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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTSSITE-WORK
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL l-?(-11 v.vrl(,)
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />-)
<br />OWNT]N BUILDER DE!,C RATX)N
<br />I hcrcby rrfiln und.r f,cnrlry ol pcrjMy lhor I m crcmfl lnnn rhc Coitr.bn- Licctr* Laq iot rhc lolbsins rctr$tr (Se.rlr:11.5
<br />Bu\ir.$ .nd Prct$n,n C,nlc): Any Ciiy or Coum, *hich rcqun \ r tElrnir r. ondtucr. nlr.r, inp()vc, dcm'li\h o. rcEtn rny
<br />srn'durc. pri,rt, irs tsurn.c. aho rcquircs rhclppli..nr lor suchI.nlirb rilen \i8n.n sdcor rhlt hcor shc n li..n\cd Nsuafi '
<br />to lhc p.ovisions oi lhr Conrnctn \ Li..n*d Lrw (ChrPr$ 9. ConnncncinS sirh Sccrnni 7fin of Division I of rhc Bu\incs\ rhd
<br />Pmfesrion\ Codc) .r rhd h. rshc ncxcmpt lhcrclionrind rhc ha\i\ ln.rhLnllcS.d crcnuion. AnyviohrnrnofSerionT03l5hr_rny
<br />ppli.nnr ror r rcnnil subjcch llrc llnrliQnr n, a civil pcnrlry or ror iorc lhin fivc hudrcd doll6 ($5m)
<br />-1.
<br />!s oq ncr .l ihc Is,r.ny, or my .nfhyccs wilh *a8cs trs rhcir $k conn .u tun, wiu do thc wort lnd rhc {tu1um n nor
<br />nn.ndcd.rollcrcdlorelc(SN.7044.Busirc$ondPmfessionsGdcThcCb.tocl s Licens l2w&,.sn.ramlyroanowncrol
<br />thc pDpcny who ttilds or inqhks rh.tun..nd stu des such R)d( himscllor hcsclror (hbush his or hcr onn copk,y.c\.
<br />lmvidcJ thar sr'.lr improwmtrk rrc mr inr.ftki or olTcrcd ,br srL lli how.rcr. rhc hoildinS or inDmrc,ftd is skl *irhir , {r( ta r
<br />.f.o pLrion. th. Orrcr tsuildcr willhlvc rhc btr&n ofpmvi'r! rhd hc.r \hc diJ lFr tlild or improvc rhc pmr.ny for thc puqn* ol
<br />I. ff osrcr ol rlc ll.onm y- am excluiircly co.trctins sirh li.ctr*d contra oF n' Bn,dd.r rh. E,rd (Ss. ?04'l Busnc$
<br />lrd lDll\rim Codc, ThcContockx r Li.ctrsc L{' doc! narlll]l,lyb rn.wnd.frrop. yvho huildsor imlR*ts rh$con.
<br />.,rd uho contds for such rriccls wnh a G)nrn'ck"( a) ll.ctrscd 0ur uanl lo rnc Conrrackr's Lic.nsc bw).
<br />I m.r.mnr und.' S..r',n
<br />lrcf,K:&)laMfENtA.rpN
<br />UECLdSAIION
<br />I h.r.by aftn rond.r p.nrlrrofl}oturyonc ofrhc l.llosing dcclrdions
<br />-lntrv.adwillminr.ccnirratcolconscnrk)Sclfln\urclI,*nrk$J.omF.nsiliulasprovidcdttrbysc.lionl70ool'lhctitxr Codc, for lhe pcrlormake .r rhc work rot which th. p.rnrn is hsucd
<br />I hrvc rnd *ill rNlir r.ricr\' c.rlDcnsnrion in*Bn.c. r\ rcqutM hySccrion.lTlDoirhe UhorC.d., aor rhc Pcrionnrnrc ot
<br />rh. work for whichrlris ncnnir is isslFl Mywork.s conrprn\rrnnr in.umrcccanicr d F!i.y n rl,cr dc:
<br />.^,'",.2dR.(C-
<br />*,,,",^,,.,*, l)Ca/5A /1 6 -6a n,,,,,.,
<br />-lccdir,
<br />ihd in rhc pcrrormm orrhc work fo. qhich rhis pcrmir n islurd. I nkll noi cnl,)loy any pcrsn i'r rn,
<br />'n.nDcr$ ask,trsm subj.rt !o rnc *orkcr onDcnrario.lnws ofcrliforni...nd !E@ lhal ir lrh.uld h.co,m \uhjccr ro lhc
<br />workcm' comFnstrrion pmvhions or se.rt'n ]7m or rhc Ldhtr Codc. I shrll, tunhwiln .o'nPly wirh rhos l)lovhions.
<br />WARNIN(;] Frilur ro $c rc vorkcn compcnsalion colcB8. i\ unlrwful. rnd shall slbjcr m cmpk,yur !D dimiral p.ulis aM
<br />.ivil fitus ut (. on. hundrcd thonsond dollln (s1(xl.O(x)), in addntun ro rhc cos ofc.mtcn\arion, d,tu8cs !s rrovidcd fttr rhc
<br />\cd-n r,'6,,r rh" Lrtn C )t, rnrcrc{JFJ rn.my. lcc\
<br />D.,e,, 1/tr/t$ o,,*"*F €-
<br />LLCENIDIIC()NIXA.(:IOE
<br />DECLISAIIO!
<br />I hcruby.ftnnulldcr pcnalryo{perjlry rhlr I sh lic.n*d ondct provisiotr olChlplct 9(.o.n1rncin8 wilh Scclion 70OO) ofDivision:l
<br />of rh. Busin.s Md Pmfcs\ions Ciic. ud ny lic.nsd h i'r ,ull for.. !M cllccr.
<br />clNir8IlEllQNj.l,lDlNli-acENg
<br />I hcL-by!m ond.r Fnahyorp.4urylhd rlrrc n n consrru.rbn Lnding ag.my id lh. Frrbmncc olrh. a.rk nn $hi.[ rhn Pcn.ir n
<br />nsucd (S.c.3097- Civ C )
<br />trtrdcfs N.rR:
<br />-
<br />AftLlCANLDliCli |BAII()N
<br />Ihr$yrfinnx dcrn trrllrolpcrioryo.olrhclnlk,wirrAdcclntulnn!:
<br />I)cnhlirn)d Pcnnir*Adrsos Noriti. rion lic{lcral Rc!ulari.ns lTirlc 10. Pn(O
<br />Rcqui'cl l-.(.r ol N.rlic i.n
<br />I ceniry rhd rlr fcdf.lrclxlari')trs Egu(ing rs6c(o\ rc'nndrc tror ,'mli.rhlc ro rhis rroF-r
<br />l..nilyrhdIhlvcrcldthi\rPtlicrridlridinrcrhdlhcrhitinlnanrii{ i\.otrccr Irgcch
<br />ordirrk$ and Srnt. Lrws rclaring h huildin8.on$fl.ridr. rkl h.rchy urlni4 r.nrc'cnr?.rc\ olr
<br />trholt nr riotr.d prc|.dy rd imlsl
<br />Applicanl or ,{8..t Sl*nalurc.X
<br />Pe itewn trttnt), - \-- 2a+1 da---? eg
<br />comDly *irh dU Cilyand Coutrty
<br />hn Cny rn'l C.dnD rn cnrcr uFnrtr
<br />",,.
<br />p/rr/ts
<br />Set Backs
<br />Ext./lnt. Lath
<br />s 7'hr''
<br />L'nh'. \.',1'c.'
<br />-
<br />f-------T------
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