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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS owNDR BUtLDUIDltL(At{ ltON
<br />I hdeby smnn und6 paflh} ol p.4ury th.t I m cx.mfl lr6,n thc ( onta.tor' Lic.nse Las for rhc folbNins r.en (Sc 7011 5
<br />Dusin.ss and Piof6sion Code): Any City or Counry Nhich requnG . p.nnn ro coGrtucl, rt6. idpmvi danolilh or rqi; dA
<br />siruc1u,e prir to ils isso..c.. also r.qond th. arplicel aor such pemil kr filc. sirnqlstatmdl ihat hcor snc b licc.n puBer
<br />lo rhe psviliotu olfi. Contrcror s Liccn.ed Lss (Chapt6 9. ComDencinB $ilh Ssiio. 7000 of Divhion 1 ofth. Btrsins md
<br />tofssions Cod.) or rhar h. orsnc i!.rcmp rhEefiom d rhc b6is forlh€ allescd eroprion. Anyviolarionolsrrion70.11.5byany
<br />applica.t lor a pnnit subjsls lfi. applicant ro a .i!il pcmn, of.ot moE lhd liv. hun&cd dolld ($t00)
<br />A&, * o*rs oirrc pmpcny. ormy d,p1or,6 wilh w0ss 6 rh.r ereconpmerion, *iu do rh. *o& ed r. nrud6. b nor
<br />miadd or o,l:rd aor s.lc (sc 7044. ausios md Pref6sioN codcr fh. Co.rracrois l-icflsc l-aN do6 nor arply to an oNns ol
<br />rhc popsly who hilde or impovGlhron. dd rvho d6 such trr)rr hidt.lror h6cltor th.oush his or hc. oM.nployl6,
<br />provid.d rhar such ifrp.ovdidrs e not inrsd€d or o,Iqcd lor eb Ir, ho$6,6, fi€ $ildin{ dr inqrov@d ir nnd wnnin o.. ,E
<br />ofcompl.lion. thc OrTq AuiEd will hav€ rh€ burd6 ol ps\in8 lha hc .r sh. d'd rcr hikl or imFov. the [ropqly ror thc plrrDs or
<br />-1.
<br />s olvnq o I r[e prcpdr, an .x.lusirl) .ontactin! *irh liccn*d conlrack B to cotrstn,ct thc pod (S€ 70J4. B6'nN
<br />atrd PtufLsiln Code 'lh€ ( ontr.r.f s l-ic€asc L{w do6 nol apply ro m oNn6 ol prupdy who builds or impro!6 rneron.
<br />and $no conlmch for su.h p ojdts si'h ! Comi.do4, licen$d pu6u l rolheconricd s Li.mse lrw).
<br />r{
<br />I hscb\ ifintrrunrtert)ctrall!orpLriu!-otr!ollhc6lk^v rsd(l@lnns
<br />-l
<br />ha!. &d *i11 mri.lain rC.nific,t.of CoMrro Sell-l6urefo,qo ds onrp.nsrrion, a puidcd ld by S<rion .1700 of rhe
<br />l,abor Code aor rh. pdfomanc. o i rh. Md( lor vhich thc pmn b isu€d
<br />a4cdilynd in e pdrommc. of rh. *ork for which rhis Fftir is isnrd- I shall dol oploy any pd$n in any ftdtur
<br />m d k' bdbmc ubj4l 1o lhe m*6' comptralioo lnws of ( aliaof,ia. dd a8,e lhar if I shorld be.o,nr suu(l Io lh.
<br />\o*ct co'tp.nsalion prolisn'nsofScctioa l?09 oalhe Labor ( od..l shall, fodhsnh co,npl, wnh rhorpmvisios.
<br />WARNING: Failurc lo ecue sorl€6 .oDp€nslion cnld"s€ t unlatrful. and shall subjct an Gnployer lo sin nul p€nahiG and
<br />civil fin6 up ro onc hundrdl rhoutud dollaB ($100,000), m add rcn !r,]rhc coi ui conrpeNbon. iloar6 s provided lor lhe
<br />sd"on ru/b nth. \&hor cnd.. 'nr.dr&datronh rrc - I // r /)
<br />,,c,e: (l l^Ij ^,,,'-*, M ( ln^.- (,/
<br />I l'" I r('F NsFa coN'rlLtc I (rn\ I pEdAR'rroN
<br />I hseby afirm unds p.oally olpdjlrr rhal l an li.oEdl und.r rrorishn.lch.fld I (co,nnm.nrg \rnh sdio. 7000) ol Division :l
<br />ol lhc 8trsi.Ned P6l6sioB(od., and my li.m* ii i. tullln&ddcfid:l.
<br />CQIIIAICIIAN.IINDII(iACT!{J
<br />I hdeby amrm und6 F.ahy oi psju.y lhar lha. is a coNtd.lion kndin8 aBmcy ior th. praom c. oarh.sork for shich this l6mn is
<br />isucd (Se.1097, Civ. C.)
<br />AfflrcrtXLD[ClA[AIION
<br />I lueb! aflinn unda pmally o l p€rrry one of rhc aollosinr d.cl&ar ns
<br />DcnDlirion Pennny^sh.sros Nori,i.ario. F.dsal R.sulario.s ( l nlc,l0. Pan6)
<br />_Rcqut d lntqolNoli6carbn
<br />-l
<br />csliay that th. l€d.ral r.Sul.lioB r€gtrdin8 sbdtos rdoral &e not rppli.abL lo rhi! proj.d
<br />I .diily lha I hrv. .ad rhis apolicarion .rd slar€ thar thc abov€ inaomariotr is corcl I asr to comply silh all Cny and Counry
<br />.'dina c6rldSrare l^v. r.ldin! to buildiu[consr^,cr hodze rerrs arir6of this
<br />D
<br />abo\. dcnrioned propcny for iBpdio!
<br />Aflrlicrnl or ,\Eenl SiEflal re -;FJil
<br />-'.
<br />Set Backs \
<br />Forms/Steel/Holdowns i7 "f'Erection Pads /dK
<br />UFER Ground JN
<br />SLAB Floor / -7\ (\
<br />s
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing )'t",Y
<br />Shear Wall r )t r- |.tvt lvl "Y,-Framing ?/zt wra./ I v)
<br />ln s u lation/Energ y s -lt I ,dF {JFeJ 'tu)
<br />Drvwall c
<br />41xt)tnt. t-atn I '3.>)
<br />B76wn Coat dlilltq tt >t\oLr.,=
<br />lt4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />bc.o-xo*, c*I 8fto lo\
<br />FINAL 2-of-zo
<br />Certificate of Occu pancy
<br />Remarks Etc
<br />-l
<br />hnv€ and *ill Dainlain *ork.rs' conpmsation innmnc.. as requir.n htS(tiool700ofrhe LaborGd..lorrhe psfomanccol
<br />Ihe $od lir *hich lhis pcnn'l is nsuoJ Mysort.( comp.nsario. insumncc ca r ed Flicy .unb€r ec
<br />!Le
<br />LA.IN
<br />b,lrc J,Ja.
<br />q
<br />Notes,
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