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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDiSIG.COMMENTS OWNAi' BUILDEN ODLCARATION
<br />I hcrcby ulltn undq Fnihy of pciury rhar I am cxcmnr from thc Conrrrros Li.cnsc taw lor lhc r{,llo*i.g rc*.n ( Se ?0:l l 5
<br />Busi.css ad Pmtc$ioi O c): Any Cir, or CDuly Bhich rcquirc\ a pcnnir b con(dd. ,lrd, inlplo\t. dcnol$h or rctl.ir rtry
<br />(rucrurc. pii,ro irs (o0mc, rho r.quncs rhc {plic,nr roriu.h Fr.ri! ro fi,c i siSmd narcmnr rhol h.or shc h licenrd pu,ar
<br />h rh. Jrovki(,i\ otrlr Co.kdciofs Liccn\d trw lchnflcr L Co'nmctuin! wirh Sc.tk,6 7000 ol Divisbn 3 ollhc 0usinc$ rnd
<br />Pmlcssio sCodc)orlhrr h.o.shc is cxcm rh.rclrum.nl rh. basir tu rhc 0lkecd cxcm nrn.Anyviolalionofsecri"trT0ll5byaiy
<br />lpplicont lor a rEnnit subjcck lhc arplicflnr k' !civilpcnrnyoinor nFrcrhan fivc hundrcddoll,^ (S50o).
<br />L!g-t, s ovr. ot ,tr. Ilnrrny. or mt . rrr',rc.\ wih tr dgcl s\ ih.n v,tu .o rp.tr{lion. will do rn wor* axl rtrc firlsc n nor
<br />inlc cd or orttrcd fnr srlc ( Sc.7l!4. 8usinc$ atrd Profcsions Cdc: Thc Contmdor's Li.cnsc l-r$ docs nor ,pply k' M .wicr or
<br />rhc pmFny who bxild\ or imprc{cs rtE@n- ud *ho dcs such m* himrclaor herslror rhtr lgh hi\ or h.r owncnDbrccs.
<br />phvidcd tlmr *ch impmEnrnl( !rc nor in cod.d d oficE (tr srL lf. h.rcrr. rhc huilding or in{norcmnr is sld wirhin onc ][rr
<br />olconlllcrio.. tlE Owmr lrull(lcr willhrrc lhc bud.n or !rcvir8 rh.r lE or shc did ml nliu or iqms rhc propcny ror rhc f rlx,s ol'
<br />l.r\.*rcrolrhc[op.ny.rnrc(lNircly..nrracrirswirhLiccn\cd.onrrrcroFn,con{tu.rrh.t(ic.rrs..70,r,1.Bdsirtr*
<br />d0d Pn)fl1\hn Cod.: Thc Coir.aftr'\ Li.cn{ Lxa d.c\ tror rptl! k' M osicr offr)ltny sho huild\ or ltrlttr.f.\ rhcr..n.
<br />i who conlrn.hlo, {:.nJmr..rs $irh r Cofrrn.kn(\) licc,r\cLl Dumui nrrh.(l,nlrr{tr s lj.cn* Ir'{)
<br />_lim.rcnrnr u d Sc.li(
<br />{*" 64L'z/tY
<br />D!:CLla I!I)t
<br />I hrrrh!rltnnu .rpctrrllyolpcrlurr_oncotrhctulhqin!dcchrrriin,\:
<br />-lhrve
<br />a *ill nnintuin r Ccnificlrc ol Conscnr ro Scli.l'$urc njr $orler' c.dpcnsor ioo. !s piovldddrorhySNriotr:l?u)oflh.
<br />tjhrr Codc. ror rhc tHlonMtrc ofrhe wort for which $c pdnril is i$ucd
<br />rtu*orkf{trshichrhnI.n,iri!iso.dMy*o.ri.onrp.n$rnn,nEurrr(.atricr rl la,lry Nnrh-rdc
<br />zL&l.cniryrh inrhc p.ironMn corlhc work ror which rhi! pcnnr h isnE,l.l (htrllnor cnrplorany pclson irany nunncr
<br />--E< h bcom suhjcd ro rhc workcr comFnsarn,n kws or Caliiomir. xDd:Brcc thar irl should b..um suhrccr ro lh:
<br />rorkcr conrpc!\arn,n pmvi\i{,n\ ofSccrion]Tanofrhe Lrhn Cdc.l shrll. ronh{nh.omtly $nh rhl* pm\isions
<br />WARNING: Flifurc ro ccurc $ork.r'conrpcnsdinn coicm8c is lnhwtul. rnd s \uni.' ri .n,ptDrr (, .rinurl ,)(trihN nnd
<br />con,rcnssrtun. drtrrtcr rr |)rtridcn tur rhc
<br />S..rii)n 1076ofrhc I xhn (i c.ini
<br />2 o^.. 0 ale/tK
<br />ITECI,AEAIPN
<br />I hcehy amm und.r p.nrlly of psjury lhll I am li.cn$d und.r pmvnion olChoflq 9 (connrcmin8 wirh Scclirn 7flx)).rDivhi.n l
<br />of rhc Burimis 0n<l Pofc\sioncCodc,.nd
<br />'ny
<br />lic.nsc k in tull f(tra lnd.lf.ct.
<br />LiccnscChssr-
<br />g)NIIAIJCIIONI,INDIXCTIIj.EN.CI
<br />I hcBh, llli undcr Fnalry ot lxrjry rh r rhcrcisxcon{n,.ri(,nlc insac.dryrorrh.Nrr.mrrcorrhcqorklorwhichlhispcnnta
<br />klucd(Scc :l{r9r- Civ. C )
<br />AIIuCANfDICI.ABAIIIJN
<br />I hcEt y,iim undc, pcnalr y ol Frjury onc olrh. folloaine dalaarions:
<br />Dcnnilion Pcrmih Asbc(osNolil'iculion Fcdcral Rc8ulali().s lTnt 40- P{n6)
<br />-Rcquncd
<br />t.lrcr of Notifi c.lion
<br />l..nil.!rl rrh.lidcrilrrguhrions r.!adi',Srn{no\'.nn)vrlrfu D,r rt,tl.rhlo t,rhr t),(ltl
<br />t4l"""rlyrhrr I hNc rcad rlr'\,'nni.nrn{ dir1c rlrrrhcnlrir. h h.orc.r I a8r.! ro conr yuiih3llcirrmdcotrDry
<br />rcnrc{c .tn$ofrhtCiryudc(rdybenrcrupoirh.ordini'n.cs and Srarc tjws rlnrirg ni
<br />cnri{nrcd fro|tny nr i',\Fcri,,
<br />t"6ZCO,a o"r" t2
<br />Forms/Steel/Holdowns
<br />Erection Pads v
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />f,oof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./1n1. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />(
<br />FINAL oa 7//t 4 v'n,o/Certificate of Occu pancy
<br />Notes, Remarks, Elc
<br />Set Backs
<br />UFER Ground
<br />civil linc\ uI ro onc hundrcd rhour!nd dollrr (lllD.lIxr), ir !ddili{,n b rhc
<br />I {,Jr' ' JJ'r\,
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