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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER BUILI'ER DELCARATION
<br />I iErcby 0ififln undcr p.n,lry .l lcrjtry Ihll I 0n €icnpr lt,m rhr conlnctor' l-iccnrc Lrv ror rh. follo*inE r.as. (src ?011 5
<br />Busincss rd Pi(rfc$nn Coic) An, Ciry or Counry whi.h rcquitc\ a Fnnir ro .onstucl. altcr. inPovc. dcDFlhh or EP,t 4n,
<br />{fl.rurc. priorro irs nsurce, ako rcquios lhc.pllicant lor slch Pcrmir ro lllcr ri8trcd slolcmfl lharlEorshcnliccnscd rurumr
<br />lo lhc !s,!ili.ns or thc conlmcrols Licc.Bd llw (ch,Pi.r 9 commncins *irh s..rion ?fin of Divnion I ol th' Etrsincs 3nd
<br />PFfcr\i(,n\cod.)orrharhcorsncisci.'ntrrhcrcrr.matrdlhcblshtotlhcallcScd.x.mpliotr.Anyvi',hrnrnofSsrionT0.ll5brtrnv
<br />rppli.strr tnm Fnrir subjccrsrhc rinlicd.t ro 0civilpcn0ltyofnor nnncthm livc [undnddolh^(S5{x))
<br />-1.a\owicrorrhcproFny.o,nrycnploreswirhsagddrh.nvncslnP.Ndn.willdoilEBortlndrh.(Muchnorircrxlcil or oftcrcd |or salc (Se 7044. ansiftss and hofcssions Cfllc ]-hc Cotrt.crois l-iccnc l,s do.s.or al,plv ro !n oskror
<br />rhc tmlEny slr blild\ or inpmvcs rrrrctr. lxlwtn' dNs slch s& hin*cll o. hcrsltor rhtuu8h his or hcr o*n cnDk,vccs.
<br />pro{idcd rhnr su.h irntoEmnrsarcml inrcndcd or ollcftl for \dlc ll howNer. rhe t{ildin8 ot nmmvcmnr is eld *irhin onc rt
<br />ofon\rlcrion- rlt Ownd Auilds will hrrc rrE heicn of pn,vina rlu h. or shc dd nor tn'ild or in{mvc $c nmFly nrrlt Purlx,{.f
<br />l.s{osturofrhc[o!.ny.!mcxclusivclycoikncri'r8wirhliccnscdcontrcktrsr..otrnrucrlhcPm]ecr(S..70tt.!u\in.\\
<br />d Erfssion Codc l hc Contncrofs Li.cnsc Laq does nor sPply r. m owmr oi nrol)crrt who huitds ot inrPtok\ rhcrcon.
<br />and who .ofincr\lb.{uch projcck wirh rContrdon\) ccrscd Pusuaor t, rhc Cotrtr.rols Liccns.liw)
<br />-l
<br />rd.xcnrpr undcr Srcl
<br />TOBtrEf,.I].I!]IITENSAIIOB
<br />IrFCt An"ITION
<br />I lrrchy llftm undrr ltuht.rFrjuryo.c ol thc lnll,,wing dcchainns
<br />IharcnMwillnuinrrinrccdifi.arcoiCotr$nrloSclflnsurcf,rrworkcn conrPcnsibn rs fftridcdtorhvS.cri(n.17(x)ofrhc
<br />L$.r Codc.ln thc ncrformtuc.rrk wolk forwhi(hrhc Pcmril i\ i\\!cd
<br />lhirc rnd willmriniair sorkcr'co rcqtrtcd by Sccrion:17(x)otrht Lnbor Codc- fd rhc rdnrn{rcc ol
<br />ion insurarcc .!dcr d Fli.y .umhcr uc:LVt-4 -u /-)
<br />lccnifyrhrr ihrhc|[nn nnn cofrhcsork tur tr hkh rh,s ,rnnir ir i\\ucJ.I \hrllnorctr{loy trrry P.ro i nnvDrnrcr
<br />v, il k) h..om nr6j..r b rhc wo ci( .. rrnsd ir)n liws of ( rlirinir rdd r8rcc r1 l ir l slnruld hcco tr {rh]ccr h rhc
<br />wortcn'.onrnD\rri{mptuvisi(,n(olSeri.lT(X)oith.lrtxrCo..lsh.ll.lnnh*irhrotrrlny
<br />WARNIN(;] Folurc to ecur. rorkcri omp(islrnr.ovcrrpc N
<br />civil ll .\ tr. n) .m hunn d rhouu d d.llrrr nsrrtr,,, dr htr.s .A trtr id.d |,tr rhc
<br />7.2 ?a
<br />I hdruhyrlirn! drr f rlryul Frtxry ;t( hrfru 9 rcoNhtuirg sirh S..ri i 7([())
<br />?
<br />I hdcby r,lirnr trndcr pcNlry of ts-.rlury
<br />isstrcd(Scc 1097. Civ C.)
<br />n,.rtn,lcn i'r8iScncyli,rrhcncrfarmar{cof rhcsorlbr$hi.hrhnNrnrit i(
<br />AIILIIANIIEILIEAIIQ!
<br />Ihrltydltroutrdcrpcn!llyol Frjuryo dollhcf.llouirEdcclariri,,,s
<br />Dc'fr)liridn P$rnir$Asltesror Nolificarion F.dcrdl RcEUhrn,ns (I irlc.{r. Pln6)
<br />Rcquncd klrs oi Norifi clrnrn
<br />,r is..rrc( lrr'ccn).o rtry trilh allCiryrid coriry
<br />horh rcprc*nrari!$ ofrhis Ciryalld Counry k'. r.r uB)n rh.
<br />a0
<br />4.eq-[
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq ro//t/6 ,*rt r]/62-
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />l\4ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />FINAL tdtr/r,r 4,/A-tH /u>
<br />Certificate ot Occupancy-
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />.'n|k,)o' r).ririful t^-'nrlri.\ trtl
<br />ol thc llusincssand Pr.f.*ntni C.dc. arrd my liccnsc i\ in fullf(tr{ d clltcl.
<br />',47:
<br />trnd.i. Addm$
<br />lidor lirguhln r\ rcgi ntr(!(o\ ro n nlrc tr.r,,ftni.xhlr ki rhN t()jtrr'
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