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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUTLDOR DELC R 'I'ION
<br />I hcrcby ifinnr utrdcr pcnrll] ol psjury lhol I 0n cnn,)l frcm lhc Ll, raclon LiccnE La* lor lhc li)lbwin3 r.,{nr iscc 70ll 5 i
<br />Btr\nrs and Profc$nnr Codc): Any Cily or Coutrry shicn rcquircs r lcnnir b coi{ru.'- ,lrcr. impn'v., dc.rlish or rcltn rny
<br />(ru.rur.. prior t, irs hsunnc.. rh. rcqxircs rh. rprlica r.r such p.rmir h filcd signcrl n0kmnl rnd tEor shc k li.cnscd Fu6u'rnr
<br />ro rhc rovisions of hc Contact, s l-icrn*d llw (Chrprc.9, Conrnencing *irh Sc.rnr 7000 of Division I ofrhc Busincs 0trd
<br />Pr'ft$nnx codc)orrlmr tEorsnc ircrcm rhcreironrndlhcbasisturhcilL8cdcxcnrplion Anyviolllionols.cri,n?0:ll5hr!!y
<br />nprlicanr tor !Frnrir slbjccls rh. applicanrk, rcivil,tnahyolnor nxrcrhu nlc hundrcd dollar (5500)
<br />l. m owncr.lrhc pmp.dy, or mycmJ,loy.cs wirh sr8c\ as Ihck q,l. .on{'cn$tiotr. willdo lh. wo.t utrd tE (Mrurc h mr
<br />inrendcd or ofiered aor slc (SN 7l)44. Businc$ rnd Profc$ionr Codc 1h. Conrrctr\ Liccns Ll* docs nor imry ro atr owEr ol
<br />rh.,mFrry rt$ ttrikls or inI)Dvcs lhcmn- ud who des such troi( him\clfor hcr*lfodhmuSh his or hrr owncmployccs,
<br />,tuvidcd rhnr \r.h intr.v.nrnB trE fr, inrcfrl&l oi ollrnl foi elc ll howcrri rhc tdildmB or iflq'mrcmnl h sld wirhin onc ,str
<br />olenll]hltn. rlr O*rcr Build.r *illharc rlE hurd.n ol pmving lhar hc or shc dit nol buiu or ir{'mE rhc pmFny aor rlt lnrrr,* ol
<br />l, *owncr orihu l[,pcny. amcrLhsivrly.oDkr.rin! wirh li.ctr*d ..ntrxns t, corNruul ihc pmFd (Scc. 7l}1,t. Bu\i'rcs\
<br />und Eobsir Codc: l hc Conraclois Licen{c t-n+'d.cs n.r rpply io 0n osner orpmp.ny *h,) hrildl.r impro!.s rhcrco..
<br />rnd who ennrncB r(n su.h pn,i.h wirh i Corka.t(9 lt.Nd NFUdm ro rhc (rn m.nn s Li.cnsc f{r)
<br />I rdkcn,fl r &r S.cin,
<br />w()RKl'RS coNtPFNSA t()N
<br />Dlicl.$aua!
<br />I hcRhyrflnmuMcr r^_ftlry.l |f,ruryoDcoirhc n'llr$nrgdcclainli,nrs
<br />-l
<br />harc lnd will Ninrain a Cenificlr€ of Conrnr b Scll lnsur€ fttr workc^ conliL.srriotr. ar rolidcd ror by sd!tun 1700 of rlE
<br />ttr'b.r cd. fq'h.nrl.nmtucnrrh"tra ntrtrh'chrtrp.nn F F.ucJ
<br />-t?rn'c trnd willmJ'ni,n $L,*cr'cnrnFn\ r!n in\umncc..s rcquncd hySccrion.lT0ootrhc tihorCodc, {d rh. p&r.nmn.c or
<br />!hclxrtlnrtrhtrhrhnncnn.r.s^suJM)unrl(rc.n'ltrJriolirhu'Jn,c,sr1'rnrln,,lrliun'tn1to.
