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BUILDING- INSPECTOH RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DIiLCARATION
<br />I hcrcby a{ljlnr trndcrycnohy oi pcrjury that I { cxcmpr irorn rhc Contrdrs Liccnsc L!* li,r lhc ioll.winE rc,v,n (sct7o.]l5
<br />Bu\inc$ and ltol!$n,n Cqlc): Any Ciry or CouDr, wnich rcquircs r Frmir b consr .i. alrcr- in ovc, dctrnli.h m rcNn dry
<br />nrudurc, pritr k, ii\ i\suamc, also rcquircsrh. rppli.Mr n' suchFrnrir ro fi|., \i8ftd n.rcnrnr rhar tEor sh. is liccnscd nur$anr
<br />ro rhc lrelnions ofrh. Co.rructn s t-icenscd hw (Chflcr 9. Gnlmrcing *ith Sccrion 7tm.f Divi\ion I of rhc Busincs rnd
<br />Pdtssnrns Codc)orrhrr h.orsh. iscrnDr ih.r.fofra.d rh. hnsi\ fff rhc dl lcecd cx. mpr ion Any violariorolScdion 70:11.5 hyany
<br />qrllic.nt lor r tE,nil subj(k lhc amlicanl lo tr.ivilpcn.[yorno( nbro dm nvc hunded dollrs ($500).
<br />-1.
<br />as o*ncr of rhc prop.ny. (, my en]Pk,rEs silh *ages ar rlEir slc comFtrsDrinn. will d. rlt work nid rtr {u_rm i\ mt
<br />i[c Ii or ollcrcd for slc (Se ?().l-1. Busincss and PrDf.sione C.d.: rh. Contrrctof s Liccrsc tjw docs nor mtly b !. owmr oa
<br />rhc pmr.ny whr hnilds or inpmves rltm( md who d*s skh srk himselfor hcr*lforrhroxlh hi\ or h.r o*n cmtloyrcs.
<br />fioridcd ihar such inrmErnt m mr inrcndcd oroiaEr] for$k l[ howcvcr ihc hildina or inlpmrcmnr i\ c,ld wirhin onc ,cr
<br />olcon{ndion. thc Ow.cr auikln will hNc lhc burdcn ol prorir8 tlur ht or shc did nol lDild or improlc thc pml)ely for lhc puqx,sc of
<br />-1.
<br />$ owmr ol rhc trcpcnr, amcxclusivclyconr&rirg sirh li.cnkd.onracrorsro consrructltE prorst (Scc 701-{.l]ulmss
<br />rpn EDtssi,n Codc:'l hc Conrra.ttr \ I-iceisc Lr* do.s nolutply to !n owncr offlopcdysho buildi or imtRxt\ rhcrcon,
<br />! pho conrrick for such Drrlrls wilh 0 Gnlmcro(, liccn*d ,,usuaflt to rhc Gnbacrofs Lkcnsc Lo* )
<br />I iDrcxcnrpr utrd$ Sccrtu . B. &
<br />slrr\16
<br />I hcrcbtdltlrNutrdcr,r ahyofl.rjuryoncofrhcfolk,*ingdc.lrarn,ns
<br />lhaccarxlwilluinrai'raCcnificar.otCon*nrroScllltrlur.titrqorkc'sconf.n\ati(,n,*ln)vidrdr.rhrSc.rn]7fi)olrhc
<br />litxtr Cnlc- &r lhc pcrn,roncc ot rhc {ork f{n * htch rhe p.rmil is issucd
<br />I hrvc rnd vill nini'nrin wo*cr! .onlrtr\dn in\ur ..c, n\ rcquncd byS.crn lTO0orrhc bh.rCodc.lbrrhc pcrlorrunccol
<br />rhc *ork inr whnh rhis l)c nril is istrd. Mr w.rkc( otrrp.0srri, iNurrncc cnricr nnd tElicy.un$.r sc:
<br />l.cd,fy rhrr in rhc pcifonmndc.i rhc sork for whi.h rhil l)(rmir i\ rsucd. I shnll mr cmplo, ufly pcr$n in atry nEnncr
<br />$ ns lo bc!!,E sul,jcd lo lhc $orkcrl conrren{rion lasr ol'CalilnrniL and osB rnrl ill fi{,rld lEqor suh.r..r ro rh.
<br />wortcn compcn\nrion pmvnionrolSdn,n:l7a{)ofrtc hhtr C.ic.l shnll. tunhwirh.o'nply wirh rho$ lmvisn'ns
<br />WARNTNC: I'iihtrc b scurc workcs' compcnsrlior .ovcroAc is unlnrr'Irl. anl shrll Nbjccr un cNplorcr b dihinrl pcnahi.s trd
<br />civil fitrcs uD Io oN nundrcd Ihousrnd dolhs (Sl(D.ooo), h ddJnh lo rhc..i olconDcns&li{}o- ddDE.\ Ds tio dcd r.' rh.
<br />S.cli{r 1076 oflhc tjbor C'odc, irrcrc( and nllorNy
<br />I hrrch, !finD undc. r.nallyoftEUury lhlr I anr liensd udcr tmvision olCh{prcr 9 (ommnci.8 *i'h S(rbn 7uJ0) olDivhio l
<br />of rh. Auiimssa l Pmfesiors Codc.8nd my lic.n* G in tullld.. url ctLcr
<br />E0NSIBIJCIAIXINDINGTIQDN!.I
<br />I hcrchy ainn undcr Fmllyoirrjury lhd th.rc is a conshclirn bndina rscncy irtr itu pcrtunMncu orrhc work rar Rhich rhk Fflni t
<br />is\ucd lsc. 30r)7, Civ. C )
<br />A"PILICANLIECIABAIION
<br />I H,, afrim undcr p.nahyofpcrjlr, one otrhc a.lr,wins dNlamli.ns:
<br />O.Nni'ion P.rnrirsAstrstos Notific!tion icdcral RcSularions (Tirlc.l0. Pan6,
<br />Rcanircd Lclror ol Norifi .{1tun
<br />-l
<br />ccnify rharthclcdcralrc3rkrions rcgarding lshcnos rcwvul arc norrppli.nhlr tu rhis tmr..t
<br />l..nifyrhxrlhrrcrcddrhirrnpi..rn,nd krc rh.rrhc rtxrc i'itu n oni\conccr Io8rero.onDlyqirhlllCiryandCouniy
<br />.rdmk$ iM Sr c tias rchriDB lo buiklnC cotrsnRrnn\ md hcruby rurhorizc rcfcscnrolirc{ ollhk Cily ond Counr, b enrd rF,n rhc
<br />rbovc nrnrioncJ nn'mdv f in\m iondm*\
<br />noru.-,*n**,."*'* f\Z- /Z
<br />Pem,.?nome(prin,': (q{,-"/"/, /-trr5
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SublloorivenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino g'r'(9 .TNP2
<br />lnsulation/Energy {,-7- tx,flJ,A)
<br />Drywall 44-rs l,r.Vl)
<br />ext.linl) Latr $"as, -rg i)rb)
<br />Brown Coat
<br />fr/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL Pluafi,n\he,/
<br />Certificate of Occupancy I U I
<br />Notes, Remarks, Etc
<br />Flood Zone Certif .
<br />C.'E"'
<br />l itr I ro
<br />L.rdeir AdnEls:
<br />-
<br />o*,, s lzt lrc
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