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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDDR I)EI,CARATIoN
<br />I hcrchy ltiirn undcr penrlry('rFrury lhd I ior cxcnrfr r'rcnr lhc Conkr.t,n Li.ctrs Lrw lor lne tollt,*in! rc.sr (Scc70:ll5
<br />llusincs ud t\onsi(,n cdlc): Any Cily or Counry *hich rcqunc\ a Fnnir ro s"\1ru.r. ollcr. imptolc, dcmlth .r rf',n n,)
<br />nflcrur.. prid b ns issur.cc. sl$ rcqriEs rhcrppli.a tur su.hlannirro fiL! tigncd narctum rhar hcor shc i\ lic.nrcd pu^ur
<br />b rhc FovirnnN or rh. cont{ror's Liccnsd li* (Chaflc, ,- Co'nmc cn!! wirh scctiotr ?(x{r of Division I of thc Bu\incs rRl'
<br />Pr oLssions (idc ) or lhlI h€orrhc t ci.nrPr rh.tufion Md rhc hr$s k)rrlE rllcgcn crcn,lriod Anyviohrion.lSccridtT0.ll5byan,
<br />npllicanr itn rycr.rir subjc.krhc {plicdtrt k, rcivill[nnllyofnolnxftrhM fivc hxndrcddoll0r (S5fi,
<br />l. (\ oEncr ol lhc prolEnr- or ny .nrl.yas sirh wrB.s .s rhcn hh compcn\dion, will do rhc wtrk axl rh. ndN h ml
<br />i' crkIl ororctod ld \alc (SN ?044. Busircss and Protc$ion\ Adc Thc Cotua.lois Li.cnsc ltrw do.s n.r amly b on owicrot
<br />rh.rmtEny who builds or i.$,ok\ rhce)n, dd who des su.h ttnk himscllor hcrclfor rhmuBh hn or h.! ow.cmplotc.r.
<br />p'uvidcd thlr ru.h inlroBmnrs m mr inrc cd n o,TcEil lbr srk ll lx)w6tr. rh( t{iHir8 or imPmEftm k $ld wirhin onc )qu
<br />ofconplcrirn. rlr O*ncr Bdld.r *illhivc lhc hordcn ofpDvin8 rhd hc or shc did frn build or iqrore rhc pmFn, tu rh. puqDs of
<br />L r\.wrcrofrhc po,).ny, und.lusikly cont!.rn+ wirh liccn\cd conrr k,^ tr, ..tr{dcr rlE lrorcr ( scc 7(Il,l. tiuqncs
<br />rnd h,nsion Codc:'l he Conkrrkr\ Li.c.sc Lrs docs trol0t)p1yii r owtrcr olProf.rlytrho huilJsor nnForc\rhcrcon.
<br />and who .onracrs tur such ,(+.h wirh r Co rurkr( \) liccn$d lunurnr rolhcContJck,'\ Li..trsc L.w).
<br />I rncx. Dr u dcr S(r
<br />\\l)RtiliRs' (t)lIltll\sl\ l lo\
<br />llI!lrl-8,!l!9!
<br />I hurl,v rlrtr rur,ler l,ef lrv,'l n.'iuryoncrr rh. l(n[NL,r dc.lrrrridr!
<br />-l
<br />have lnd $ill roinrM a c.nificarc or Cotrrnl to Sclalnsulc for *orkc6' .onrt.sornin- .s Prcvidcd rd by scclion 3?(x) ofrhc
<br />hb.r Codc. ior lhc l)crformNe ofrhc *urk ro whrh rhc !.rm is nsucd
<br />-lhrvea
<br />$illmonrritrwork.s-.omD.nsrriotriNurrn.c.t{rL'quncJhySccri,3T(XJolrhcliborCodcforrhcl--rlinnrirc.f
<br />(hc r.rk i,{*hichrhn prnni is r\ul\l N1yu'ork.A .o'nF-^n\rri,,, ntr!tuncc.nricr rftlPli.y nu $cr ra.
<br />NA$) dfsi ?N? v1g(s crf,Jffrfy
<br />Bnu w r-o itt tr 4y'o \c1
<br />Iccnnirh hthclrrtu un.cofrl[w.rkturshrhihnpcnnili\i$ucd.Ish]ln.(cnrlloyrrryr^-^oii'rnnvmMrcr
<br />vr r\ t, bccoar subjftr ro rhc work s compctr\arion hwr olCalinnin. Md i3rcc rhir iaI slnrld htcom subFr lo rhc
<br />sorl.r\ coml.n\trrion provisions otSccrion lT0Oofrhc tihr Codc.l shll. lonhsirh .onrrl, sirh rk)s ntorisnrns
<br />WARNINC: l'.ilurc ro surc wo'krr\ .onBtrsrliotr covc,rsc i\ urllNrul. nid \hall {rbicl a. cmPl,D$ r, rinriml pcnahil rDJ
<br />cNll tnrcs uf ro onc hundrcd rhous,nd d.lldn ($l(x).Lx)o). l irion k, nrc ron of conrr.n n. iltrn,rg.\ n\ Drovi,ILi ntr rho
<br />scctiotr :1076 of th. l,$or Codc. inrcrci dnl lorncy s fccs
<br />o1l2-ait
<br />I hcrcby dnirn unncr pcnllryolF jury rh l im lieNd undc. Pn,vhion ol Chlprd 9 (.onnirming *irh Sftrion 70m) ol Divhion l
<br />ol rhc Btr\inr\\snd PolcssionsCodc. !d myliccn{ i\ in iull ror.c,nd cficcr
<br />Cro
<br />o.,", o'i la"lld
<br />C()NSTRIICTION Lr"\DlN(i A(iANCI
<br />Ihcrcnyafirnrr ldr pcnrlryol Nriuryrhrllhcrc isr.onnflcii L.diraiSeNyittrhcl}crtrnrn.c.irhcsorklarwhi.hrhispcnniris
<br />i*ucd (S.. 3(I)7. Cir C L
<br />AITLICANLDEII.AAAI]OB
<br />I tn:by limundcr pcnlli, ort*rjuty onc ofrhc followin8 dr.^laarioor:
<br />Dcrmlniotr Pcirnik Asbcstos Noritlc bn Ecdcnl R.lulnrio.s(lirlc.l0. Pan6)
<br />Rcqnncd Lellcr oi Norifi cari{,n
<br />Ircnifrrhrrrh.lidcrdrc8uhrio.\rc8rdi'rgr\hno\rc rivrlircn rrmltrhlcbrhnloic.r.
<br />Iccflityrh lirvcrca.llhisappli.dn dd (.rc rhrrrhcrh)rc itrli)'D rn rN.orrc.l ,rsret,comtlywirhallCilra Cotrnry
<br />ordimn.csnnJ Slalc t.lus rcl iighbtrildir
<br />Jh,vr f,trri(rul pmp.ny lor inst*.-'rionpr
<br />^rDlio .r^[0'r siatr{lrrc A
<br />remire ont tprinO: M qrr.q . f-,^rn 1Clzs
<br />ofrhis Ciry md Countyh cm., lpon rrE
<br />^," oqlartid
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Shealhinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Cerlif.
<br />rl
<br />FINAL 4\Lr\ts 4.'
<br />Certilicate ot Occupancy
<br />Notes, Remarks, Etc.
<br />Erection Pads
<br />ll or
<br />Y,1-\?41
<br />trtrJfl'. \ddr+
<br />I
<br />fT
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