|
BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE IDiSIG.lco$.4,lltENTS
<br />(r\!Nl:R BI ,t)t,tR IrIiL(', \R,\1 I()N
<br />I h.rcby elftrnr unds llcnrh, of p.rjury rhlr I ao cxcmpr li.nr rhc Conta.ro$ Liccnsc lj* for lhc folb*in8 r..$n (Se.7031.5
<br />Busincs ! Pnicssion Cqic) Any Ciry or Coriry !hi.h rcquncs r lf mil lo con(rucr- altcr. imntuvc, dqmlth or rcprt lny
<br />stu.rurc. prhrb ns isu,tr.c, ,l$ rcquncs Ihc ,rplic fo. such tlc.ri o filc ! sisncd srarcftnr rhdr lfor shc is licctred pu$ua
<br />t, rhc r *i\ions Dtrh€ Conrrac(tr\ Li..n*d tjs lcharrcr 9. conmcn.inB wirh Scclion ?(xD ol l)ivhion I ofrh. Busi"css and
<br />Pn,r.sstuns codc)orlhnt h.orrh. kcxcmpr rhcrcnonrann rhcbasn nn rhc allcscd cic'nprnrn Anyvn,hl nofsction70.1I5hyany
<br />4plica tora p.,.rit subjcchrhc opplicanr lo acivilpcnollyoinor morclhrn fivc hundmdd.llnn (55fl))
<br />-1.
<br />as .wrcr of thc F,Irny. or nU cml'lorcs wilh *agcs rs rhcit slc $mpcnston, will .k) rh. wuik dd lh. nru.lre is nol
<br />i' cnd.d orontrcd r( srL (Sm.7Ol-4. arsine\sand Pn,rcs\ionsC(dc ThcArnra.roir Liccnsc tjw docs nol lmltrosnosn.rof
<br />rhc [o!.n, who burlds or irnDrorcs rhemn. and qk) dms such ]r* hinFcllor hc^cli.r rhn,ueh hh dr hcr own cntttlorccs.
<br />Inlnh rhrr!trch i'npmw'nnrsmft, i .ndcd oro,ltml lirr sk ll ho*c!cr. rhr hildir8 or inFft,vcmDr issold wilhi"nnc t!,r
<br />oiomplclirn. rhc owmr Buiklcr will h.\t rtr burdc. of rDvir8 rhlt hc or sh. did rer l,ui[ or i'nr".vc rhc pR,r.nt rd irr pu4.t.r
<br />I. n\ o*nfi of rhc ftupc r,r rcx.lusivcly.onticrrtwithli.ctr*d.ofii.lo6k'conirucrih.pnjccr(S..7Or4.3trsncss
<br />.'xl lh)f.*in C.d. lh.Coirrr.k \ t-i.ci!. Lrw doc\ norlfplyb anownd uft(,p.nywh. huilds or iDfnves rhcrcon-
<br />!trd who conkachlor su.h rric.rswihaConrBcro(s) lionrd nururnr h rhc Conkacnn\ Licen\c Lr*).
<br />-l
<br />rmcxcnrpl undcr Sccrio
<br />O*n€r
<br />]IAB&:IiI!AUI})NIAIIAN
<br />DEI:LANIUON
<br />I hcrchlrlinrundcr pcMllyof pc.juryo.colrhc tull,,wjfsde.luari,ns
<br />-l
<br />hovclnd sill roinroina CcrrificaicolCoisnr lo Sclfinsur. fd w.rk.n .o.rr.nsarion, as rruvidcd lor hySerionlr?O0orrhc
<br />Lntxtr Codc. lor rhe p.rfolruncc of rhc uork for whth thc Frmil h is\ucd
<br />rhcso tu shrh rhi\ p.rinir i\ i$uLi Mt workcF .u rlr \,rl i( irsurrn.c.rnicrrnJF)licytrutr,hcrrc
<br />Poli.yNu.rbcr-Expircs
<br />-r
<br />ccni, thar in lhc perrbrmamc oarhc *ork aor !hi.h rhn Fnnir i\ issucd. I \hrll nDr.rnploy dny !$sotr itr rny manrc.
<br />o $ k, b...m subJd! td rhc workcs' co.r!.nsarion hws or cahturnir. ard osN lhll if I should trco'E subjc.r ro rh.
<br />$or*cn.lmpctrs.iio.pnJvisionsofSstiotr3?00otrhctntnrCodc.l$Ull.lnnh*irhdnnplywirhrh,*|n,vhion\.
<br />WARNINC: Frilurc ro surc uorlc6'.onrcn\ari,,n.ovcrrg. it unlawtul. and shrll subjcct M cmplorcr ro simi'd pcmhas rnd
<br />civil ,incs up nr orc tundicd tholsand doll6 rsloo.O(x)). in lddili{Ji h rhc .os oi.ompc.sllion, damnacs as lrovided lff rhc
<br />Sccli, 1076 ol'lhc L1htr inr.rc( lnd rrkn'rv s nc\o
<br />!2r!L lt.lltltt
<br />I hcr.hy rfirm undc, rc alryorp.rjury rhd Ln li..trk\r und.r pmvisi(,n olCha cr, (.omrrctrcira *ilh Sr.'rio.7000) orDivision l
<br />of lhc ltusimss and Pmlc$ions Codc. and ny liccnf is in full torcc (d rfi.cr.
<br />a3 2_{/s
<br />"*",p77/2/44 -"
<br />CANIBIJqIIANIENDINC.AAEM]I
<br />I hcrby .firm undcr lEnollt ol pcrjury th lhcrc is i on{ruclhtr hndirs lscmy lor rhc perronumc or rhc work ror snich rhn lErmir h
<br />issucd (Scc.3097, Ci!. C.)
<br />AISLICANLDECITAAIIA!
<br />I Mry dJlrn lndcr pcnalryofFijxryone o, thc following d.cldrarions:
<br />Dcmlition Pcrmils-Asbcslos Norificarion F.derul Rc8ulations (Tnh 40, PBn6)
<br />-Requned
<br />Ldrcr of Norifi carinn
<br />-l
<br />ccnilyrhd
<br />'hc
<br />Ln Elegularions Egordnr8 asbcsros rcmvalm norapplicablc r. rhi* pmirr.
<br />-l
<br />cenify that I luw Bd n aptlicarionad srarc rhd the rlDvc ioromrion G con.cr I aec ro coq'ly wilh lll Cil y Nnd Counly
<br />ordinrNcs lnd Starc L{wsrclarin8 k, huildinsc.n(rucrion, !d Jtrrlb'n.,.prc\.rrnrivc\.l thi\ CIy rnd C.uniyb ctrrcr uIxn r)r
<br />rk'vc riEdn,rcd lmFny lor ins &.- ^,ry./r//a
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathing 'oh*/tr +
<br />"11nr71A
<br />t6>
<br />Shear Wall
<br />Framrng
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL fril/lrryk /{z
<br />Certifi cate of Occupancy I_
<br />Notes, Remarks, Elc
<br />ttl<lL8
<br />txndcl. addrcs:
<br />-
<br />I
<br />I
|