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BUILDTNG- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DELCATATION
<br />I hcrcby ll'tum un,ls lcnllly ()l lcrryy lhal I im crcn!,r 6rm thc Conti.loB Liccnrc Llw lb. rhc tollovir8 rcasrn (Scc.?oll 5
<br />Bu$n.s anJ P^ri$ion CoJc): Any Cir, or Cornry uhich rcqunc. a Itmil ki .onsfl.l. allcr. imnRivc, &mlkh or rlun .n,
<br />nnEtuc, pri, to irs isuan c, also rcqurcs rhc dll C.nr n, suchFnnit k) lilc. $gncd s.tcmni rharhcor shc 6lRn*d tusur.r
<br />n, rhc novi\nnN oi rhc Gnrrra.(tr s Licnsc!.t &w (ClDplo 9. Comncneins wirh Scclion 7m0 of Divish -l of$c Busincs on.l
<br />Ptufcssidrs Codc)drlhd h.orsh. is.rcmpl rh.rchomard rh.hd*s for (h. aUce.d cr.mruon. Aryviddio.olS.crion ?0.115 bta.y
<br />,mlicanr ror at'.mn subjets rhc aptlic r t,,civilo.nilryorno' do6 rhln tlvc hu*li.d dollars (!500).
<br />-1,
<br />as ooN, !l lhc prupcny, or my cmployes vnh w08cs as lhcir solc conpcnsal ion. will io rlE wdk an l rhc ,tute ir nol
<br />i.rctr'l.rl or ollcrcJ rnr eh (Sr.7044, Bu\irc$ end t'rd!$inN Celc: 'I he Conrr,.fttrt L&ns Lrw dMr trdr 3p,ly b rn .*rcr o,
<br />thc l'$tEriy wlD toildx o! imtturcs rlrh)n, dhd wtu des skh k)* h,msclfor hcr*lfor rhnu8h his or hcr o*n.nl'by..s,
<br />ptuv .d rhar stcb n proKm s e frn inrcolcr or ori'c,ql nn eb. li hruEr, ltr hu!!tn3 or inlmrmnt h stl wirhin om rc-
<br />ol compblion, lhc Owncr Buillcr will hlvc lhc burdctr ol I'nrvnl! thal lE or shc did trol buiu .r inrl'n)\ thc Dnrsly lar 0E llurrr& oI
<br />l, rsosrErotlhc F)!cny, imcxclunvcly cotrt*hne w h liccnscd conrrcrois ro c.trsrfl.t rtE I'oJer (Scc.7044, Busncs
<br />an, PnlsbnCoJc:'l-hccl,ntrielu'sLBcnscL.wdtEsnotrtJrlytod.own.!ofph,Eny*hohuildsorimprovcslhcr.dn,
<br />and who eont,cB lir such nn,jcc( wnh a Ct,Iltracb($ liccnRJ ttrruant b rhc G'ntelfi \ Lic.nsc bq)
<br />_l h:vc zBr will mrinrain! Ccllillutcol Conscnrnr Scllltr\trc n)rworkcri c$mr.ns,tion, !s Foridcn nn hySccrinrl?Oooirh.
<br />Ijhr Ct)dc. ror rhc dbmmcc ol rhc wo& lnr which rhc pcrmn is is\ucd
<br />-l
<br />hovc ann will'n.inlain *orlcri (omp.nsation insurancc. as rclutcn byScclinrl?L$oflhcGln C*lc.lbrrh.F hrmrcc oI
<br />rhc wo nr,hichrhn pc,nir
<br />c,icr: t Fa,
<br />is issd. My workcm .omrcnsllion insuran.c caricr a,n F)ltry numhq re:
<br />t^r\'g-S
<br />6 670 2-
<br />_l c.dili rhar $ rh. lltrfi,tu.cc ol rhc wo* in whih rhi\ r.rhir is issucJ.I dullnnr.mtk,y any p.^o inrntmarnr
<br />$ ,r Io tr.om subi(t lo rhc work.lj conrr.n\rr dr lrws of Crlifoirir, drd a!r. thar if I should hc$m sublcd k' rM
<br />workcri ..mpcnsrl ion pmvnbns ol Sctbn l?00 ot rhc L2t$r Crlc, I shall, tbnhwilh conrply with I k)$ lrornions
<br />WAINING li{ilurc t,' s...urc wortc( ..mFtrs,tbn covcr08c is rnrlawtul. an! shall su6lccr an cmpn)ycr ro sininal Fmllics MJ
<br />.Ml ,inc\ np r',{r hunJrcJ 'h u\.nl tl,'llJr, llrro(Jotr,M lhc co( of.omtcn$rnr llmircs as l)l)vilcd tur lhc
<br />Sccri,r.10?6.ldr Ljhtr Ci\lc, ir crc(rnl.riomy s tccs
<br />,a-r, D(
<br />r.iiid:/ttrnr n,r,rur----ffi-
<br />I h.rchy rl ltr tn'l& n n ryolplrjuryrl rI rn h.n\cJ unJcr I'n'risn,n.l Chaflcr 9 (.onmnong wirl S..rur7((X))olD'tinnn.l
<br />oi rh. Btsn sratrJ I'}rof.s\i,,N CoJ.. a'rl dy lic.nsc n i'r hnllnr..rnl.llt(i
<br />-tl (rs
<br />o^",'?b<1>r
<br />I h.rcb, .flno u.dcr Fmlry of Frrury rhar ficrc Ls ! sNrdcrion hBli.s a8cfry lbr rlrc refomNc of rhc sort lu whnh rhls Fynil is
<br />isuc{ (Se.1097, Civ. C.).
<br />AttLtc NfD[ciLAaAIa!
<br />IIER$yanimundcr n n,lty otncrJury onc of thc fo,lowin8 deldations:
<br />Denbhnrn Pdnik-Asbcnos Norilication Fcdcral Rc8(larions Onlc 44. Pafl 6)
<br />_Rcquircd t tl.rof Noliicrtiotr
<br />-l
<br />.cnify rhor rhe rcderal rc8llrrioN rcfadinB aslEsror rcmval rc rct lldiabL lo thn pmj.rr.
<br />>l{c.n'ly lhrl I hrE @d this arplic.ljon nl ial. lhd th. .h)rc i.tormt,on I .lllE.-..t. I a!rc b .{qrly wirh !I Cily .n l Counly
<br />o,tlnlD..\]DJ Srrr. lns\'!hr ! ro h, Jnu "n^^W:*-ol rl!\ C yriJ Coutrryr,.Dr.'
<br />I
<br />ltxm mc.rioicJ pr)p.ny lu rlpcrrx
<br />2-,.-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />IVasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />FINAL 'f-26-4 Ylt))taYCertificate ot Occupancy
<br />Notes, Remarks, Etc
<br />_l ancxchfl !n lcr S(rnr_, B. & P.C. fd rhn rc6dn.
<br />]IAAtrE85:.CAMIENSAIION
<br />DECI.ABAIAN
<br />I h.i.by rlltnund.r Fhd]ry dt ldjtrry onc.f rhc tuloein3 d.cl,rlrions:
<br />^",
<br />.
<br />-z lc,s lz,
<br />SublloorvenYlnsulalion
<br />Shear Wall
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