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BUILDiNG. INSPECTOR RECORD
<br />()\\'NtiR Itt lt,LIaR t )t,],c]\ R,\1 1()N
<br />I hcrchy aiirn und$ lEMlty of pcrlury rhal I cxcnF from rhc Conrrlon Liccnsc Llu for rhc follo*in8 rcaq,n 156 70.11 5
<br />Itusincs !d Profcsion Codc): Any Cily or Counly Bhich rcqutcs a p.rmn 'o con(tucr. alrcr. io{tov.. d.nblth ,tr rcrBn rn,
<br />docrrr.. r, trro irs h\uancc. aho r.quirei rh. applicanr f{rtrch Frnrir t,lih r sigNd srdcmnr rhat tr.r shc i licen*d pu$uanr
<br />ro rhc pmvnioN olrh. ConrEclois Li.cn*d ljw (Ch.prcr 9. ConrnEmio8 wilh Sccri'n 7Un or Dilhir..l orrhc Brrin.ss dnd
<br />Ptufc\stunrC.xlc)orrhrr h.orrh. iscx.dpt rh.nfr.6lnn rh.bosn for thd r lhg.d cx.nlpr ion An! violtrlionotSsrio"?011.5 $y!try
<br />antli.anl lor a pei,nit subjcchlhc arflicont ro acivilpcn.ltyo, nor mrcrhan fivc hundrc.l dolhr (S5mr
<br />-1.
<br />r\ osncrofrhc pr.IEny. orfiycn,ploycc\ wirI wagcsrl rhcir $]cconlPcosiion. $ill do rh( sorkd rhc{ulu.isDol
<br />idrhd.d or ofiired nn srlc (S( 7(x4. ausiisa md Pn,fc\\ions c(xlc: Thc C'ontra.tr'\ Lifttrsc Lrq docs ooraDply h rn o$nflof
<br />rhc I[)tf,ny who huil,lsori'npro!.srhcKn,,xnd !hodocs{rh*1trk hi'nscli orhcncllorrhn)uEh his orh.row c'ntlorccs.
<br />ol con]Irlcri,n. thc O*mr Builder slllhrve rhc h'd$ ofrn,vin! rhrr hc or shc did Rr buiu or inuolr dr pn,p,ny ftr rhc nn4r$ of
<br />I. Ao*ndorrhctrol.ny. rncr.lusiv.ly.ontncring $irh I iccn\cd co nta.ros ro consl nr.r ltE rn)jc.r (Se 7(84- Bunnes
<br />!tuj ltfc$inCodc:lhcConrr.croisLi.cn{chudesnornnrlyrorn.wncrorpn,pcnywhohoil&orinrlmlcsrhcrcon,
<br />a.d stu .onk..afor\uchrroj..rstrirhrC.trito.rtr(s) li..n.cd Nsurtrr roth.annriclq s Liicnsc liyJ.
<br />"^e\i)t(
<br />DI|rl &r.UoN
<br />I hcrchr_ rllnnutrdcr ]tr ihy.tpcrjury. c .l rhc ln lk,wi'rg d(lnrdnr\:
<br />litxtr (i)dc.,nr rh. Ifrtunn mr of rtu work lbr ahi(h lh. rcnnii i\ i\{'ctl
<br />rhc $ork f(tr shrh rhi\ |tnr i\ n\&{ lrl!sorkr^'.onlllrtr\rr(tri trtrurr (.rtricr lin].y trtrrh.r rrc:
<br />Poli.y Nun,tcr Erlrc\
<br />I ccarly rhrr ir rhc |trLrowEc.lrhc Nork lnr *hl.h rhi\ rrnrir i\ istr.d. I shxll nor cmtk,j_ rny n.^on fi xnt irtrtrrr
<br />v'r\t,h.om$hj.dt,rhc$,ork.r\conf.nsrri()nh*s.tCrlilafl,ir.rdrgr.rhnrifl\]k{ldh.ont\rhl.(rrorh.
<br />sorkcr\'.onlnctr\rri{nrInNisi{'nsofSccri,r.lT(x)ofrlIl]hrCodc.lshxll,n,nh*irIc.n]frlyf,ithrh.\cpnv^i,x
<br />\ trrLxslul. JDn drx I {'hic.r rr rnrdo )cr ro dniml lEmhics ond
<br />rm08cs !s providcd lor rhcc vil lnro\ trI, (, otr. hundrcd rhorsrtrJ
<br />^'"'- E/t/i'$n*-
<br />I husbyaftr u ndm Fnrlry of p.rjury rld I h li..Rn undn,)ovision ofchrplcr 9lonnmncinE sirhScdio.7000).fDilhion l
<br />ol lhcBu$imsr t otsnrn\ Codc- Lrtl my liccn{ n io tullfucmlcftLy'
<br />AIILISANLOICLANAI]O!
<br />I lErby dfiim uNi.r p.n,lry or p.rjury ofl. orrh. rollusire d..lmrn]ns
<br />Dcnnirion Pcrmiri Asncsros Norificarion Fcdcral Rqrhri('n\ (Till. ro. Pad6)
<br />-Rcquncd
<br />Lcrrcrol Norifrclrion
<br />ont'nrncc\ aftl Strlr lr*\ rcrri'i! k,(di.rtrtrr. rrlhcrcl)y rdll,izr rc]}c\cfhri!og&h \ ( i'y xnrl(iir r! tr, rntr ur[ rhc
<br />rnxc Ntrriincd pn,Dcny Iitr iN
<br />AIDIi(onl or aetrlSianalurc
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathi ng
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL llH x TM:*Y -
<br />Certifica te ol Occupincy 17
<br />Notes Remarks, Etc
<br />^", b/t/1i
<br />rax$f,ucuqluENl).lNclcllcr
<br />I hcrchy allirnundcr p.nrlryofperury rhd rh.E h i con{d.ri,n lcndnr8 aecncy lor lhc |xrhrn{ncc olrhc nuk foi which rhn Fnnir is
<br />nsucd (Scc.1197. Civ C ).
<br />rxtrdcr'. N nc'-
<br />I c.niryrhrrrh.ltdcrrlrcguhri{)n\ rgrnli'rI \h.{.\'rnr)ilJc nornttlirxhlc k, rIiN nn)icrr
<br />lnn4
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