurc Ihc bud.. or povin8 rh,r hor shc dkl mr toild or if$tulc tr tmltny ror IrE puqns or
<br />!\ooncrorrh.pn)pcn!.0'ncxclusirclvcoMicrin8*irhriccnrdconaldorloconsrrucrrhcDrojcdrsc. Tlx-1.Bunncs
<br />rRl Pnni\sion G)dc: Thc Contrrttr\ Li.cnsc Law du.\ nor apply ro M owner ofpropcn, who build\ or inpmlrs rh.rc.i.
<br />a.d sho conrEcts lu su.h Eojccrs sith ! Conh.rons) lianscd puNaN
<br />'o
<br />rhc Conrrtoas Liccns tjw)
<br />li'
<br />Ist I $ "-*",
<br />DECI,AE6IIO!
<br />I r-chya,nirnundcr lEmltyolacrryotrcoirhc rollo*ir! d.cldrarion\:
<br />' /l havd rlwillnrnnrinrC.nificridorCoo\cnrroSclflnsurclor*orkcr'compcnsdion.!stmvidcdfo.bySccrion:lTlnolrhc
<br />Lrtrr C{xlc. r'or lhc pc olmnccoflhc work lo,which thc psnrn n kucd.
<br />vcrtulrvill rtr ni'rwo cN.(nnpc satn,n in\urrncc. rs rcquircnhySccti()n.l7lx)olrhclih.rCod.,ntrrhcpcrfonmnrol
<br />$.rk,nr$hicIrhisNnn[r(isuLrlMysork${.on1pcn\]ri,n,nLurrnc.umcrrdB,lir"tr!n,h(rnrc
<br />Polic\ Nunrhcr'- l-\nR,
<br />I(irilyihnri'rrhc|*nnnnrnc.ofrh.sorklnwhichlhislErnlnhsucd.Irh3llnoreutloynnypc6oninatry,rn'u
<br />s'srohcconEshlcdr()rhcw{)!lslconrNnsarionlawsofcdlifoni{indigic.rhnriflsh)uldh...trrsuhjo.rrorl..
<br />*rrkcn' conrFr\orion fovi\ ions oi S$lio 37([ oi rhc Lrbr Codc. I drll. tonhwnh comtly sirh thos pmvisnnr.
<br />WARNING: hilulc n, B.urc Norkcn .omrensrrion corcmsc i\ unhwtul. rnd shrll suhjccr rn cmDlorcr lo crimiNlpcmllic\ Jtrd
<br />.'vLl lnros ut, ri .n. l,tr rdl rhou\rnd
<br />:::-"5',r;ilt? """
<br />{loll6 l!l(xJ.0U)). ir iddir lrc cosl ol coDrpcDxatim.
<br />I I(]IiNSED CoNTRAL''I'('R
<br />DrlttaAr.loN
<br />I hcrcbydlllrnu rr FnJly.fFrjury rhar I nm li(nssl uodcr prorhion ofChapter 9 (.ofrftncin8 wnh Sdrbn 7000).fDivisn,n l
<br />nr rhc Bu\nr\\ und fnlt$i(in\Codc. uod nry liccnsc n i. tull forcc d.ftirr
<br />caNElf,ltcuoNrrNllltia{i[NtI
<br />Ihcrchydflirn\u.rJrnrlry.lr.rjuryrhrrrhcrcisa.onntudionkndinErgcncylnrrh.Frfortun..ofrhcrrtrknnwhEhrhisFynm(
<br />i\\ucrtrs.c lll)7. Civ C r
<br />A.TTLICANLDECI,INAUON
<br />I tErhynitrurdcr pcn.lly oipcrjury onc olthc fol6wnr8 dc.lftrn ns
<br />D.rmlIn P.rnrir$Ashc(osNorifi. nr Fcd.rrl RcAulari{,ns('Iirlc,10- Pfi6)
<br />-Rcqutcd
<br />l.rrcr ol Notiicdiotr
<br />l.dnrly rl rrh.l.tl.ftltululxriiiDs rclrnliDSr\hc{o\r.nn,vrllrc f.r !J,l]li.ihl. n, rhi\ fr!..r
<br />..nlrrrhnrlrDlcrcrdrhisrfplirari(Det\rrrcrharrh.{hnrinlonNio.i\corc.r l!E *roconuly$irhrllCirta Counry
<br />oftlnirN.\ nd Srnc l-r$\rLri',9 n)
<br />rh,r. nrd iinRl In)pdr ry lnr in\Fcr
<br />AD[lic,nr or Agenr Sitnniue
<br />Pmnirce nore lDri nl)r 'a(,,-€Lt
<br />'i".''uil;fifl
<br />Sublloor/VenVl nsulation
<br />Flood Zone Certif.
<br />I
<br />l.n'llr'\ \J\l,c-
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