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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set BaCKS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />I I
<br />Certif icate of Occu anc
<br />FINAL
<br />Notes, Remarks, Etc.
<br />OIVNI'R BUILDEI' I}ELCARATION
<br />I h.r.hy llltm lnJcr p.mlry oi p.rjury rhar I rm .rcnpr liom rhc Cotrtrdtrs Lic..t lrw n rhc tull.wm! t .s'0.(S.( 7011 5
<br />Bunnc$ nnJ Pn,fc$r,n Grlr): ny Ciry or Counry wh'(h rcqufts r li.rnnr n) con(n'.t. allc.. inrpolc. 'lcB,lrh or nlun any
<br />(ru(run. pnor k' irs islutr.c, !l!' rcqun.s rhc lmliunr ntr \urh F-.rmr r, hlc a s+n.d i.rcmtrr rlrrlEor rhc n liccnsc! lrur{r r
<br />t, rh. ln,vannA ol rhc Cotrkrrr, \ Li.cis.J Liq (chaflcr 9. onrm.Nr! wxh Sc.lbn 1x)0 .1 Dirnio' .l ol rhc Businc$ and
<br />l,firasir$ Conc) orrh0rhc.rshc isc\cny rlrrli{muJ rhc b islorrhcdlcgc!crcmrrn,n. yvi(,hridofsccridrT0ll5hya.y
<br />i,rfli.r lnr ! pcr nil srhic.ls Urc anplM.r l,' i .iv il ltrn.lly ol nor mt rhxn livc hrndr.d dollr( ( 5u).
<br />_.1. as o*rer or rhc ptr,pcay, in my.nploy&J virh qas.s as (h.n sb comrctrsllion. *ill Jo lh. wdl rlrh. dturEisml
<br />nnc cJ orofic,.'l ttr sal. (Sr,7Oa4. Buxies r.J P&tcssn,E Cod.: Th. ConrodDr's Lic.n$ L.w dNs not rprly lo.nowncrol
<br />rhc !)n{Eny pt$ bo di or in\mrc. rhcR)n..nJ wh) tnB sah w* himsclior hcmllor rhrcush his or h.r.qn.nPloycc\,
<br />povincl rhir su.h iry,rokEnc m ret i cdcJ or.rtRl ft)r qh If. louw. th. builling dr in{hrcmnr N $! *irhr oN y.a
<br />ot.drrLh,, rhcown$ aoirJ.r will hirc thc ho cnofEoviry thar lrcorshclil tror huiu or in{,nrvc dr prrdy L, rh. nuqr)(oI
<br />_1, {\ own.rolrhc Pl lrnr. xn .r.hrsivcly $turdnrt wnh liccnscJ rontilrns rr.oinnr.l rhc F}lcul (Scc.?O14, Rllncs
<br />rnd l,\.Lssrn Codc:1hc Cunkrcntr's Liccrsc Law docr nor ltiplyl(' M.sncr otnoF(y who huild\ or m,Iruvcs rh.r.on.
<br />!trJ who .onta.h n)r su.h 0n+.( u h a Conkach(n hcnscJ pursoa n,rhcGfilcktr'r Lf,cnsc Lrw)
<br />I rm.rcnpr rDJ.r Scrtotr
<br />tloa(E&t:eolENl^llo!
<br />DEsl^Bt!rul!
<br />I h.rchy rfltn trnJ.r Jf,trnlry ol fcrjry oDc.Irlr Lnl!)wnr! dc!lrr.lior\l
<br />_l hrvc Jii sill mainrain rC.n,ficdtcolCo srnr h SclLlnsurc for workc^ omnctrsdn)n. as Foridc! t)! ty Saii,)n .1700 ol rhc
<br />lihr C&L. tur rhc I'- i'rtunc. ot thc work tor ehich rh. f'.rnir s isrucd.
<br />_l hav. !tuj will m,lntain workcrs coh!.hsioon insuran.c. ds rcqurcJ by SeI bn lTO0 ol rh. Llhor Ci,J., ntr rhc tdnrmra. t
<br />rhc sor* brw[.hrhN p.mn,s iskd. Myqorkcrr Lompcns0tion insuah-.c.aricr aB] Ix,lE, nh( d.:
<br />:a,(cn,lyrhrl ,rl*nrl,rrmnL(,,1rhcw,rl|,trwhrhrhNpcnnil i! is\ucJ. I \hrll tror cmploy a y P.r$n tn nny mrnrcr- ,,r\L,hcr,m ,hEJnrrh.q! cr d,mFcn\r n,n ldws ol Calinrtr'a, d,rd r3e rhdl rt l shouU h..om suhF l r,, rhc
<br />woAd! compcnsari'r l)n'v6ons of Sccrion l70o.l lhc ljhr Oic,I shrll. bnh,ilh comply wnh rll,s rov'sonr.
<br />WARNING: F,ilurc r) srrrc workcE .onrt trqhon ..v.fl!c is xnl.qtul. and shrll rblc.r .n cmlloycr ro uininll rnallts md
<br />dvrl liflcr !p i, onc hurlrcJ ihotrvtrJ Jollrn (11(Xr.(XXr)
<br />S.cuon 1016.l rhc LrhtrC,ic. irrcrcsr atrl ar(irEy s lc.\
<br />n) rl[ (o\ or (.mrn\irur
<br />IECLAEAIION
<br />I hcEhy alftrn undcr lcMlly oi p.rj!ry $,r I an lien$J untlcr lrnrnlln,n or Chaflct I (.ln1mncine with Scd ion ?0001 of Division l
<br />ol thc Ausirc$ !n! Pn,lc$irns Co!c, and m, hcnse is in tull nx.r rJrl cracr
<br />/.'',",,"r,,,", ZclC )<'i-,-^" ",**,(o^1t,t,o*
<br />CONSTRUCTION LFITDINC A(;ONCY
<br />I hcrcby .flnm utuls Fnalry ol ,rcdlry rlur lh€rc h a conntudhn lcndins asc*", aor (h. p.Jro*-c dl th. wo.k l'or whth lhn lcmil is
<br />ssu.d 1So. 3097, Civ. C.)
<br />IIIIIC NLOECL/ISAIIAN
<br />I lc$yrnmund* pctr.lty.llcrj'try onc ollhc folloqnr8 ncebations:
<br />Dcmolirn'n Permir$A\trsros Nolilic{ioo F.J.rrl Rcsxk nnr (IirL 40. P,n6)
<br />_R.qutcd trncr o, Noliedsn
<br />,.-+-cc,rili i)[ I hrvc rcid this iptlicanon arkl
<br />orJiMne.s and Siarcl,oss rcllriryi) huildinsc
<br />i$ r\ (or..r. I rgrs r) (on{ly wrh rll C , dd Cou y
<br />trc r.F.{ntalivcs ol isCilyar Coutrly t,, cntcr uBr tlE
<br />P"nrtrrbncd F),'cdy lnr insrs--.rbn
<br />\ Pen ir.r n fu rp.ino:----cvry7\
<br />aL1 -o$.y 1
<br />lE/,TllllllAz.i6,
<br />Shear Wall
<br />*"'o'i-oC 'z I
<br />l. rl. .AJJ.'..
<br />l..nrlyrhri rfu lincnn rc8trldi,,trs rcguJing r\h.ro\ rcn^,3l rn mr q'th(rhL r,rhs pnr.( r
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