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BUILDING. INSPECTOR RECORD
<br />COMMESITE-WORK
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathin t
<br />Shear Wall
<br />Framin
<br />lnsulation/Ene
<br />allD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/]ason
<br />T-Bar
<br />Handica Re
<br />utD Final Re ort
<br />En ineer Final R ort
<br />FINAL
<br />Certificate of Occu n
<br />N emarks EtcES
<br />,\,/n'
<br />d
<br />OIVNER BUII,D}:R|)EL('ARAT(
<br />I lErcby ariri und.r p.mlry or rrjury rlrll I m .rcmfl ltum rhc O,nrr.k t I-
<br />)N
<br />.acnsc ljw aor rhc follovi,s r.aern (Se 70.]1.1
<br />Burinci\ fui Proli$ion Cotl.): Any Ciry or Cou.ry whrh rcqund d lEmil ro con{ru.t. sllcr. inpfuvc dcmolish or rclair tv t
<br />dd.ruc, llri,k, ils is\xmc. rko rcqlirc\ rh. lPtlia ntrskhFm lo ilc a $sncd sllcmnr rhar tr or shc n !dn{J punu'nr
<br />n, rlrc l)!*aioni ol lh. Conr.acd's Li.cnrc't trw lcluflcr 9, Conmcnuin! wirh Secrnrn ?0(l) of Divtitn ] ot rhc Businc$ dl
<br />Pnnc*tuns Oic) or rhar h. Dt she t crcnq,r (hc.chm !d lhc b trorrhc.llcscJctchNnn. Anvvnrhhdnolsarion70rl'5bvonv
<br />aprlica nr r p.mil subic.k thc rlfliuMl ro a dril t)cnllr y ol flor morc I hrn rivc hundrcd dollds (S5d)).
<br />/'<(zlP* ." *, nr ,t
<br />" o-rn v. "r mv.nnl.'ttcr w h wa!c\ as rhcir srle cotr\tns'ron. w no rh' wdk tn'l rhe dturmis rur
<br />n ctr,tc,i or olf.rd lm slc (Se.?044, Busincs rn,l Proftshns C*te: Thc Conx !ulr\ l-ic.nk tis des not 'ptlv b u owkr df
<br />rhc Fmncny whrbu ls or inDn,ks rhcdr. ail wh) das s(h wo* himscl, or h.r\clf or thoulh hn ot h'r owtr cmpktyccs
<br />poviJ.J (h!r $ch impoffinh * mr nrcnled oroffcNd Ibr sL. li hN.rd, rhc huiLlhs or ii{n,Em n $U wnhin om vta
<br />;l d,nr'hr$n. dr Ow;r Bufird w,ll havc rhc hurJ.. or tNviry rhd hc or sh. dil
<br />'r)1
<br />nnill or rqnv hc PNpcn, lor rh' |dtlxtt ol
<br />l.asowncrorrhcpmr.ny.an.rclusivclyconka.!i!3wirhltcnscdconiracn,Flo.onsrtuctihcpofd(Sc'7041.Bu\incs
<br />ili Ptur6srn 6dc: ih. Conk.uln\ l,iccnsc Law der not apply b rn .wnct or p!,lcdv who buiUs 'r m{tuvcs lhcE n,
<br />and *ho conrr.k lo, surh rojccts wirh d On'r,(ktn, li.cnscd Purumr b rhc Conrr((x s Licn* Law)
<br />O,.)C-t-
<br />\\()Rl(tits ( olIfu\sA'l l(r\
<br />t)ti( t,ARA]l()N
<br />I hcrchy al rim unJfi pcnrlly oI Friury oft ol th. inlbwine .t&laratbns
<br />Ihavc!dwillmrint|raCcrlircarcotconscnllosclllnsur.ntrwo*c6'conwnsarion,rspl)vidciti'rhvSccrttn\?ol)olrhc
<br />lr$r Grlc. lbr rhc lErfornEre ot rh€ wotk lot whiuh rhe Fm s isucd
<br />-l
<br />haw and will mlinr,in *otk.s comncnsaiion nEurrn.c. rs .cqxidl hv Sc.l ioo .l7(n of rhc L.hor Codc. fd thc p'rrdmn" ol
<br />ttc worklorwtu h rhisFrmn L\ isnd. My woik.s' om['cn$rn'n in afrc..mcr ar rntvnumbcroc:
<br />1,5*.r
<br />"
<br />u*, * ,n" *r*.a&c nr rhc wurk htr r h( h rhis ncrmir r rsNcJ l stutl nor cnrfl(rv unv r'6on r lnv m'nm'
<br />--*'.n"."**tr.iu,'r""oL1i.n'l.nvt[nlr*.,'lc:l'i,'nru rnJ,er'h,t l 'h"ull rYconf, \uhq I L r\'
<br />worlcs u.mpctr\rroh pRJvkhns ol Sfrrn)n l?OO.llhc lihtr Ciiic.l shiL tunhwrh co.ulv wirh rh$ PDYirnrn\
<br />WARNTNG i lurc r" *.,'. w,trkcs'.oDp.trsdio. covcn8c rs unlxwtul. .tuIshrll {hjcct an cnpl'vq b cn'biDl l8nahtr rtul
<br />.'vrl lincs up b orc hundrcd rhouu.i dolls (!10{.(xl(,). ; rJ,l n b rhc rod uf compcnsrrb' d'nDScs as lm!trt&l l'r ric
<br />7i ,,rltl" LLry' (,,1. nr!k\//z/20 ,/J u
<br />l,tcr:NsEp coNTt,\croR
<br />!Er! x{DQ!
<br />I hcEt y aflnm unJlr Fmlryorp.rjury rh{r I am licniJ;d.r pNvnboorchaPler 9 (dnmfrin8 wilh SmriJn ?lno) otDiviihn l
<br />of lh. auiim$ ,nd P(ntsioor Codc, anl my liccnsc is in fu ntM d}] ctLcr
<br />CONSTRUCIION LENDTNG AGENCY
<br />lh.rb1/aftrnlUndcrEnrllyofpc'jurylh,lllteLsaconslru.li0nlcfu]in!.ccnuytfilh.lcrfomunccdflh.qolk{d*hi.hllispcrmilir
<br />issucn (So. .r{}9?, Civ. C.).
<br />LnJ.r's N"mc
<br />A}fUSABLOSCLAEAIION
<br />I h.'rhy'trmu lcrlcaahyorPcrjuryonc oirhc rtnlowins dccldarknr:
<br />Dcmlili,n Pcmils-AstF(oi Norirr.at{n Fcncral Rclulal,ons (f ilL40 Pin6)
<br />_R.qumd r/llcr ot Norirr,tion
<br />I.cnilyrhdr rhc ialcri| resuht(,ns regdnins ast {o. 'tnNv irc nor aprlkdtlc lo drh l()jct
<br />rl$v. ftnroncd F pcny,,tr insP..r0n
<br />t^-^
<br />o com/y wnh aU Cny and c.unrY
<br />rh'sc yMJ c dyrns cTFrrrf,
<br />,*," . / />126
<br />UFER Ground
<br />Pool Fence
<br />Flood Zone Certif.
<br />Lc crsAd,iftsl
<br />foare I rD/src.
<br />lElzo )
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