<br />,.,,.,",-fraJla-r iC<
<br />t1 qq lo'L8 ",/-l-2 /
<br />l.cnifyrhar in rhc NrlDrnRmcat rhc trork lor whichrhis |E nir is nsucd.l sh!l!nor cnDn,yanypcRr inrny
<br />'nanncr{' 6 ro hcom suhict ro lhc *orksi onrpcnqrion lows.l Cditurnir- a asr.rhd irI sh.uld h.co't suhjcct ro'hc
<br />worl.s.onrr.nsnrionpDvisn'nsolSc.ri{nr:17(x)oIrh.L!h{Celc.l\h,ll,tJdhBirh.onDlysrlhrhorrmvnions
<br />WARNIN(I Failurc r. {ctr.c workcrL .o lr.\aridr .ovcrrlc is unhstul. tr nrill subl.d m cmplorer lo crin nrl ll.nalrics ,nd
<br />riril hr.s rtr k, o c hudrd rhousnnd olktrs ($l(
<br />SLrrn :1076 .{ rhc tibr C.dc. n[cr{ Md rnonrt'
<br />"*",1:2?:=2o appricn,:
<br />.ddnion lo lhc cosr of conDcnsarion. dnmxes N provall
<br />DICI,IBAIION
<br />I hcrh, atfimlndcr pcnalry orFrjury rh3r I "m liccnsd !ndc. nrovi\n,n orChrp'ur 9 (dnnrmn.in! silh Scction 7l{x))olOi!hi(,n:1
<br />oI lhc susinc$ iM Protsn,o(Corrc. rtrd flry li.cnsc n in tull n,cc xfrlctiicr
<br />c7 4l
<br />t-za-zo
<br />CqNIIIAUIIIOII.ENDINIiAC.ENI:I
<br />I h.Eby rmrm und( Fnalry.fp.rjurt rhd rhcrc is a crnirudn'n hndi,rB 0fcmy |or lhc perlornurcc olrhc sork r,tr whicl rhs Fmir h
<br />hsu.d (S.. ll097.Ci!. C ).
<br />AITI&ANI.IIEILABAUAN
<br />I h.rchr- rnifln ! fulq t.nnl{, ot tcrjrry om ol ihc tu lk,suE dcc l rrro \
<br />t)cnnnii,,n Pclnrik A\h.dos Norilictrri.n Fcd.rrl RrBuhri{n (Tirlc.l0, Pd6r
<br />R.+t d lxncrolM ifi.rtnnr
<br />I ccnify rh{ lhc Ldcrulrcgul iotrircgddnrga\bcnosrcnhvrlnrcnorxpplicuhlcrorhhpi{ic.r
<br />tl.c.niry rhd I h3vc rnd rhi\ rptlictrrion &rl rdrc rhrt rh. rk,vc inrdnrri.n k.orccr.I iSre rocomply *ilh lllCiry and C.unry
<br />ordinrtuc\ aid Srdc llss nl,!i.g t' building.onnrudn,n. {d lrtuhyrurhorizc rctrcsnr.rircs nfrhn Cilr.nd Cohtyro cnrcr trFn rh.
<br />nhot. n.n,,nrcd nroncny n|n"Ni"1!!6?r t I
<br />no,,,**..n"-,.,"-.*.LL <-H ^,"1"L5-ZQ
<br />""^,,*"" ",,^"',fLti"A-?( H *^spxzet
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor I
<br />Subf loor/Vent/l nsulation T
<br />Roof Sheathing /'&
<br />Shear Wall L', /\/u
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />l\4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Repon
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />rl
<br />FINAL 4 2 .LO )
<br />Certificate ol Occu pancy
<br />Notes, Remarks, Etc.
<br />Vt
<br />*.**"*
<br />L{ndci\ Ad.lfes
<br />-___+___
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