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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq I t5 D4 nrt a L-+rq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />n
<br />FINAL
<br />Certificate ol Occu
<br />,
<br />()\\ tIk 8t lLt)tlR lr:t.( \R \t
<br />l. rs .*ner ol ihc polsny, or ny cmployccs wirh tr1rcs 11 rhcn $b conltl.nglon, wil do rlE *dk e rhcdndmt R,
<br />mr.nJcd droft.tul tai srk rSfr 7014. Busmrsand Pn asDNCi{d fhc O,.lm.itr s l-i.cnsc l-rq Jocl nor aml, b an o*ncr ol
<br />rhcpn'Fny *lD bu ilJs or inw)vc\ ihsc,n. .Bl wlx' &r: n'ch u)rk hih{ll or hc^clt rlhi(N3hhs hcr own cmployccs.
<br />pn,vidcJ rh.r such in,ft,Eftnh e rrn idcnticd .r ofiarll li)r qh. It, lDwckr. rlE h! Jine or itrWovcnnr tr n,Ll wirhr on. rd
<br />ol(,nplcri,n, rlI Owncr Buill.r w]ll hrvr rh. burdcn ot pn)vn! rh! hc or shc dil n, tu lorinuov. rhc on{cn, turh.Elilr,(ol
<br />l. ts owncr ol rhc t opdly. !m cx.lurvcly (onrra.ons wnh lEcnrJ contrrrs h (onnfld rlE pDFt (Scc ?Lra4. IrNrnds
<br />d*l Pr,liiss i C(ic: Thc G)ntrncrtr's Lrccnsc Lrwd.cs norrlnlylli !nowncrolpro!.dyrho brilds or ihtntvcx th.rcon.
<br />itul *[o contrurrs t)r su.h pn,r..( w h a A,nkicb(n liccns.J rtr6ur.r b rhc Cir ra.kn r Liccnsc Law)
<br />I amcxcmpr ulcr Scctn,
<br />\t()Rxt:ks' ('()III'uNsA uo\
<br />!.)!!! a!!!^
<br />.5 ptuvirleJ for by Set,on l7m .l lh.
<br />th. rrhor Codc, lor th. p.rlolrrj,M ot
<br />OI /-,1 2-O z-.
<br />l.cnilyrhrrrIhcpcrturBxnc,,Irhcwo titr wl'(h rhN r.flnir A rs{rcJ. I shjll nol cD dyrtry
<br />I
<br />s, rrt,b.om suhj&r i,) rltr workc6' co m!.nsal nnr hes ol C,lilonria. an,l rsre
<br />'haril
<br />I rhoou h.d,rE suh]cd tolhc
<br />work.6 ompcngr
<br />'on F)v$idns or Sd$n l?0Oolrh. Llt$rCdc.l shnll. bnhw{hcofrPlyw hrlh*rovisrns
<br />WAININGT f.ilrc to Burc *fic6 .ompensari,D.orcrrsc is unlawlul, rnJ drdll suhj.d an.mtl()ycr lo (ininll pcnahis &d
<br />civ ,lNs up tu onc hundrcd lhousanJ 'ioll{s (5100.000), i, lJJ n,n b lhc con or.onqxnsarion. Jlmscs as pn,vilcd ,i,r rlt
<br />Culc. inrcrc(.n,, arkrrcy r nc\
<br />Zoz-s D lhL
<br />!!!EIsE!_Lqrr!r!croa!E$taar!!lN
<br />I hcEby afinn utulcr l'cnall, oltcrury thal I am li{tren undcr lmvnio otCluprd 9 (onmnunS with S$tbn ?mO) o{Divtion l
<br />of th. Ausincs rnd Ptulisions Code. ind myliccns is ir tull lirlr andclliur.
<br />a6fV t>
<br />Z-\)-<\,)frr,6 9ss
<br />eoNgl!lcI]oN.LENllNc-dc
<br />I hcEht alltm un'lcr rcnalryofFrjurythar rhcrc is r.onnrucrion Lndng.Scnuy ltr rhc pe,imraEe ol rhc work for *hich rhN lrrmi s
<br />i$ucd (Scu..1097, Civ. ( )
<br />APPLICANT I)FCI,ARATION
<br />I tErd,y lnim un ls pcnlh y of t rjoiy om ol rh. follown8 Jel*rr i,ni:
<br />Ocmliron Pc,nrih-Ashcsros Notilicarnrn Fe,lenl Rcsllarions (Tirlc.t0, Pan6)
<br />-Requncd
<br />lJlrcrol Nniaruri,o
<br />I.cnilyth!( I h!r. rcalt rht rpll'crL.n 'l {rrc l!tr rli{rn r\.on..r I n!r.c r().o0rtly wirl rll Ci! r Cotr0ry
<br />oklinak.\rn'l Srarc llwsrhrmg k, bu'U rs uc rcp.cscnlarivcs olrhi\ Ciry and Cotrnry ('.nr$ qin Irr
<br />ah)vc nrntioncd r)pcny li)r in\pccr o2-o
<br />UFER Ground
<br />Notes, Remarks, Etc.
<br />I lNehy arftm undcr p.nalry or lc ury rrdr I m cr.mpr rit,m rh. c()ntrh6 Lrcn{ Llq tu (hc lollowiry rern,'r (scc ?oll.t
<br />BusnrsunJ l']rofcsi.n Gtlc) An, C(y or Cirutrry whrh rc{urcs r Frnir t, condtu.r- alrc.. i6prdv., dcmolish ot ,qdt My'
<br />(ruuxrc. nritr k) ils issurcc, ako r.quirs rhc atplf,3nr br \kh flmit h l,h a ilncd {arcmnr rhrt he or shc i\ lielrcJ purstranr
<br />b rhc ti( visbns ot lhc Conrr..rni Licctrscd Lnw (Chaflcr 9. aonrmcnqnr *irh S..rido 7(XlO or Div*nrn I oi rhc ausincss !nd'
<br />Pdasons Co'lc)or thll lE orslE i *cnrpr lhcr.,n,manJ rhc han\ irrh.JLscd.rcn{ .n. Any viobln,n olSccri,! 70.11.5 hy rny
<br />rprl'canr ,i,r a pcm ruhjc.a rhc amli.. b . .rvll pcmky or nor mtrdhan lirc hundrql Jollan (5500).
<br />(i c.li)rrhc p.rionmn..olrh. work lnr whirh tlr $nni ^,\tr.d.
<br />L{nici\ A.ldrcs:
<br />-
<br />I ccn 'fy rh{r tlE LJ.ftl r+ulllDns ru3$ding islrdos rcnovallrc norslnlicahld t, rhi1!nu..t.
<br />tt
<br />I lLtl2z I
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