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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDER DEI-CARATION
<br />I h.eby drtm rolcr p.n y,n pcrjury rh{ I ah ctcmpr lnnn rh. G)nlnckni Liu.n\c hw nr rhc t'lbwhg rtMn (Sc.?oll t
<br />Btrsincss .ni ProL*ion Culc): Ant Ciry or Counry wh'ch rcqu(\ , Frmi b .onnDct, alld, mpnrv.. dcfr,kh or rcp.n ,ny
<br />srruururc- rnrl. ils n !frc. lko rcquncs thc amltanl tor surh lEmnt t' filc ! siSnc,l slalcmtrr th lEor shc is li$nr,j pultu l
<br />lL' rlr 0hvist,N of ttE Contacrois Li(n{J tr* (Ch{r.r 9. Conhctuin! wirh S(!on 70m oi Divaion .1 ol lh. Busircss atuj
<br />Pnnbsn,n\ Codc) or rh hc or rhc s gcnDr lhcrc,iom lnd th. h.sis lor rhc llle3cd cremprion An, viohln)nolsftri)n?0ll5byatry
<br />i[1|rl(rN nr rr.rmir iuhicch rh. {plicant tu scivilpcndlryofnor fr,(rhd.liv. hundrcd .lollds lS50O)
<br />-l.rsowncrolrheroFny.(trnrrcnD!,lccswirhwa8csarrhcir$Lconrp.nslrn'n.willdorhcw.rkudrh.nflcru.i\ior,ncndcd.rollcr.Jturslc(SccTI}l]l,Burincsan'iPmrc\sn,nsC,xlc:-l'hcContarkrrLtcn\cLawdocrnorirplytuMown.rol
<br />r,N |nln.n! wh) hn&ls.r inrpi)Kr rh.Rn,. aNl wh) *f,s nrh un* hrnr\.ll or h.r.ltor thoueh his or h{ owncmtloyccs.
<br />tovrlcd thrr su.h impn,vcm.h N Nr n(cdcd or.lfcrcJ ktr sllc ll. h'w$cr. rhc huillre o! mpnrvctrf, n$Uwnhoo.cF{
<br />rf(mfktbn, rh Own& BuiLLr w l l!rv. rh. hxrd.n oflmving rhrr 1.. or \hc Jrl *n bu d ofunprovc rhc ln,pcny fr rhc,,uqbeol
<br />l. !sowncr.frhc pD!.ny, dnc{.|$iv.lyc.trlilcrmC wih lrcn\cd conrndoE b..nnnrLl rh. pn,lccr {Scc.1044. 8usi.c$
<br />and Pnnc*ir Co]l: ThcConrBctr'\ l-'ern!c I-awdoc\ not rpply b rnowtr.rol p('p.dywh,, h'lJsor inrpn,!.s rhcro,n.
<br />rtr't wlN ronrnd\ lnrsuch r..k wrrh.conki.k,(9 |ccnscd runumr ro rlE co.rr&rois Liccnsc h*)
<br />a\
<br />I h.r.hy rllirnundfi Fn.kyol r.rjury onc ofrlt n,lb*ing J.chartr,n!
<br />Ihavcrlq,llminrxD.CcdrltatcotC.nanrtuScll.ln$.ftnwrk.6'coml,chs{tu.,asFovdcdinrhyScdbnll?00ofihe
<br />tlh, Cdic, ntr rh. l).nnlfun( of rh. wolk tr which rh. p.d is r\kd.
