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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS owNDL tlulLoER DFiLcALAlloN
<br />I hcrctry rlfirn uRlcr ncnilry of pciury rhrr I rn crc'npr nom rhc contictF l-iccnsc lrs f{, rhc folkrwin8 rcr$n (sN.?(,.11 5
<br />Businc$ Mt lt ltsion C{xlc): Any ciry or Q'unry qhi.h rcqutcs ! Frnir n, ..innd. alicr. inrrotr- Lh rri\h or rclDn itry \
<br />nncrurc, prid n) irs isurn.c. rls rcquncs rhc arplic.nl li,r{'.h Frnrir b llL i si8rcd sltrrcrmol rh r h. or shr is liccnscd Dursuanl
<br />rr lhc F)visi(N o, lhc Gnrirrcttr's t-rcnscd I1w (Chaflcr 9. Co nEn.ing *irh Scdi( 70q) of Dirision ] Df rhc Buttrc$ ..d
<br />Pn,rissions G).lc ) or rhi h.or sh. scxcmplrhc.clronrnndrhc}[rhrorrhcallc8cJcxcmPrion AnyvdrrionolS.criotrT0.ll5l,yrDy
<br />lmlicitrr lor I |Emil subjcckrhr spplicanr h a.ivilPc .lrr.rml nrc rlurllr. hutrJ'cd dollrs (Ss(n).
<br />-1.
<br />r\ owmr or rhc tR,lrdy. or yempby.cs {ilh snscsisrhcn w,bcom,rtr\.tion. willdo rh( work dd rh. sflcruN i\ ror
<br />inirdci oroficr.d lar srl. (S.r ](],,4. Ausincss d Li)lc$ions Codc Thc Conr.clols Lien\c Lrw do.\ tror lptlyh o*mr or
<br />rhcpmFny who burlds or nnprovBlhcB)n, ad wkl dms such k,,r hlnr$lior hcrsllor rhmugh his or hf osn cmPloycc\'
<br />prortl.d ih \uch i'nl}fi)wnf,n( rc nor inrcndcd or olTcal r.r !rL. ll h)*cE . ltE huildi'r3 or inptu\tnrnr is skl eirhin on. itttr
<br />oiconrllcriqr, rl[ Owncr Buitlcr willhtru rh. hordcn oftfuvtrE rhf hc or $c dil nor huild or nnnr.vc rhc lmPdy for rhc I}urr,{ of
<br />I.No*ncrofrh.ri()lLn).incx.lu{ivclyconrrlcringsiihli.ciscd..trtrrcrorl.con\rrucrrhclmjc.t(Sc.rolt.lluli"rs
<br />rRl F\nlirssi.n Codc thcOn rr.r{n \ Li.crsc l-nw(l.N nor rrrnly ro !no*n.rofnro|f,(ysho build\or i nnilc\rltrcof.
<br />rnd who oit.rsf(,suchprolcchsirhrConrtuttrl\)li.cn\.dpursu n) rh. Cijtrt{nr's l.icci\e trq )
<br />I aDcx.trrpr uftlcr Sslio B &PC larrhisrcrvn,
<br />]II]BXE8S.:Ca!ITI'NSAIQ!
<br />DECIAXAIII}N
<br />IhcrcbylltuDutucrNMltyofpcrJury.n ofrhci.lkrwirBdcclar.rlons
<br />I hrvc and will nEinrain u CcnirKarc .r Con*hr ro sclrlnsurc ior $orkc( c.nfcnsarn,r,,s t'Nvidcd lor hrSc.rnJn]?([orrhc
<br />tihtr GrL. iitr rh. pcrfoflmrce of rhc uork tor whtn rh. pcnti i{ nsucd
<br />I hivc rtrd willD.intiin workcri cotrttcisdi, iIsurxmc. rs rc!utc(lhySc.ri,ii.rTlnotrhc Lib.r ('oJc. turrh.,Y
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<br />ccniry rhrl i'r llr Frronur.. orrhc work hr which rhis Pcrnrir is i\\Dc,l. ! \hrllnor cnrploy ntry r^-r$n i'1rnv trrnncr
<br />so tr\b h..o rc sublc.r h rhc srlkc$ otrlPcn$rn,n l,ws ofCrlinrnir. md rBrcc rhst ill sbuld trto r suhrd h rtu
<br />works{ conEnsrrion rrovhions of Scd n,n :17{n of rhc uh, G)dc. I sMll. tunh*irh $m!ly wir h lho$ lrovhi.ns
<br />WARNINC: Frilurc h *.urc qoikcd.oNpctrs0riotr ..!crigc i\ unh*ful. rnd rhill suh]cd orr cnPlo,Ir t,.riminnl |tmhir rnn
<br />civil finc\ un r,, olc hundRd rhou\rtrd doll!^ (Sloo.(xxr). ir !.t,lirio, kr Ihc cosi of.onrP.nrulnnr. dr E!c\ is [ovidcd nlr rh.
<br />Sdion.10?6of rhc ljbrAxlc, i l.rc( darlonry s ltur
<br />Drle: ^ppllonl:I I(:FNSFN CONTRA.TOR
<br />DECI,AIAII!]N
<br />I hcrcby,infln utrdc. I]enalrroipcrjury rhar I liansn undcr rovhion or Chapr& 9 (.onrmn.itr8 r'ilh Ssri,n 7fiD) ol Divisior l
<br />of ihc Busiftssand Pmfc$ionsCodc. ond nylic.n{ ir in rull r.tt.nd cflccr
<br />0*",4 \<0r
<br />AIILICANII)ECLIIAUON
<br />I tEEby {iian undcr pcnahy or p.rjury onc oilh. Llro*irs dcclarlrn,n\:
<br />Dcrmlirion Pcrmirs Ashcdos Norifi.drnnr Fcd$alRCEUldi.n\ (lillc 40. Prna,
<br />Rcquncd l,cllcroiN.rific i{n'
<br />-l
<br />ccdiryrh,rrhc r.drr l rcluhlnnN Essdins arhcsrosr.Brrlarc ior flrli.0blclo rhn Pr+cr
<br />l.c ilyrl[ I hdvcrc.drhirrDnl'.rrionafrl{rrcr rhcrbrc itrtu,nrrit ir..trNr l rlrr t).rnlt
<br />ordinan.cs.trd S! cbwsEloling b huildin! conn iif, rxt hcrchy rlniTc rcprc*trrrrivr\.f rhi{Ci
<br />Jh)r nrnri,nra |n)llny lar ns|ccr
<br />ufu
<br />ly wnh oll Cnya.d coxtrry';;ULV
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywail
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL -+/2-' /tf1 9>*<6
<br />Certificate of Occupancy
<br />Notes, Bemarks, Etc
<br />q>6
<br />^otLsCANjiISIJEIIONIIIIIINGJCENSI
<br />I hcrehy rlfirm trndcr p.trdxyofNrjulylhd rhsc h r con(rucri.n kndi.8 a8cncy Io. rhc I.rforroncc orrhc sork lirr $hich ihi\ |{nnir n
<br />hrucd (Scc 1097. Civ C ).
<br />tjii'lc''\ \. rc
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<br />trroc''\ AJ.lrc\J
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