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BUILDING. INSPECTOR BECORD
<br />SITE.WORK DATE tD/stG.COMMENTS OWNER BTIILDI]R DFJLCARA'IION
<br />I hdrchy rrlth undcr pctral(y.r Frjry rhll I rmcxcrrpl rionr lhc (innrNl,,r t,iccnsc l,rw l$ lhc lnlk,rin! rcr\. (s& 70.115
<br />Bunncs\ rM Pmt l\i(,n C(xl.) Any Ciry or C(rnr! shich rcqutcs r p.nnir t) corntu.r, rlrd. i'nptuvc. d.nxnish ,{ rc|trir Jtry
<br />{ructuc. triorr. irs isu ce. rko rcqutcr th. lplni.Mr tur \u.h Fnnir ro riL n si8ncd $ ar.mnr thnl hcor sh. k liccn\cd pursrnt
<br />l. rhc lnJrnion\ of rhc Coitackr's Li..nrd trw (Ch!pr.r 9. Conmcncin8 virh S..rtun ?O0O of Dilil n I of rhc aus $1 md
<br />P0iessiursCodc) or rht( hcorshc iscxcmpl rhcaftoral]d rhchrsir f rhc rllcgcd cxcnrptlotr Anyvnn{xotrolscction?0ll5hyany
<br />rmlicxtrrfinatrmir\uhlccr\ihcrpplicanit,scivilpc.iltyoinotBtrcihrnlivchdndrcl,lolh^rs50o)
<br />-l-
<br />!r owner oi lhc popcny. or my cmpl,)yccs wirh wr8cs rs rhcn ni h co"r|xns.rion. will do llE work and lhc (urur is mr
<br />inrcnlcd or ofrcrcd f{tr slc (Scc ?OiJ. Busines and PF{c$ions Codc Tnc Conrracroi\ l-iccn* Ljw dml n r apply t, Moqn.r of
<br />rhclotEdy who builds or iNn,vcs rh.mn. ud qh. d@s such w.rk hnn{lfor hcsclfor thruugh hn or hcr owncmploycc!.
<br />ln,vidsl rh,r skh i protcntnh m nor inrcftl.rl or o,IcRl lor sh li lx,wevcr. ttr huiklilE or ir'll,mwnrnr i\ sll wirh onc ,sr
<br />olcolrll'l€lhn- lh.()*ner Auiklcr qillhorc rhc hrdcn of F)virE ltur lt or nE d d not build or nlll'rorc lhc lr(,trny n, rhc puqn{ ol
<br />l,!rownc!olrhcpr.J}cny.rmcxclusirclyconn.clin8wihlicc.s co mcror lo consrrucr rhc nreicl (Scc 7Ot4- Bu\incs
<br />rl Pn)frslnn CGlc. Thr Cl)ntacktr s Lic.n\c Lr* doc\ not apply b m ownr ofptup.ny sh() burlds or nnpr.\ts ihcrcon.
<br />rnrl who onlmcls r'or such projcch uirh n coftrcro(9 lrcnscd rurru rt brhc (t,trlmckn s Liccnsc Ln$).
<br />I rnc\.trrtr utrtlcr Sccrn,.,J & PC ,(trlhh rcas,r
<br />troBtrDS[cl]MflNta.IllN
<br />DECIJNAUON
<br />I hcrcby.flirn undfi r.n,lrt or pdjury om orrh. lnll({i.g de.hrnii.ns:
<br />fl havc md $ ill nuinrtrin a canir.nr. or consnr ro sclr lnsurd nn w.rkc^ .onl.nsrion, N providcd ror bt s(tio.17fi)ofrhc
<br />Llt.r G)dc. fdr rh. I.rf.ntun.c ofrh. wolk fd whi.h rhc pcrn,it i\ issoql
<br />1l hrvc .nd q ill noinrlin workcr' compcnsarion nNurnmc. as rcquncd hy scchon r7(D oI thc tibor code. tnr rhc tarforutc ol
<br />lhe work for which lhi pcrnril is hud My vortcn cotrqxnsarion insumncc carhr and Inlicy numhcr sel
<br />i t+wnY,
<br />rl tk'
<br />-l
<br />cenilrrhar inrhc pcrforrume oirhc*ork nn whichthisrcnnir h n cd.I fiallnor cnlloyany
<br />b N ro lroft subjL{r h rh. s. cri ...9.nsrrion Lw\ of Crlif(,iir. , d ,grcc rh[ if I stx{ld b. rnr {hi.d h rhc
<br />w.rlcrs.onf.n\drhnpm$i(,nsorSNtn,n:lTmofrhctitrrC{..1\hdln)dhwirh.onflywirhrlxrclnrvisidx
<br />W RNING: lirihr ro {curc sorkc^ .omncnsarion covcra8c is unhqtul. and \hrll \lhjccr m ctrlpbycr t, di'nirdl lfMlri.\ rnd
<br />.nil finc\ up i, onc hondfud rhousntot do)ln^ lsl(n,(Xx)). in rddiii{rn ro rhc co{ ofc.nrFnsrrhn. drnb8.\ r\ rn,v cdf(trrhc
<br />"^,",' 1/rol,* ^*,,-,,X-6"'t- S&'oeI<(
<br />I I I |CINSED C(rNTl{A( IORt lE!].irxlllgr
<br />I hcEhy rllirD utrdcr pcnrlly.l |xrjuy rhal I rD li.cn{d trndcr rrftrirlot orChrprd 9 (.oNncn.i|s wirh Scclion ?0001orivi\iof .l
<br />ol rhc Busirc\(.M Pr'fcsroN C.dc, turl.rt li..n\c i! in fulllhrd md.lL\r ,
<br />,.iccnscNtrtrrh.r: - lojl z-,3€I {0 rQ:,'-"** >i ifuo^ O-*.n ylo.. +rov,.
<br />(INSfB!(TIOI l,L\DIti! r\crN(r
<br />t hcEby rIItrr undcr lEntrllyolpcrjurythal lhcE n tr onsldction lcndin8 a8crcy for thc rcrformncc ollhc work lor whtn rhis Fntir is
<br />hsucd(Sc.. lgl7.Civ. C ).
<br />Attutl![I]E!;LAaaultN
<br />I lfn+ry.tln u M.r ,.nslry ol p.rjuiy oft.lrhc nrhwinA dccl&rrions
<br />D Trlirir,n Pc'n'ir\ a\hc.k* \d,ftr'ir,r Fcd.3lRcpu.J.iol, r'I lc,]Irrd6i
<br />Rcquirdt (.rofNorikdbi
<br />lccnifyrhat rhc lcdcnrlrcsullrionsrsudir8d\beslosrcDrovrla.c mt rppliclhlc lo rht pnr.cr
<br />ral.cnnirh l hrr. rcnd rhNrtlli.rrii{ntrd n,rcrhrrrhcrh)\c innn rrri(!r n..'y..1 I cc l..onUly wnh.llciryrnn ('ounl,
<br />ordin.nccsnM Sfurcbwi ml.ringro huildinS .onnrud tun. dl h.r.hr" Nrhoriz. rcprc
<br />Jh,trc mnrinnc,t nmNny t r in\IIcJi,,n purtn\lr,
<br />\r,Drionror^smrsi,nnru* l\?:= -
<br />""-r**.",rn*,; X. 6a- rt- EC l^oe
<br />7 "/,v
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />l\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />E ngineer Final Report
<br />Flood Zone Certif
<br />FINAL Altrltl. tt,X\t<<+ltl .))
<br />Certilicate of Occu u-{pancy
<br />Notes, Remarks , Etc
<br />=
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l.rDJ.r', AJJrs
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