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BUILDING. INSPECTOR RECORD
<br />IDiSIG.COMMENTSSITE.WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathin
<br />Shear Wall
<br />Framin
<br />lnsulation/Ener
<br />allD
<br />/lnt. Lath
<br />Brown Coat
<br />Mason
<br />Pool Fence
<br />T-Bar
<br />De Final Re rt
<br />rtEnineer Final Re
<br />Flood Zone Certif .
<br />FINAL
<br />Certificate of Occu nc
<br />Not arks, Etce
<br />LLIi.l{,tL I
<br />(rltNl:tr Bt, ,t)ER Dt:t-(-lk/\l I(r\
<br />I h.tu$y allirm utrdcr pcndry (tf ncrjury lhal I crch ft,n rhc Conrta&,6 Li..nrc Law n, rhc nruoqr4 rcr$n tsc''?oll'5
<br />Busn.s ind ProEsion CoJc): A y Ciry or Counry whi.h rcquircs a 0c.nnr tu .onsrru.r. ax.r. imp('ve. d'molish ot rpat anv
<br />nru0(urc.orbrro (s ssrMcc, rho rcqurcs rhc !t'!lic!nr lhrsuch lrmr lo liLa sisndl enrcmnl rhrr lroi rh.6 hccn*d otrNdt '
<br />ro lhc F)risi,'n\ ol ih. Co.ra.nx s l-ic.nscJ trw (Chrflcr 9, ConnMc,nP s h S&tion 7(xU Dl Divisirnr .l of th' Ansincs and
<br />Pn,rcsnons codc) or thrr hcor \hc E.rcqr rhcrctim 3nJ rhc h,{1tu thc,llcs.d e(cmdnm. Anv vidari()noiSc.lion 7011.5 bvanv
<br />xpplEanr tor a rmir rul,jeG rhe .mliuanr b r civ
<br />'l tlcndlry ol nol more rhdn fivc hur rc'l dollars (lsoij).
<br />l, rs o!fti oI rhc rron n!. or nry .n[byccs *irh wngci as rhcn \rc .onrPcn\d dr' will do llF work ,nd th nBi@ 'r mr
<br />nlcnJcd or ollircJ tur sL (se.7)44, Busincs rJ Pntf.{Nns Cqlc: l hc cbnrtactr{ s l,tcnsc Law docs nor '|rlly b an n$ncr ol
<br />rhr Im'ttdy wlD build\ o nlPR,Es rhcGrn, and who Jms ioch wo* hrmscllor hc*clfor lhouah hi\ or hcr owncmplilcci,
<br />tmviJcJ rhar ruch inFrrvcNnB m nor iurcnLd or oficrcd for s,! l,l how.tr, rlE hu lin! or drfdrkmnl is nrU *irhin "nc rd
<br />ol compLri()n. rh. Ow ci Buillcr will halc rtt huJc. of ln)vine rhlr hc o' sh. drl .rn lru .l or uq,rot Ut Pn)Fnv ktr rtf, pu4$c of
<br />L ar owNr ot th. t)I)!cny. am crdrsivcly cont{.lm3 wilh lic.nscd conltucloB b on{rud (hc lorcur (Se 7014. Ausmsr
<br />,nd Poh$rn Co,ic: Th. CdnkrdM s Lrcc.sc l-,w dMs nor aplly b odwnci ofPorcnv who hurldr ot inDrovcs rhcrcon.
<br />!n'l wl$ o roch tu such r.oFtr wnh i conl!..n(o l''cnd pusuanl r' rhc conkrctois t'tctrrc hw)
<br />I !,n c renrpl u!'j.r Serion-. B & P.C. t]r rht rcason
<br />II!86!8!-CAUENSATION
<br />DECLARATTON
<br />I hcrcty 0tim hJer pen,ny ol pcrjury on ot rh. lollowme lelatarn,nrl
<br />-l
<br />h.vc oi qill @inran . Ccn it_Kar. of Corrc.t b S.f_lnsurc rbr sork6- dmFnsation. ,i nruvrlcd fin bv Srtrion ]? l) of rhe
<br />Llbor Code, ro! lhc pcdomncc or rhc wotk tor qnich rhc Fmi' is i$ucd.
