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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUll-DllR DF:t,CARATl()N
<br />I hcrcby rf,lnn und* Fnalry ol Nrjury th l .o cxc.ru lnnn Ihc contmchnl Liccn{ Law tu rhc dlowins rcr$n (s..70.11 5
<br />Busirrc* i.d Polc$iotr C{rlc) Atry City or Counly *hich rcquics a lcrlrit xi c.nsrrucr- alrs- inrrn,lc. 'Lnolilh , rrrr r'ry
<br />slru.lurc. priltrro ils nruancc. rlw rcquircslhc enlicrnr lor such ncrnrir lo filc a sisrc.l {arcntnr rhir rr.r sh. ( li.cn*d 0uru.
<br />ro lhc trclniotrs ofrhc conri.ttr\ Liccnscd h$ ((hiflcr 9. (hnlnctrcins wirh Sc.ri i(xxr ol't)ivisi.n.1 ol rhc Bt\incs rnd
<br />P.ofcssions Codc) or rhrr hcorshc i\crcn,Irrh.mriomMd rhc hr\is nn rh.rur!.dcxcmfln Atryvi(,hrnnofSccrhn 7ll1l.5 hyuny
<br />rlplicrnr r(tr ! p.mn \uhj.ch rh. ,ppli.n b,.iviltctrrlryormr rrc lh.n livc hunnrcd d{llttrr ( S5m).
<br />-1.
<br />{s o*mr ol I hc nmplriy- rtr my .mpl.r!c\ *nh wasc\ r\ rh.tr vnr .,,n'Fn\tr tr'n ** f Il* .* r* ;. *,
<br />idcndcrl oro&crcd n, sb (Se 7014. Ansincs.nd Prcli$i.tr\ (i'dc thc t'ntrhd.f\ LiccneF:* dnci n,i rnn\ x'Jnowncrof
<br />rh.Ihpcny $ho hnilds or nnpn)vc\ thcr6n, d*hodocssuch*o*hi'nsclrorhc(clforrhruu8hhi{orhdosncnlrhyccs-
<br />Di.viJcd rhtrr slch itnlfi)wrnnh ,a mr inr.ftcrl .r .rTcad fitr sL ll h.tr crr. rh. huill in3 or i'rynrmni is $ld *irhfi om )mr
<br />of..mpldiotr, ItE owncr Buillq $ill hrlc lhc l{dcn or novin8 lhJl hc.! $. dil nor l[ild or inlPmt rhc pn,pciy r(n rhc puqnsc or
<br />-l-
<br />osowncrofrhc rmpmy. omcxclusiElyconracrins *irh licenEd conkmioFio drniru.r
<br />'h. rmj..r (scc 7044. Buiinc$
<br />Md Pnfl*sirn Codc Th.Contacror's Liccnsc La*'doc( n.r rl)|]ly to .tr otrmr of pn)pcny rho huild{or imrtuvc\ rhcrcoi.
<br />rnd who .onrracrs tur such projers wirh tr conh.n,n s) li.cn\cd p!^knr b rhc c(r mdoisLiccn\chw)
<br />I MrcxcnU undcr S.cr
<br />rvonx n ns' r rou prns,r'riri r
<br />Bt cLtBltM!
<br />I h0chyrfltntrn cr p.nrlryof F-rjrryomolrtu tulll)wing Jcchr.otr\
<br />_lhr\csnd*illruinrai"!Ccnifi.lrcoICon\cntk'Sclfl'r\!rf(tr$.rkc^.ri1|]cnsdtrnr.rs Jrovidcd hr hy Secriotr .1700 ol rhc
<br />L!hr! ('.nc- r'orlhc pqlbnnincc olrhe sork lor which rhc ncmrir is n\ucd
<br />rhc work fttr which rhi\ pcxnir is is$cd My qo $! co i|r. {ri(trr i'r\uhtrcc.micr { Jr,li(} .uni,.r r.
<br />-Ll.cn'l rhrr Irh(lcrnrn6n.cut,hc*urt r,trlhrchrhi\pci,nir k is\Lcd. ! shrll no' ctrlploydny |Effitr irr rtryn nnci
<br />e, N ro b..om {hjc.r l. rhc w*kds conFcns ionl,ssorcrlirornir,nMrtsrccrhdillshouldhcconEsufijcdfurrr
<br />workcn .o D.nsnrion prcvisrons of ssr io lTm of rlr Lrhtr cod.. l shall. lhnh$irh conrdy *irh rtx,{ pmvision(
<br />WARNINC: Failure k, *nic *ork rs'.onpctrs n)n..v.agc rs unhsful. Md shrll srhjcd an cnrfl,,ycr n, sihinrl l.trrlri.s rnd
<br />.ivil fin.r rp k, otu hundrcd rhou\and dolhr\ (il00.1XX).o{ ot.,nn|xtr$Ii,n!. ,lrtr'rg.\ r\ |i,rnlc tur rhc
<br />s..ri,)n 1016.lrh.l rhtr ( fth ini.rtxr rn/ xror
<br />",,",/'>3 t-')
<br />I hcEh, alfifln undcr pcmltyofpcrjury th.l I t liccnad unncr provhiqr otCh!flcr 9 (oh'tun.ing wnh s..inn rfiD) ofDivisio.3
<br />of Ihc Bu\imrsand Proh$n NCodc.md nry lacnsc h ir tu]Iiorcc mdcfccr.
<br />(-71 . B {2-f u,/
<br />n*",/ - Ill -t--
<br />"4tlI hdhy lmrm undcr lrcnllryofpcrjury(h!r lh.rc h d.onsocrhn rcndine a8.ncy for lhc pcrfornDncc ofrhc worl fo, whkh rhh Fmir k
<br />hsucd (Scc. 3097.Ci!.C.).
<br />d.PPI.IIANLTECI.ABAIAN
<br />I lmby aiim undcrycnalry ol pcrjury oe ofrh€ followins delri6nr
<br />Dcnnnilnr P.rmik.Asbcslos Nolificrrion fedcral Rcsulaln'ns (lnh.u)- Pan6)
<br />-Rcquncd
<br />Ldu of Nolifi caion
<br />I Qnifyrlrrrhcfedurlr.guldri.n\ rug&lhB i\lE{.\rctrtr,vrL rc ror r!
<br />.otr€r I nsre n,coarply$iihallCiryand Codnry
<br />'rfrr\c turnc\ nl rhn ('iry rnl CotrDry h.trrr. trtrr rlr
<br />e f ../,rUFt.ermire nanrc rprirlr/.,'=-l--_
<br />o,"/' 2.3
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation I
<br />Roof Sheathinq o L-fr go
<br />Shear Wall I
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVasonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />(,l2t?7 Ylt W)o L+r 87
<br />Certiticate of Occu --Irpancy
<br />Ngtes, Bemarks, Etc
<br />(o 4',11 /]-LJ
<br />O/V €VL
<br />,)A>oc.zt-e-((
<br />I Dkno (
<br />Pool Fence
<br />Flood Zone Certif .
<br />FINAL
<br />E
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