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Bl'JtLDIl.iil. INSPECTOR RECORD
<br />SITE-WOHK DATE ID/SIG.COMMEI.ITS OWNER DUILI'SR DELCARAIION
<br />I hcrcl,y rffirm undcr p.nalry of Frtu.y rhar I an.rcnDr f6,n rh. Contrtun l-iccisd tiw for rhc f(rlowing Esn (S&?0:ll5
<br />Bu\ir.ss Md Piorcssion Cod.): An, Ciry o! Counry *hich rcquirc\ a lcnrn ro consrrud- !lrs. impmvc. dc,iAhh .r rcnrr a!!
<br />ntocturc. fiorlo irs hsu.cc. dso rcquircs rh. aprlicdr ror \uch Frmir to filea siEtrd notmnr rhlr hcor \hc i\ liccnscd pulaanr
<br />lo rhc pnrisnrns orrh. Contacrr's Licc.*d LjB (Ctflprcr 9, ComDErcir8 wirh Scction ?(xD or Divhion 3 ofrhc Busincs!,nl
<br />thrfc$n,ns Codc) or rhal tEorshc iscx.npt rhcEiiomand rhc hosh rbrrhc rlkscd cicnuriotr Any violarion ol Sr..rh. ?011 r by r;y
<br />amli.nrr for r lcrmil subjals thc {prlicsnt b,civilrcn,hyornorfr,.rhrn fiv. huddrcd dolla^($tu,
<br />_1. rs osrcr .r rh. pmlrny, or fry .mpk rccs *irh woecs !s rhct solc conrrcnsar ion- will do rtE *o* lod llE (unrc ir ml
<br />iircn iql or oncrcd fu slc (SE.' 7044. Busirc$ {nd P(,f.s{,ns Codc Th. Conkkror's Liccnr tiw dr*r nor nmly b mo*ncr ot
<br />rh. t'Nli.ny qho huilds or inl!rcEs (h.r$ . MJ whl dms su.h q.* hiaxclf or hcr{ll or rhn,ugh h t or her owtr cnployccs.
<br />D.ovitlcd th{ such inlrokmdr dc nor i cndcd orotlcrd lor sb.Ill horBcr thc huilding or improtlnr nsldwirhin,,m,tJr
<br />or.orddi,,n-lhcOsncrBlihcrsillhorcriclludctrorpmvnrelharhcorsh.didnorhuildornnpmvc r r$Fry ror lhc Nrlrs or
<br />_1. $ own$ol rh. pop.ny, r cx.lusivcly cotrrrxclins rirh li.ctrscd co.rrrclofi lo onrtru.r rhc nr'rccr (Scc 704. $u!!s$
<br />aid hri:\sirnCodc: IhcConrr0clols Liccnsc Lrw docs i.r,fpl!t, anoe.d.frr.t. ywho huildsor nnprovc\ rhcicon.
<br />lnd *ho .om!rc( for \ucn Fojc.r\ wirh o Conrmcro( I ljcctrkd oursunr ro rhc Conrracror s l-iccnsc hv).
<br />uaaa[&r]raufElrallaN
<br />DECI,IXAII!]N
<br />I h.rchy ofiirn undcr pcnaxy or p.rJury onc.rrh. rollowins d(l{rrionsl
<br />I h.rr dkl willnrinraii r C.nificrrc ol Con\cnr h Sclt:lnsurclor $ortcr'conrpcnBrn,n. !s pmvi&d lir hySlrrion.lTlx)oIrhc
<br />hlFrCodc.lnrihc pcrforman.e olrhc worli kn wnichrhc rtnnir n nqrcd.
<br />lhivc a *illmiinhh *orkcri compcNdhnn in{trrn.c. r\ rcqxircdhySc.rionlTrD.frh.trhorQnk.ntrrh.f[rformrn.cof
<br />rhu worl lnrNhichrhn pcrmir is tsEd Myworkcn conp.trsdn nNurnn ccitrf,r,nn lroli.yntrnrbcr:ft:
<br />ol rhc B!\incs rnd PR Cssionso'dc- my liccnsc is ir tul|r.rca clfccr.
<br /><3 3q t-ze1)
<br />D.t ,^1- /('e_-
<br />I hcrcby rlftnridcr rf,.rlryorFrjurt rhd rlu{ ir r cotr{rucrinn hniin8 l8cmy lor rhc ncrrhrnraDcc.lrhc w.'k nx Bhich rhi\ r,cflnil n
<br />*sDd rscc 1097. Civ C r
<br />il.tfL.IC NLJIECLAIAIIQN
<br />I rrnh, afnn urlcr Fnaliy ol'pc,jury onc olth. fdlownrg dc.l,rarn nr:
<br />Dcnollrion Pci,nits Ashc(o\ Norificrrion I;cdctul RctsuIinn,s ('lirlc,ll, Pan6)
<br />Rrquircd kncr of Norifi clriotr
<br />l.dcmTrcgtr 0rins 'c! di'rF rshrno\ r.nn'uLrr. nor rl,tlicrhL. ki rhi\ fn)j.cr
<br />rcadrhisaplrlicrri.nafrlslar.rlrdrhch,rc,nfdrri(nii.om.rl.gr&t,.o,tltwnhrll(\ryrlCouirt
<br />*s rclaring x' huilding.onNru.ri.n, Md lrtohtrurtxtrrd rctircscnidiv.\ ofrhn Cirynnd Ci,!dy kr cm( utoi rlr
<br />?-6-/F'
<br />Set Backs
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation /1
<br />Rool Sheathing o '/// /t k e 14/1fizb r7<"--/
<br />Shear Wall
<br />ftywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />T-Bar
<br />Handica Re
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1nr\\\l lLffl
<br />Certif icate ol Occupancy
<br />Notes Remarks Etc
<br />Forms/Steel/Holdowns
<br />I
<br />Framino
<br />lnsulation/EneroV
<br />Pool Fence
<br />I @cx.mfl und.r Sftlion_. B. & P.C. for lnh rcason.
<br />D.l.: O*.er:
<br />Curif:
<br />l.cnifyrhrrinrlr p.rfoflnrnccol rlE work ntr whichrhis |Nirnir is irsued- I sh!ll norcnDloy rtrytcrvr iI0tr) {n cr
<br />v, r\ ro 6.dnx \uhlc.l ln rhc $orkcrs co.rlx.srri(r l.ss of Crlifimir. r d r8r.c rhri if l sh,ukl b.c.'ft \ubid t, dr
<br />$orkcr conrpcn\rrion[ovtion\ olSNriotr 37(Xrofrlr lrh, C{x]..llhrll. fonhsirh.. fly wirh rhor F.visi(nN
<br />WARNINC: Fdlrrc k, {cur *ortcr\ conDtnsdi{ .o\crr8c rs unlnslLrl. and rhrll \uhi(r an cnDloycr tr dniml p.nrlras and
<br />\c.r ion 1|76 o l'c bt4 L-.dc mrrcn . d .'urnr! , t.(\ /,nar(: \ l6pri"*',X ultNrLrcNr.tsA(l!)B/ \ IlflLa.uauaL
<br />Ih(tohyrlliltrrutulrr NnJ ryolFrjur) IhrrI ")rukluml.r nmri\nrn olChaflcr 9(conmf,ncing sirh S..rion 7lD0r olDivirnn,l
<br />/2a.-,'.n,4.r*,-\
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