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BUILDING- INSPECTOR RECORD
<br />SITE.WORK OATE ID/SIG.COMMENTS OWNI]R BUII,DER DEI,CA&AT!ON
<br />I hcrcby afirm undc. pcnllry ()f Frjxry rh,r I a cxc rl)l In'n
<br />'hc
<br />Coffictrs Licc.sc Law lor rh.lollo$ing icasn (s..70ll s
<br />BusnBs ! l Prclcsion Codc): Any City ur Coumy whi.h rcquncs ! IErmir lo con\ltucr. !lre,. inrovc. &nDlish.r rc,n' ony
<br />srrucrurc, fuor ro ns isladc, lho rcquircs rhc appli..nr ior such lcmrir to lilc a \ismd srarcmnr rh2ltr or she is liccn*d p.runir
<br />k, rh. pr.visi.ns orfic Co.lr.cttrs Liccnscd tiw (Chaprcr 9. Commn.ine wnh Scdion 7txl0 of Division 3 of rb. Burinc$ lnd
<br />Ptr,fc$ions Code) or lhor hcor\he is e&npr rhcrcfrom rnd rhc h is t)rrlt rl h8cd crc nror io, Anyviolariono{sc.rion70.ll.5byany
<br />stplicafl lnr r !c.dn \rbjers rhe mplicMr b , civil l,tn,lry or nor mrc thdfl fivc hundrcd dolla^ ($500)
<br />L as owncr or rh. pbp.ny. or.rycnDlorccs eirh srEcr $ rh.ir q,h.onFnerion. will do d* wo dn rlt srBrm is ml
<br />nne n or .llccd for sle (SE 7O{, Au\irc$ lnd Pmfcrsions Codc: Thc Co.rraclois Liccn{ llw dds n.r ,frly ro !" o*ncr nl
<br />rhc tmpcdy *lD i,uilds o, iqmkrrL@n. a l sho dcs skh w.rt him\clf.r hcr{lf or rhmugh his or her oun cnphyL!\.
<br />F.vidcd rhnt such i,npmvcmnls m Dol inbncd or orc.crl for sh. l( lnNca. lhc buildiog or irqrorcmni h v,B wnhi'r .'E )tJr
<br />.rconptrtnr thc Owncr Builder willhaw rhe burdcn ol pnvir8 rhtrr tE or sic did mr huiH Di iilro\t rhc pmFny for thc l)ur[nso,
<br />-1.
<br />!sownc. ol'rhc propcny. ancrclusivcltcorradins u'ir[ ]iccn\cd conrxcd\ t,.o.sru.r rhc pmjccr (Ss. 7044- Bunncs
<br />rM tbrssbtr Codc: Thc Conaidor's l-i.ctrsc Law d.cs tro! rffly b r. owmr oiDtr,pclry who builds or inprclcs rh$con.
<br />rnd who comack iu snch tmicrs sirh r conrrcro( t li.cn\cd puNnN h thc (rn ra.rol s Liccnr uw)
<br />I mr.xcnl/ undcr Sc.rion ,B &PC.larrhisr.lsotr.
<br />D.,. Ua1:* ,".".r C,R,\'=.
<br />' ilbRl.FRl' aull li'Ns^'r!oN
<br />lrFcl aRArloN
<br />I hcrcby !lllrm!ndcr pcnllty ol p€rJ!.y onc ofrhe nnl,wn'r dcclardrt,ni:
<br />I hrlc affl will tuiorain a Cedificdc of Con\.nr b Sclf-lnixn fn wor*ers comNtrsaln,n- as Eovidcd fd by S(l bD 37(x) ol lh.
<br />tlhorCodc. lorlhc periomnccof Ue wo.l f{, whichrhc lcntri n n\u.d.
<br />Ih!v.lndsillmainrrinworkrJcomp.nsllioninsurukc.rsrcquircdhySari.n:1700ofrhctjhntrCod..forrhcncrlormnccnf
<br />thc Rork lor vhi.h rhir p.rmii is is$.d. Myworkm comFnsition insurancc cMicr a.d tnicy oumbcr {c:
<br />l.cn1l-vrhdr ir rhc Erli,nMocc.l rhcNo.k lol which rhn pcnnir i! i\ru.J I \hrlltror cmfloy.nyncran in u, 'nrnrurv, a{ft, h(oE ubFd iorhc Norkc^ c.trfcn\ ri,nr hw\ol Crlilnnrin. rtul llliNrl ii I siould hcconE {hJcd brlt
<br />*orkcrr.on,Fn\rrn,nF)ei\io.r.fScrrn :lT0O of r lt t]htr C,rlc. l \hrll. 6dh+'irh condy wir h rk){ r(,vi\t i5
<br />WARNINC I'liluc ro ccurc *orkcr conrpctrldnn, covcrrgr i\ unlntrful. rtrd drill subjccr in errllol..r b cri'ni'ul P.mlri.\ r d
<br />civil fn.suIroonchu rcd rhousrnd dolla^ l$l(x).{$l)), i rddniotr n) rhc..s olcnnrpctrsari{,n. d!'nr8c\ r( frovnlcd,rr rhc
<br />S..rior 107( oIrM Lat r Cqlc. inlcrcn rfttittrtrry s ri.\
<br />Drl.! l!^.tu!
<br />ol Ih.llNinc\\rftl l}ol.sn,nl Codc.,kl ry li.o sc i\ in lllltur.c Mdcfi.cr
<br />ca!flf,l]cuqNIlluNcacENll
<br />I hcEhy aifiirn undcr lr..lry of lclury lhd rhcrc h a con{tuction leoding rScmy for rhc p.rforn]mc of lhe lork fDr which rhis Fnln n
<br />t{cd {Sr.'. :1097. Civ C ).
<br />ASX.IIANI.DDILAAAIDT
<br />I tfrby ufinD undcr pcnahy olpcrjrr, o d orrhc r{rlowinS d..lmr nrs
<br />Ocnninnr PcirnilsAshcslos Notificorion Fcdcrul RcgllarnnN (Tirlc 40, PM6)
<br />-Rcquircd
<br />Lclrcr oi Nolil'clrion
<br />l.c ifylhdrthc Ldcrslrcgul!tions rcsdirs islicnos rcnolnl rrc Dorqrfl'.rblc ro rhisfrojd
<br />,1|,pliul or Aa€nt SiSnuluR
<br />lc J le -J1-tl
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Shealhing '1.|b-t6^)eL*a
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL e/s//*
<br />Certificate of Occu n
<br />Notes, Remarks, Etc
<br />Policy Ntrnrbcr
<br />-Exlncs
<br />Liccnse Cla$:-Li.cnrc Nunb.fl
<br />-
<br />I.q'lr''\ ,U'.-.
<br />xrvc nrnrioncd Inolr€dy ntr in\p..ri.n
<br />Set Backs
<br />Subf loor/VenVlnsulation
<br />Brown Coat
<br />1
<br />W,,,
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