<br />I hrvc rnl willflrinrrin woikcrr conPcnsdr n iNUrMcc, rs rcqut.J bv Sccliln ]TOO of rhc tjbur Orie, tn rhc Fdnlrun'c o'
<br />ncm F tr\kJ M) qurl.h'umPcTrrnn m\urd\clann uJrl lx,l(v numhs e"
<br />EDda-'€V
<br />-160oo o'764 O 7/Z.-'
<br />I.cd'lyrhrr orhc n rt,man.c ()frhc wolk ln! whichrhuFrnnr h i\sucJ I \hrll n r cnlpl('v 3ny 0.^.tr in invm'|nn'r
<br />q) !r b lf,com \!hr.r b rhc eorkcr' conD. lnrio. ldws.l CllitumB, and rlrc I hlr it I sh ld hcc.m ruhFr o rtr
<br />work.ri .onfcnsart'n prorFnrns.f Scdtun lTUr ol rhc lf,hrr Cc{
<br />WARNI\t, l'a'lL'. n, {. rc s"t11(,unlc1{rn,n .,,w1Pc F
<br />wirhcomtlyv n rkE povrsions.
<br />shau ruhh.r an cnrrl,,ycr b.timotl
<br />'rcullrs
<br />5nd
<br />uivrl lnrr trp t, onc hond(a, rhotsdJ Jouds ($lm.mo), in nrrnsaln,n. ,hmscs ,\ l,rlrvnh,l ntr rhc
<br />zd
<br />DECI.ARAIION
<br />I hcrchy .lltm unlcr pcn,lry or n rjury rhal I ah li6n$d und.r lNlisbt ot chxpld 9 (comftein8 w h Sculhtr 7000) 'r Division l
<br />ol rhc Busin s Md Pnnt$ilns G'J.. drl my lrcnsc t itr fttl foer a,! cllNr
<br />./L c)7
<br />_2 u
<br />CONSTRUCTION LENDIN6 AGENCI'
<br />t hcrch, uJtum uddo Fnally ol rEriury rhar rhcrc is a uon(dcrb. Lk r! .3cn(y ri)t rh. ,.nomEncc of rlr srk Lr whih rht Frnil (
<br />isucd (Scc. l0r7. C,v. C )
<br />t ndcrs Nam:
<br />-
<br />t.nJ.1'. A,lJ,c.\ _
<br />APPLICANT DECLARATION
<br />I Er.l,y ,ltin undcr pcnalr y nt Frjury oN of thc bl!,win! J.cld,l ions
<br />D.mlnion P.rfr $Asheslos Noriricdr F.tl.ral Rcsublion\ ('lirl..l0, Pin6)
<br />R.quucd lrncr {f Nolirtralion
<br />-l.cadi
<br />rhar lhc rid.ralr.Culari,ns EssJin! sbt(or r.rtuvularc nor {llicdbk k} rhis 0n+cr
<br />IccnifyrhdIhrvcrcadlhiuprli..rnD{rln c rharrhc ali,k,nbnMton rs.od.cr.I r3!e ro (omrly wnh a Cirva.dColnrt
<br />.llman"cs anJ SrIc titr s rkrs q bu,Ur8 LiArru.tts,n. .nt h..chy auhrrnc e!6icnutn$ olnlt Ciry rnd Counrv ro chrcr upon th'
<br />::::::]::::"':"24'"'L--'' ;" /- 7-20ll*-i"''ll'"17'"' t'-'* *":--
<br />VWN:E
<br />Sublloor/VenUl nsulation
<br />/1
<br />/ /{'/L'vlilHttiy w
<br />Handicap Req.
<br />--').I
<br />t).w*fl
<br />trale:_
<br />O'1
<br />I
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