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BUILDING. INSPECTOR RECORD
<br />SITE.WOHK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />Handicap Req
<br />Depuly Final Report
<br />Enoineer Final Beport
<br />Flood Zone Ceflif .
<br />/-)-...-;7'afls^t ;a*-lFINALt).23-/ b t
<br />Certilicate ol Occupancv
<br />Notes, Remarks, Etc
<br />o\\ \ll{ Bl Lr)r R l)l.l ( \R \ I l()\
<br />I E+rch, trlftnr u dfi Fnrlly oi pcrjlrt rhrr I x cxcnrPr riorn lh C.iLrnrs. l.iccnr l-as n, rh. foll{r*i'rg r..sn (Sr.. 70.11 5
<br />Bu\ldc$ rnd ProL$iofcode) Any c,ly or Counly which rtquir.\ i |rcrr r k, co jn.r. rlrcr- intPn'lc dcmlish or rPan Mr-
<br />Nfl.trtrc,,rritrlo il\ h\lrrcc. lho rcquncs rhc aPrli.aN ntr {th Fnnil h fi!. r \ i8trcd $utNnr rhrr lr ot $c i\ licen\cd F'su'nl
<br />Io rhc pmlisnnN of r c()ntlcktr s l-i.cn(d Law lChlPlcr t- Conntncii! silh Scciirri 7(XX) ol Divi\ion I ofrh' Busin'ss aid
<br />P'ofc\si(rsCodc)orlhar hcorshc iscxcmnr lhcrefromand rhcbNi\ lurhc rlltgrJ trcnrfliotr. Anvvi.hrn olSLrri'n70ll5 bt rtrr_
<br />rfi'licr n)! rFrn,ir \ubjc.Bth. eDlicanrrorci\ilpcmlryor.ornx,crhrtrfilchuMrcddollarls50o)
<br />I. ns owncr ol rhc frol8ny. oi n! cnpn'y(s wirh *agc\ d rh.r $lc conDcn\dn,n. *rll do rhc qol dnd rhc rlrD.le i\ mr
<br />i' cxLd or oficrcd n, sl. ISe '7044. Br\imss ,nd Pmfcssions Cod.: Thc C.ft..tor's l-iLTnrc ti* docs nor q,ply lo an o* mr ol
<br />rhcnn,,iny wh, hikl\ or inDfl)vc$ rh.mn. inn wh. dc {ch w,fk hnnscllot trr.lror rhii,usi ht or hd.sn cflDlov'c\.
<br />proridcd thrr such n\rorcEnt rcmr inr.ndcn o.oficrd lot qh Il trJwcvr- lhc ttriklinA or inpftrtn.nr is uld sirhinoR )tr
<br />;fconphrhn. rlE Owncr Built$ will horc rnc hord.n or tmtnE lMl hc or \h. did mr L{ild or inDovc thc lmFnv for rh. !u4ne ol
<br />-l,0sowncrotrhc
<br />pn,r.dy. nmcxclusivclycdnt|.rinBwirh licctsed conr(i,F !) con(rucr rhc pn,j.cr(S( 70J4. B 'i"'+aM Pn,rssrnCodc:ThcConkrrof'sLi.cn\cl,!wdoc\norapplyro!nosnrr.{nr.nrlvwhobuildsorimprclc\rhcrcon.
<br />atr{l who contds ior such lrjcck wirh r Conhdons) liccn\cd puisnlnl ro rhc Conkr.ror's Liccnr tl*)
<br />lrtrr.\r r|l un,lcritri,in- Il ' PI it 'h ! o'!r
<br />D!lc lroKons' tnrtretls,r'rrortr
<br />DICLAMIION
<br />I hc(by ifln undcr rcnnlly orl,crjnryonc ollhc iollosins dc.l,nrions:
<br />-t
<br />lrvcd sillmrinr.inaCcnifi.ricofconscntloSclflnsurtforw.rics co'np.nsdion. a! Dnrvitud nr byS(rion:l7t$of(hc
<br />t,ahtr CDdc. for rhc pcrlormnccoflhc work for whichlhclslni is hrucd.
<br />-l
<br />htrvc.nd BillnDirllin *orkcs conrPcnsalion in\uratuc, Ns nquncd bysc.rn lT(xJolrhclil$rCudc.lorlhcrdr'nnrnccor
<br />.onr.n\nrt{ irr{nrmccJ'ritr rtr Fnicynunnrcr dc
<br />u
<br />/r,"r,..*'*,a0a
<br />r in rhcr.rrohErcof rhc a.rr roi whichlhis Pcrm is n\u.d,l choll nor.tull.y a.y
<br />\or\n,lx.on{\uh}"(tblh.*orkcrt.ompcnr ion laus ofCrliftntrir. a!{l rgrc rhd ifl sh.uld h(otu sxbjcrI
<br />s.rk${ .rrnrrnsorion nR,rhbns of Scction :l7tn of rh. trbn Codc. I \Mll fonh* irh .otrlJ)|, wirh rlxr$ nFvhion\
<br />WARNIN(;: Fril$c ro ecurc *orkc* ompcnrlrion covcrrS. is unhwlnl. rnd lhall \ubicr rn cmPl.v.r ro rininxl Fnakrs ind
<br />s0nd ddla6 (SllD.ftD). in ddirt n) rhc.oi olcomP.n\ ion. ddnEsc\ ,s Provnlq, tu rh.
<br />t]!:!-Lll!! r!!^
<br />Dctrrlryol p.riury Ihrr I m liccnsd unddr fn,vFion ol Chrrrd 9 (co,nnEncirg *irh Scclion 7ln0r ofDivisiotr 3
<br />ol rlrllusi'lc$riJ Pnrfc\sioN (inlc, trrkl nry liccne s intulltuic nlcl{!.r 7zJ
<br />74t.
<br />(t()Nsl Rt c ll()N I !NlrI\l;,\(;1.:N(lY
<br />Ihrrhy l]nn u.Jcr tcnrhyofFrurylhrl lhcr is a.oi(t.rn kndilr8 rgc ry for lh. lcr|n m...lrhc $or[ r(t ehi'h this f'rn r i\
<br />isued (Sc. .1097. Civ C )
<br />lrndc''. AJdr(.:
<br />-
<br />APTLTCANLDECI.AEAIION
<br />lhcrty rlli,nundcr ncnalry orr.rjury onc ollhe foUowine d..ldr.ti.ns:
<br />Dcnr,lirio. P.nnirs^shcslor Notifi. n,n Fcdcnl R.phr nnn I Tnlc 4). Pan6)
<br />_RcqLncd lxricr ol Norifi carion
<br />l.cnilyrhd rht frdcrtl rc8uhrion\ ro! ding ashc{o( renxiul xr. frtrlnli.$h n, rlri'ftulcct
<br />il.! rh{ Ihivc rc lhn r|plicxrotr d riarc rlrr rtu ntxrr inlaannri,tr,
<br />on{n'c(6r J hcrrbyrurh. rorlinrnccstrnd Srdc Lrwsiclllirg t) huildingc
<br />dholc trErri{nrcd lr'opcny f(tr irrsPcclt,n prrlh$!{,\ppli.trtrl r 1!(trt SiHtrtrlo
<br />K /ZK
<br />Set Backs
<br />UFER Ground
<br />T-Bar
<br />71-J'--
<br />7-
<br />I
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