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BUILDING- INSPECTOR RECORD
<br />COMMENTSDATESITE.WORK
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathi
<br />Shear Wall
<br />Frami
<br />lnsulation/Ener
<br />wallD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason
<br />Pool Fence
<br />Handica R
<br />De Final Reu rt
<br />En ineer Final Re rt
<br />Flood Zone Certif
<br />lqFINAL
<br />Certificate of Occu anc
<br />Notes, Remarks Etc.
<br />()ltNER BlIt,t)ER l)El,( AR,\ll(lN
<br />I hcrchy aiirm lndcr pcndly of Poiiury rhir I am crcn{r itrn rhc Conlr 106'Licnsc Lzw ror thc tolldwing rcasr rsfr 7lr| 5
<br />Busircss md Pturcss$n CGltlr Any city or cdunry which ,cquio n Pcrmr l{r cdnnru'r. allcr, idl'rot 'ilcnolhh '; miJtr rnv
<br />sld.trr..prrxroilsGsu,n.c,alsorcqlirtslh.apllicanlti)isuchpcnnittolilcdsigncdsloleftntlhaltEorsltigli.cnrJnlEuant
<br />rorhcptr*lion,oflllccontrclorsLiccnscJL:w(chaplcrg.cohn.ncinswithscclion?001)ol.D]vis,on]oilh.Btrsin.srnJ
<br />Pnnt$ioNCoJc)orrhdh.orshciscrehrrrhcrctiofldlhchn'stniihcalles€d.xcmPlionAnvviolalbnofS'ckon?0ll5hv'nv
<br />rprl'.,nr loraFrmir rubjcckrhc lmli.ant lo..ivilPcnaltyorn.r mo,erhM rivc hu ndrtd dDllds ($500)
<br />t,ar.wncrollhcpotdy.o,nycnnloyesPilhw!8csasrh.tsoh.offc,t r. sill do rlr work drd rh' (ftruc h not
<br />lfudc,l "r "ltsc,l le salc (S( ,044, Busine$ and Ptuf.*iotrs CGlc: 'l'h. clnrrclfi\ Liccnsc tiq locs nor rPllv k' in dwmr nt
<br />rhc pDpcdy wlli [uil(ls oi trhttuvcs lhccrn. dd who d€s su.h w.* h,msclior h**lfor rhoueh hk or hcro*n cnnlovccs
<br />p",,l l..r rr,ur ",.rr rmp!*em s N nol ntRlc,l or oficrcd nx salc li lDucvcr. rhc hu iui4 or imPnrEmnr is $Lr * hin n' vu
<br />;l complcrion. rhc owmr Burldcr w l h.vc rhc ttur'l.n or psviry lhat hc or dr tJ nor hui[ or mprorc rh' proFnv for rhc AulF rc ol
<br />-I,rsow.crolihcpotrty.amcxtlusivcly.onlrdcrinawirhhccnscduonrracrosloond
<br />clrltlmicci(Scc 7044, Bnsin*!
<br />atr,.1 t\,lilrin codc:;l h; c.itrcitr s Liccnsc bw des nol !!plv k,,n;*ncr orpoPcrrv wt(' huilds or irymvc\ rhcron'
<br />ind who {nr!d\ Inr su.h p(,jccrl wirh I ConrBki(, lienscd purDnr lo thc Conrrrcro's Liccnr trw)
<br />-l
<br />amcxcmpr !nd.r Sccti,)
<br />rvoI(I(llRs' coi\o'ENs,{TIoN
<br />DECLARAl'ION
<br />llyolpcrjuryon.oltlrlalk)win!Jc.l[rn ns:
<br />nrrinhd r(cdrli.rrcolC.n\cnlt, Scl|ln{trc Ltr uoi(.$' ( oD|rcnsrtron, s fnri'.lql ld hy Sccli(nr 1700 ofrhc
<br />lhc n .6rm3n.c of llE work nt Nhch rhc pcm t\ lstrc,l
<br />vc rrt r,ll mriNrir work.r! .onrDctrsrri('n ins!tu..c, is rcqu t 'i hySccnon.17(xlol tlrc Lahor Codc, tllrrhc pctfo na.uc of
<br />ilr.tia,,tu Uu i.r-r 'l Fr e-b)
<br />q Ao
<br />I ccnil!rhdr inlhc rrbrroncc ol tlrc work iff whichthB,i.rn!r t issucl l slull 'r cmP!'vonvOj^on InovnMtrcr
<br />n, s b lf,oNc suhjeci b rhc workcr I .omp.nsiriotr laws oi Crldntnr. a a!rc. rhd ilI skruld hcLom suhjccr iorl'c
<br />worlcrr conrEnsari,)n pn,va,o ns oisccrion:11{rollhe l,rhn coJc.l slEll nrthwith c.mply wirh lhxc pr)lNus
<br />WAITNINC: FIhrc r) \c.u'. workcr\ .oNPcnsrr ion ov.nlc t unl.sful, and shrll {blcct an cmrl.}q k}.riminal Fnaltics and
<br />ki .trc hunlr,t (tlnrsnDi.tollx'. (S 10O.0OO). in &iJ nr b lhc corl of.oq)cnsarion. drruecs ar lnvideJ iif rh'
<br />Scc(i,,n .1076.frhc Llhtr Codc, irr p.
<br />r fu rfN\rr) ( rlN l k,\r'l oR
<br />Dt.l l,\R,\'l lo\
<br />Ihcrhy rtltrmunJ.rl( rky.l F'ju ,,rl-t,,,,u*,,"tCt,nDr",'11."'nntcncn!wirhS.Lron7000)olDrvr\on l
<br />ol rlr Busncs an'l P*nassoneco'lc, m'l nrylrcn\c '\ ir luu ntrec ar .ll..r
<br />e t80l
<br />J
<br />I hcrby dtu undcr rFnrlry or Pctjuty I
<br />issuctl(Scc 1097,Civ.C.).
<br />n'(rr)nlc.tn!4.n.yturth.!.'knnarcc.f rhcworklnrwhichrhisttrnril s
<br />dlEllcAllpEcll8MlQr
<br />l,Erhyrnimunrcr pcnrhy.l lt,juy on. orrltr lnllowins.h h rtnx:
<br />l)cmolirion Pcrni*Ash.$os Notlftarion fc'i.rdl RcSul{li,)nr (nlc 40. Pan6)
<br />_RcqrN_d tillcrol Nor
<br />lrcguldrions rce{'lint r\bcn.srcn$ulrc nDr $nli.rhlc t) rhFpn+d
<br />rcadthislpplicdbnd slllc (hrt rhc rbvc inln.mdn is c.nc.r' 1 4rc ro..m0ly wilh all Ciry and counlv
<br />ws rcLlins il, huilding connrudion, d,J hcrchydrhorizc tcEcscnhrivcs ollhis Cirv nd Counlvro cmo nPn rh'
<br />.ltl
<br />0.
<br />T-Bar
<br />L.nJcr',\ AJJf$
<br />*,", t f t,tlawt)
<br />ID/SIG.
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