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BTULDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWN!]R BUILDER DET,CARATION
<br />I hcrchy allnn undcr n nahyol nlriury rh lamexcmnr tom rhc On r0clon Liccn{ hs ttr rhc lollowils rclv,n (s..70:ll5
<br />Busi'rc\\ nd Pi(,f.\\ion C,nlc): try Cny or Cormy lhich r.qtrirrs n Frnir k' conitud, ,licr. inrpr)lc- Lt slkh or Etxrir any
<br />{fl.rurc. priortu irs issudrrc. lho equirc\ihc rrFli( r for\u.h Frnnt o filc ! ri8ftd sucmnl rhlr hor rhc is liccnsed prrlulnr
<br />b rhc poeisi,in\ of rh. Cd rrch \ I-Ni$d tiw rchrprcr 9. Con,nrn.i'rg wirh Sc.rion 7UD oi Division I of rhc Businc$ r.d
<br />Pn,fcrsi( s Codc).rrhar h.drshc ircxcnu rhcr.fnDa*l rhcbasn fdrhc rllcgcdcxcnDlion Anyviohrn ofSccrionTO.ll5hyany
<br />rpthcrr fttr ilcnnir suhjc.k rhc amllc! lo acivilocnolryor nor nrnc (hrn filc hrndrd d.Urs 1$5fi))
<br />L nr ow.cr or rhe pn,l.ny, or nry cq)l.Frs wirh wtrses os rhct $lc a'nrt \rrio.. sill do tlE wori ard th. nfrtE is nn
<br />n cd.d oroftrcd ior elc (S('7044. Busircss,nd PR,fc*ioN codc: thc Contrucrois Liccns liw docs mr aIPl, ro inowm.ol
<br />rhc pmpcdy wh, boild\.r imlmv$ tlLrun. qxl who dcs such qnk him*lfor hcrsllor rhrcugh his or hct owncmpk,y.cs.
<br />lrovidcd rhal such impnlcmnrs @ nn i.rcndcd oroffcEl for sh li lmwrcr. rh: huilinA or nrlmvcrEnr ir $ll wirhhonc re
<br />or.omplclion, rh. ownfi Bxiklcr rill lEr lhc bord.n oi !ro!in8 rhal hc or ahc dil mt build ot irq,nc rrc porcny for rhe I[rIb{ oi
<br />l. asowncr.frhc lrmFny..flcxclusivclyconracring wirh liccisd.onb&ron t) condrucr rh. nnjat (Scc 7044 8u\im\s
<br />!d l}trI6sion Code: Thc Conkacrdis Liccnsc LtrR does norUply t' utr owndr.rpropcrty who huilds or nnFoves rhcrcon
<br />and who .onhds ror su.h ,'o.,.rts Birh a co ndo(9licor{d p!(umr rolh.conlrrtois l-ic.n{ tjw)
<br />I rm.rrn,pr undrr Sc.r(i
<br />De
<br />lIABtrEIlLrcIllfENli UrON
<br />DIICLA.EAIION
<br />I hcrchy0lIinnutrdcrDcnrlryolrcrjuryoncofrhcfolloq'nFdc.l*rrn s:
<br />I hrvc md will rurnllin oCcniftarcofCons. h Sclf lmurc lr wotkqr contp..sarbn, $ povidcd ntr byScclion l7(x)orihc
<br />Lrtx, Colc. ntr rh. p.rfonun c of rhe wort lor which rhr ptmir i\ isucd.
<br />h rhi\ pcn,ir i\ i\sucd lvly.$orkcN.otrrtEtrs.riotr iNurun.ccrfttur ind nolicynun,h.r rc:
<br />1,*/(€ hnerrc cnn
<br />Rd cc Gil(l szo q-l'?ot't
<br />-l
<br />ccnily rhll in lhc Frr.rmrn...rrhc Bork lor {hich lhn pcnnir is issucd. I shtllnor cmlloy lhy i,.mtr in 3nv nunmr
<br />s N t, h.c.m sxbicar ro rhc wodc6' cotrrpcNar i(,n lsws of Crlifdmio. Md .3rcc rhlr il I shouli b.torN iuhjcr i{' rh.
<br />workm conrp.ns,rn,n fbvirions otSdn,n 3700ofrhc htxr codc.I shrll. tunhwnh comply si'h lhos novnion\
<br />WARNING hilurc lo surc w.rkcB comf'.trst.on.ovcrrBc is nnl!*rul. dd shdl su$rc.r .n cnrlortr ro diminolpcuhts and
<br />.ivil lincs up lo onc hundred rhousand dolla6 (SIU).Urc). in rddirion k rhr.os olonDrnslridr' dnn!8cs as pr.vidcd ror rhc
<br />Sccrion 3076 otrhc tjhlr Cdlc. '.r.rcsl and auorrcy\ lces
<br /><,",., b- Ztr- / K'
<br />lrltlNt-r-ua!
<br />I lurhtxlln r trn(lo t,.trr ry.lt).rln,yrhxrlJn,l ui cr ntuvi(i( ui(hrprc' 9((o nN0.iD8 *ilh Sccri{n,70()0) Df Divi\i l
<br />B q1(:u o
<br />€nb.<<)2,_Lg-/x AC 4..
<br />, IQN5:IAU!:IIANTENDINIi/IIiI'IIJ
<br />I hcrchy illlrN undcr penrhy oi p.rjrry rhal lhcrc is a coNrrucri()n kndn,8 asctr.y r r rhc pc,{onroncc orrlt work lbr stich rhi\ Fnnir n
<br />n{rd rs( :r09r. civ c )
<br />ABIICAIiLDIII.AMIION
<br />I hNby rmm undq pcnslry oi p.rjury onc.rth. nrbwinB dsl!!{lions
<br />D.nr'lirofl Pcirnir*Asbcsros Norillcarnrn Fcdcml Rcguh(tuns (Tillc40. P 16)
<br />Rcquhd rnlcrol Nolifra,bn
<br />>vc nrctrriurd lfl,l[ny r(" insFclion
<br />".,. b-2{-/{
<br />J.,4. e.h.r'aflE-[^r|plnsnr
<br />nr rrtj" si*n{'um
<br />\",ir* ""..rp;nr,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall I
<br />Framino .truf,(
<br />lnsulation/Energy '-rL )hrall .1---1+'2-o{
<br />tQttnt. Larn c 2 -/I
<br />Erown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Ceftif
<br />(
<br />FINAL /zt 'q/// i qa
<br />Certiticate ol Occupancy
<br />Noteq Remarks, Etc./'r'\ |
<br />7
<br />' '.f ' - 7
<br />(
<br />ol rhc Bu\inc\\Dnd Pmf.\sbn\ Cod.. nnd my licctrs is in ioll nnc. rkl cfccl
<br />-l
<br />ccniiyrhrr rhc t ,lcral rsxhr iDn! tog*di.g 0shcso!rcnDvrl c n.riprli.nblc Iorhntrord.
<br />-lrdniryrhrr
<br />I hxvc rcdd rhis!p!li.0li.n and {alc rhlr rhc ahrvc i'innn hn iscorccr I isrcc t, c.nrrly wirh all Cir, rnd Cou y
<br />ordinric.\mdSr,cLnwsrclrlingrohuilding.on{tucrtnr,udh.tby lhori.ercl).cscnrdiv.sofrhisCiry dCounryr)ctrrtrulr rlt
<br />?/tz// )
<br />X/z /,? \o5, ?,R- /:
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