<br />--lhr\c rfti *Lllnurnr n sorkcr'.oaipcn\rrr)n Nurinc.. !r rc.tur.d hy S&ri)n.rr(x)olrhc lihor(intd, nrrhc ptrr,tr'rmr. ol
<br />rlt work k, ehi.hrhis li.nnir '\ 'strcJ M ), *orkrrr .onlp.n\rltr tr,surrn.. um.r:m'lrn'.y numh.r r.:
<br />-l.c.irli
<br />rh{r in rhc pcrntrrok_c ollhc *ork t)r whf,h rhN lcrnrir N isu.d. I shlll nor.rpli,y iny pcron io $, nunncr
<br />!J a( ro h...n* {$i\r to rtr worlcn .onDcrsrhoh laws of C.l,hm'!. ntul i3ec (hrl it I slDrld tE om subl&r to l}E
<br />*orkers conrlErs.hon Frvrnl s .l Sc.rnnr l70O ot rh. titrtr Clrlc. I sh.ll t)nhw h .omdy wilh ltnrs B,vi!n{!.
<br />\4ARNINC: Fdlure ro scurc sorkcF lrBpc,salnn uovcrile is unh*tu|, .nd shau sul,Jccr .tlj,loFr k, mmal FmI.s ,rl
<br />n' onc huntlr.J rh,usxnJ JrlLr\ (51m.(x)0),
<br />'n r'ill[(in r, rhc .o( ol (,)mFnsrrnn. Jsmrlc\ r\ ,,'ov ul Ior (h(
<br />I h.dhy alltnrunncr pcnal0 oltxrjury rhir I am lirns'l undcr pmltis ol Chrflcr 9 (co'nmftin! w h S.crion 7000) orDN$on l
<br />.l lhc Rusnes u'i Pxntsions Codc, o mylncnsc s in Inllnltuc Jdcli.(t.
<br />Dnler (onlm.l
<br />CANEIBUEIIANIENDINCJSENII
<br />I hcrcl,y arii,n ! erpcnallyoipcrjryrharlhcrhadrn(rucliotrlcn'litr!rscncyli,rrhep.'1i)ronccolrhc{orkrffwhichrliip.mirk
<br />islcn (Scc. lr09?, Civ. C.).
<br /> C&]C NIlrEe! f, rAr
<br />l hrhyillimrndcr Pcnrlrt olFrjLryon. o, rhc l(n[)*'ngd..lrrrrrn\
<br />I)ctrxrl $n P.,nrir1 As6c(o\ Noril,.rrr f.,l.rrl l{.Suhrnrns fl{lc 40, Prn6)
<br />R.rtuicrl l-crr.r.f NolJii0
<br />l..niiylhar rhc ltdcml E8ulalions rcBsdins ashc(os rcnnv.l lrc nor lmli..hlc k, rhn potcrr
<br />I ccnr,yrhd I hrvc rcad (hA lptl(atron !flj(afu rhrr rhcrh'v. ' I a8re bohplyw h.llCxyind Counry
<br />od$,n(s dil Srdc tr*s
<br />ahovc.rnr('kd IrR,Fdy
<br />Appli.&l d Asenl Si*n,*yvru rrc rqEicnrr'vcs otrhis cny rtul c!
<br />s
<br />Set Backs
<br />Forms/Steel/Holdowns .,4
<br />),t{,)
<br />UFER Ground /n ''M
<br />SLAB Floor 7 {j
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing 8/8/tc
<br />Shear Wall l'/otr / t c MrQ toz
<br />Framing ..{-\
<br />Insulationi Ener Si --7 u?${f4 L7/
<br />Drywall q/ilrt r'lJ rJ:
<br />Ext./lnt. Lalh llJrq )He lc\
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />lleldicap Req
<br />Qqruty Final Report
<br />En gineer Final Report
<br />Flood Zone Certil
<br />an.<zlL qlz,t lq SDqr.t€ 1rrl
<br />a\eor b-m- firo*tz {.1-rg-19 D6r* /ol
<br />FINAL.4'o T>^tnqltg ^/d.9 )
<br />Certiticate of Occu nc
<br />Notes, Remarks, Etc
<br />Policy Noob$:_Erpics: _
<br />Ltrci\. ( li\\: L'.rD\( Nr lrr:_
<br />Erection Pads l')
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