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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE OlVNER BUII,D!]R DELCAI{ATION
<br />I hcrcby alrrm u dd p.nally i,t p.riury rllr I an cxcm ,nrD rhc Conlft$n Li.cn* Iiw l{,r rhc lblnJeiry rcaw,n (St.?0.11 5
<br />Burirrss !n,l Proicsion Cotlc) Any Cily or County !hic[ rcquncr s t rnrir k' (otr{tucr. ,lr(, nptuv., dcmolNh nr mn.n any
<br />srrucru., rM b ns Nsudtrcc, aho rcqurrcs rh. apphc! nn such Fnnit ro lrlc a sirnql darcmot rh,r l{ or sh. i\ li..n{d pusua
<br />b lhc l'olisioN or rhc Conrraclfi s l-icD{'t l-aw lchlprcr 9- Conmcncin! wirh Sc(ttn ?00o ol Divnhn -1 of thc Ausincs .nd
<br />Pn,,tsn ! G'dc)orrlur h.orshc iscx.mfl rhcrctonand rhc l.,rrs turrhc rllcgrd cxcnDri,xr. Any vl'Urnrols6.'ri,n 70.l l 5 by3ny
<br />{ptli.anr ntr aF mir suhjccrsrhc rltli.anr fu a.ivilr.nalryofnorfrtr rh.tr fivc htrnd cJ dollds (S5{D)
<br />_1. rs owncr orrhc prop.ny. or flry crplorccs wilhw,8cs lhct elc .ompcnsarion, ,ill do lhc wort ard rtr N^t1@ !r &r
<br />i c,i.d orotlcrcd ror slc (se.ro44, Busikis.nd Prolcssions C{tlc Thc Contr.ct{ s Li{ns La* d{f,s nor attl,l. an owrc. ol
<br />rhcp l.dy vlx, huilJs or iqr)ws thcE)4 sJ wk) Jei nrh k)rl hitucr or h.rs.lf or rh$u8h his m h.r own cmtLycci.
<br />phlidcd ihar such inDroEmnrs N nn irlc al otlcrcJ ,6r s.b l,i ,D*cE. rh. ttuillin8 or iqitutm n sou wthin onc
<br />'te.,(.r1,krs6, rh. Owncr BuiLlcr *dl hnw ltr hntich or I'R,rine lh,r tE or shc dii ml h!,ll or i,qrow rhc p 'ndry aor (lr lnlF$ol
<br />L .wrcr ol thc n oFaly, am cr.lunkly $ntrrin! eirh liccn{J ronka(h 6 $nnrucr rh. Fn)jc.r (S.r 7Oa-4, 8u$Dcs
<br />rnJ Pbliss0, CoJc: Thc Conrr(o.r Lic.nsrlf,wJMr nor rt'tlyb atrd*ncr., ln,pcflywho builis o nprorcs rhcrcon,
<br />rnd wlD conrBcr\ tur such pn+* wnh. (tnrd,,nr) licctrsi pur\u,nr tr, rhc Conkecntr\ LKcns Law)
<br />_l ahcrcmfl und.r Scctn U & lC l;rr[i\ r.]in,.
<br />Det.- o*ier-TVORXEffi
<br />lECldlAIIaX
<br />I hcr.by aii.n u.d* Fhalrr.t Frjury otu ofthc iallowiry d.uldathrns:
<br />_lhavcar wnl mimrf a Ccnirk.rc olconscnl kl scl,-Lru.c li)r workcrs u.mncnsllion. as prcvidcJ iq by Scrtron:l7oo olrhc
<br />Lrkr ctdc, Lr rhc FrformMcc ofrhc vork t)r wlr(h ihc l'cmil i\ hsucl
<br />-l
<br />hdvc atrd willn.irrdi. workcri.onpctrsrli,'n irsrin c,0s rcqun.J hySc(rnnr l?0Oolrbc l-ahorC(l].. turthct lnrndtc ol
<br />Co.^.,My wo,kcr' conll'.Ndlion iNur.ncc codcr onn Fnicy oudhq m:
<br />I
<br />Lo 5o 610 ' 1)t lsz
<br />_l c.nrr rhar in rhc Frlo'man c ot lhc woik nx vhrh rh'r l}.rnnr is rsncd, I shrll n r cmplo) lny p.6on in any manNt
<br />$ dslo hcconf, sublccr to lhc wtrkctr' conlFnsllDn laws ol Cllnnrn$, utrd "trcc lnnr ir l st$!l(l b.r.m subjccr io rh.
<br />workcr' .omn nsarbn porhn,ns of Scctn,n llm of fic t- xtr Cotl.. I \hrll tudhwirh co,nPly wtrh rhos tmvsions.
<br />IVARNING Failurc b scuc *orkc6 con{rcDsdnon ovchlc r\ unldetLrl, i dnll suhF(r !n cmnk'ycr t, si'liml pcMhirr and
<br />.ivil lnrr un b on hrnJrrd rho!\md
<br />I
<br />I hcNby .l'lirm un,.lcr pcnalry ol F.ju,y rrBr I !6 lienkl und.r provision or Ch.t Ly 9 (.dmmnurnS vxh Seti, 7O0o) of Divison l
<br />01 thc Busincssand Prcrc$irnr o)dc, a,rl nyliccnsc n in tull turuc aalcffccr.
<br />S
<br />co!fiaqcuoNrENptNll
<br />I hcrhy altum unlcr rEnrlryoiFrju.yrh"! rhcrc i\ r.rn*rtucnon LiJih8 aEctuy ror rh.lE,rornumc ofrh. wort lirr {hih rhis Ilc mil is
<br />isnrrl (Se 30r?, Cil. C ).
<br />d!!u(anl!!!cl BAII9I
<br />llrr.hyrliinrnnlc' F-trrlryol n.r[.y.n ol rlicln]L)*1,t!l..lrark,*
<br />D.n$liim P.r xreAs1{!.r Norlnirir l;c.ldrl R.!uliltr J r lLrk ,1lr. l'.nrfi)
<br />Rcqnncd L.(cr oi Nolilicdi0n
<br />I ccniiyrlur the icdc,al rcsrlarions rclrding ,\h.n.s rm)vrl arc nol rmliuhh b this p,olcct.
<br />y,{$diry rhar I lD,c rc.,l rnis lmlicariotr an,.l sr6lc lhll thc !h,vc i'r,iruhoi s cod.cr Llio lo rontly wrlh all cny ond counly
<br />ordinatucs and Sr,c lf,ws r.lrt,na to bn,ldnr8 uonsln(il)n. ani hcrch)aulhoriTxrcprcscdarilsolrh$C yrnd Cduhry to cnrc uPn rhc
<br />albv. nEnin,rcd pNNny lor inv'c.lonI'ulmscs
<br />hAppri.a D.AsenlSisn.luR
<br />fr".,i,* ..u. ,p.i,tr x
<br />x <.)-,'t/esJa-t
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsu lalion
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL 4-26-z)Widl
<br />Certilicate o, Occupancy
<br />Notes, Remarks, Etc
<br />--)
<br />ID/SIG.COMMENTS
<br />T-Bar
<br />tv
<br />n^'"' 3/2-'l?'
<br />L rJ. . . \imr
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