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BUILDINI. INSPECTOR BECORD
<br />OM ENTSSITE-WORK DATE ID/SIG.OWNI'R AUILDER DEI,CATATI(}N
<br />I hcrchy amrm lndcr r.nrlry or l)crrury lh.l I 0m €xcmfl ln,nr rhc Coita.bs- Licctrrc lis tn, rh. n,lhwing runsr lscc 7031 5
<br />Busincsr ard Pn,fcssion Codc) Any Ciry o! Coutrr, whi.h rcquncs r Pcfllil r. conitu.r. dr$, rnProvc. dcm.lish or (-|un My
<br />stru.rurc. gior lo ils issurncc. ul$ rcqun \ rhc tpPli.mr nn {r.h lEnnir r. file! lirn.d arcnrtrr lhlt hcor she is li..n\cd Nrstnt
<br />t, rhc novisi.nc ortfu Conlmclols Licensd Li* (Chaplcr 9, condcminS wirh Sccrion 7(x) or Division I oI rh. Bu\ines rnd
<br />Pmlcsions Codc) or lhal Lo!shc kcrcnu rh.turi(,mnnd rh.bnsn ior lhc illcscd cx.tr'prion A yviolarionofS(rion70:ll5byrny
<br />inpli.lnrforapcnhit\ubjLyhrh.,npli.lnlro!.ivilpenrllyolnotnncrh,trfirchutrdrcddollrls5lx)
<br />L N owncr olrhc pripcny. or my rtpl,Dtc\ wirh saScs rs rhcir solc compctr\arion. sill do rh. work uld lhe nB1!n k ior
<br />irn.ndcd orollcrcd tur\slclsd 7044. Busilc* trd Pronsidr aod.: The Conrx.ttr's LiccNc L.rw docs noraPpllt,trtruwncrol
<br />rhc DNncl1y who tdilds or i'lrl)mrs rh.Rrnr. Md tho de( su(h $)r* hnn\cllor hcr\cll,tr rhroush h(., hcr own c.lpk,rcr!.
<br />ln)vidcd rh r su.h i'nlF^uEnhmloi i .trJcd o'oftRltur {L ll h.trcur rh. huildin8 or tryro\ unEnr h $kl wirhi""r hr
<br />oi$DDldion.lhc O*ic' Buildd willrun rhc liordq oiprovins rhx he or \h. did n.r builtl or in{rcvc ft pn,I.ny for rh. PurF{of
<br />-1.
<br />!\owrcroirh. pn,p.dt. anrcxclusivclycontrlclina wilh lic.nscd.oit .trs h coDntud lhc Pojccr (Sc..704-1. Sunnc$
<br />uid PnassirnQ)dc:lhcConlrNrofsl,i.cn\cl-nwdocsnorlpflyror.owtrctofPx,tc ywh.buildsotinrPovc\ihcrcon
<br />ann who.odrac(IorsuchrtuFd\wnhrCnnln.lM(rli(c.\cdl]ur\or t)rhcGnractoirLiccn\cLrw)
<br />I rn,urhot unJ( Sclron .B &P(- f,r rhn rcrrn
<br />D6t€: O*ner:
<br />woRxFRs' c()MPENSI tXIN
<br />DICIAXAIIAN
<br />t h(r.hy rfilnnundcr lEnilry otrcrlutyonc of rh. ftnb*ing dNlnrdrn s
<br />-l
<br />havc .nd will rMinrlin a C.rrificarc of Con* r ro Sclll trsrc for sorkeF coorcn\drion. ar fmvided ior hy Sdion ]7m or lhc
<br />hbor Cod.. lbr rhc Frformnce ol rhc *olk fff whi.h rhe Pcnnn is hsuc!
<br />rhc tr.rk Ltr {l,ih r[n ll.nnir rs i\s]cl Niy *or k.rr ..n:lEr\rri{r ii\urrn.c rnr rtulplicy ntrnrhcmc
<br />Iccnrlyrh nrrh. Nil'oflmnccolrlN work lbr wl'ich rhi\ pcn [ ls is$cd.I shr]lnor enrplotr yl)fn r ir inynnnn{r
<br />v, $ lo bcconE \u6J$r ro rfu workc^ .onDctrcthon l.trs ofCtliioDi!. md 4ruc rhd ifl shuuld h(oN lubJcd tr, rlf,
<br />wor[cs o'nn nslr i(r pmviiio s ol S..rion :lTm ol rhc titlr Ox]e. l shrll lnnhqnh .unDly * irh rh,{ Pmvirnnn.
<br />W/tRNIN(;] Farlurc h surc *orkc^ snnp.tr\nrion .orrrgr i\ unliwful. ind sh!|l\utJe.r rn.trltlL]tr ro aininrlpcrolrhs Jnd
<br />.r'l l '.( uI i, ntrc I'u.drcd l-nu."nd J,,llJ'. r(llvr(xro,.rhc cosr ol con,tc eri,nr. drmgc\ !s nrolidcd r(r rhc
<br />s.cr,.tr lr,r6 orrh.lrbor C
<br />D,,€, -7tql,
<br />o'le i'rcrr! r d [on*y-\
<br />?
<br />DECI.AB{ITON
<br />I hcrcl,y !flirn lodcr p.naxy of pcrjury th{t I am liearn undcr prolision orChnPrc.9 (commEins snh scdb.7ur0) ofDivisn,i l
<br />ol rhc ausircss ad Pmlc\rionr Codc. ond my li.cn$ is in tull foEc ard cr'fkr
<br />4'=1 z 4-2a41I-r..tr{ clt'l
<br />tq /g
<br />a @- raNiur,rcrroNrDN,rNciliENq
<br />I hcrchy rfinnrnM.r pcnohyoipcrJuryrhur rhcft is d..n(d.rn,n lclrding qcncy fitr rhc !. fonnnrrc ol rhc *.rl loi *hirh rhis,tanir is
<br />is\ucd (Sec. .1097. Civ. C.)
<br />LLj!,*ald'""
<br />ATELICANIIECIASTIIO!
<br />I lE$y iliinn u ndcr pcnslrr.rp.!ory otrc ollhc lollowirs d.chririons:
<br />Dcnx,litinn Pcrmih-Asb.\ros Norifi.ardr rcdral Rcsul.rNn\(lirl.40. Prn6)
<br />Rcqutcd t rlcrof Norificarn,n
<br />l cUriryihrr rh. fcd.nlrceullli.trs rc!!rdi'ra xslrno cnn,vrl rrc Dor iffll.ahlc k, ihi\ Pflrccr
<br />I.cflrrythit I nrvc rc.drhn rpplic h,v. inli,nuri,)n i!c.mr I a8d to con{ly wnh all Ciry ind Counry
<br />ordnDkcsaM St(rc Ussalnriry k, hu nd hcrchy rurhoir rcprc\.nrdncs olthis Ciry md Connry ro cntcr upon rhc
<br />rt,vd 'm ton.d rtuFny l'ot
<br />rS A /.-,+Z
<br />el"l s
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq /,
<br />Shear Wall
<br />,r'{w e ?I,UG'
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL ///b//f 9//16.'14 1E-'
<br />Certificate of Occupancy '/ -
<br />o^-/
<br />7*7 2a) za -Qltt ,*&t -
<br />..1 A
<br />Set Backs
<br />Subf loor/VenVl nsulation
<br />a)
<br />Ext./lnt. Lath
<br />Noles, nemarks, Etc.
<br />t n&r'\ Nemc
<br />-\Dplnrtrlori[.nl Sis ! rc
<br />fT
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