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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BU!I-DER I'ELCARATION
<br />I hcreby amnn undd pcnoliy ot psjury that I m crmpl from rhc Contadore' Lic.hs. liN for lh. lirllo*in! r.en {S( 70lls
<br />Busin6s and Pror*ioa Codc): Any Ciry or Counly *hich ,.{ut6 a Fnit l. c.d{tu.I, alld, imPrcle donolish or .epat any
<br />strudrtr€. prior ro its isumc., also r<un6 ihc.pplicar aor soch p.nnn ro 61. a sisned statcmd,l thfll he or sh. ie lictus.d pNuad
<br />ro rhc lmvisions offi. Coorracroas l-ic.nsed l.v (Chapr6 9. conmencins Nnh Scdion 7000 of DNisio. :1 or(h. ausi.s dd
<br />,tofBsionsCodc)orlhathcorshciscre'nptrhd.lioflrodrh.b6islortheallcs.d.\cftlr'on A.y vnnalio. ofsElion ?0ll 5 byany
<br />npplicanr for a lEmir subj€ts th. applicanrlo acivilpenaltyolnor morc rhe fi\. hundr.d doll&s {ssL$)
<br />I. 6 ownd o arh. pmp.ny. or my Gmplole wnn vas6 6 thet $1. comp€Eation. \ ill & rhc $orl dd Oc $ddm is nor
<br />in'd&rl or orld.d ror s.lc (Se ?04,r. Bsi.6s dd ttof*ioN Codcr I h. ('onlractol6 Lictrs tiN do6 nor .ppl, io u oBns ol
<br />lh. pFrEly vho buildeor impm!6ihdon. d who do6such\rclt hin$€ltorhr*lrorlhroqh his d hd o$n.nploy6.
<br />prolidcd ih su.h ihlrovdstsftnor intddaltuofiirtd to' sl. l[ hotrdc. d.ttuildin! or nrprol.1mt nsE wnhin onc y@
<br />ofcompl.iion. lhe Osrs Buitb vill ha{ lh. hrd6 oap.oving lhd lE or sh. did mr t ld or inEolc lh. poFly for lh. purFFof
<br />_1, a os ner orlh€ flnpEly. d cxclusivcly co rhcrinr *irh liccns.d co.tadots
<br />'o
<br />s6rrud rh. Foj.cl (S(. 70.1r. 8618
<br />and PNLssion cod. I hc Conlraclor'. l.iccns. l-aw do6 ml apply to e o\rtrs o I prcp.ny \ ho builds or inlrovB lh.ron.
<br />a.{l *ho.onEcrslorsuchprojals\virhaCondloi9lirmedpmmltolhcConrrack,rLiceMlnw)
<br />I dner.m und€rsccrion . A. & P.C.lnrrhk rcdon
<br />I hcrcb! amxn utrdd tmalryofp.rjur) oneofthe lollowin-! dNl aliotrs
<br />I h0!c md \ ill Daimain a Cdilicate of Consmi to Sclf- lNu,c for work.a' .onrpeNarnJn, 6 povnkd nn by S(rion 11700 oflh€
<br />rjbo! Code aor th. pdfonMnce ol the lork for whicn rhc pmnii is isucd
<br />_l hav. and \v,ll frainrain uo.ke6 compcNarnnr i6urad.c,6 r.quircdbtSalionlT00oilhclnborCodc,lorrhop6lonnar.cof
<br />lh. *uk nn which this t6ir is 6suql M, ror isr comp.Mrioo i6urdc. .drio ed policy nnmb.r de
<br />I ccnily llml i.lhe perlomane ofthc sort lor {hich this lmril is issu€d. I shall nor ftdoy an, psson in ony me.q
<br />$ d k, b6ome subjct lo $c *6 m' c.mpderio. laws .acaliaohi,. ed a8r fiar it I should b€comc subjd lo
<br />'he*ork6.omp@rionpolilioBolsstionl?00olrh.tjborcodqIshll.lonfivnhcorpl,\vithIlospdvisnE
<br />\,!AIININ(;: liaihrc ro s-ue so €*'.oi1p€asari{,n cor.Dle is unld*lul,nrbier e mpbrcr ro riminalrrBhi6 d
<br />crvil lin€s up lo onc huo.,rcd lhoused dollets ($l p.nsilion. d.na86 d p(vid.d lor lh.
<br />S.crion 1076 olrhe Lrhr Corl€ inrcr6r
<br />Dtt :_ A
<br />I he.hy aatn undd p.n,lty ol pdjury rhar I
<br />DECI,AEAIIAN
<br />undd provisio. of('hipl6 9 (con'nm.ios snhS$rion 7000)olDilision l
<br />ol rh.Asin6sdd Pmf6io6Cod., dnd mylic@ is in full for.. ed cfier
<br />7%?o/
<br />t hdby arm und6 Fsllyofp.rjury llBt th;r isa conslrudion ladins lgdcy lor$cFhm c.ofthcwork6rwhich$i3pqiitis
<br />issu.d (Se.1097. Ci!. C.)
<br />dfi,rcANrD[0aaaui]r
<br />I h6ebr.flin. undo paahyolpdturyone olth. rolh*ing deldarions:
<br />Dcnrolitioa Po,nillAsbetos Nolifi calion F€dcral R€suldions (-rnk 40, Pan6)
<br />-Requir€d
<br />Lerl( olNorifi cdioo
<br />I cdlily nd thc fcdsi| rcsularions Esddins sbBlos removal e nor applicable tr rhis rojur
<br />-l
<br />cdr,yrrdr I h/ercdd!\Fapnl'.ari.nedsrar.rhrr r,'.abr\.'nlumr.rion sc.nd I dsrr
<br />-a--, o',f1s' "{ r "" , *r,,,j i, bu,rd,ns r,{.h.h( ,nd hd.b adr horiHq,*nror, 16 u I^-\w_*_;:%z o co'nplysirh all( iryand ( ou.l)
<br />?;Z.dr7- SZzXd
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 4,ltelUa'T1\rl @ 4e?
<br />Certificate of Occupancy I O\
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Subfloor/VenUlnsulation
<br />T-Bar
<br />L.n'lo'! Ad,rLd.
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