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BUILDING. INSPECTOR RECOHD
<br />SITE-WORK DATE COMMENTS OWNFJR BUIT,DER DELCARA'I'ION
<br />I hcrci,y sffifln und.r pcnalry {)r p.rlxry rhrr I n.xcnrpr fmr rhc Con|mcio6 l,ien* tn* ror rhc rolbwin3 rcln'n (S(?0ll5
<br />Buqnrs\ and P(na$ion Codc) Any Cily or Counly which E{tltcs a pdnrn b.otrnruct. ull6. imnrovc, d.nmlish.r rcllir rny
<br />nrcturc. nriorio irs nsurnce. aho requncs rhc atpli.rnt r ru.h Frnln ro fiL a sisrcd nncmnr rhsr h.or shc n liccn*d purun
<br />h ihc prcviii.nr or rhc contacrors Liccnrcd L{w (Chn cr 9. Cornmn inr sirh Scclion 7fiD oI Divhion.l orrhc Busincss a.il,
<br />Pn,rcssnni\ Codc)or lhdt lf,orsnc iscxcmpl thcrcftr,m ol lhch\il{drh rlLgcd cx.arPIn,n Anyvi{,larion.rs..liotr?0ll.5byony
<br />!pplicrnt lor oll..inil sutjcclsrhc lppli.anr ro a.ivilp.trrlryorn.t nmrclhitr nrc hund.cd dollaE rS5ff)r
<br />-1.
<br />a\ own.r ol rhr l)n,Fny. or nry cnrfl.y!{s *ilh sr-!c( tr\ rhcir $lc conDens,rnrn. Bill do
<br />'tE
<br />work {d rhc sl@rm n ft
<br />inr.nd.d or oiar.d ror nrlc rSe.ro4,l. Busimss and hofcsions Codc: Thc c.nr..rols Liccn* LIw doc\ nor rmll
<br />'o
<br />nn oa.cr of
<br />rnc pmpcny who huilds or ihproks rh.rstr, dwhodoc\{rhw(rkhinNcllorhcrcllorlhr.ulhhkorhcroBncnDloyccs-
<br />pnltlcd rh,r {rh i'npmwmn* ar Rn int'xlcd orofi'c'rl lhrsh ll hosc$r. rhc tn'ildi'r8 or irpK,rcmnr k {,ld wiihii onc }mr
<br />olconllJktnn. rhc Owocr luiticr sill h,vr rhc hurdcn or ptudng rh.r lE .r she did nor huild or nnpmk (hc Isndy fDr rh. puqre ol
<br />-1.
<br />trro*rcrolrhcproncdy. am.rcl$iv.ly.otrkrcrin! s hli.cn\c(l.onlr rrsr,cotrntoLrrlt pn,Jccr {Srt. 7(}{1. llu{ncs
<br />al Pn)fcssir Codcr'I hc Cotrrricrtr s Liccnsc Lrs dncs Nripply i) rn.uicr ofPtulcrly who bninn or imPi{itr rhcr$tr.
<br />itrl sho conlrra tu such ptr,j.r( wirn x Conr.rckd\ | liccnsd Nnu! ro rhe CoDrEcntr \ I-iccn\. trq )
<br />I rrr.r.rrJ, trhlcr S.1lil,
<br />D.le: O*tr..
<br />wt)RKFns; (:()luPaNs,tTl()N
<br />DEIIABAIIO!
<br />I h.rcby rll'irmundcr Irn!lryofp.rj!ry onc ofrhc lnlhwir! dc.lrrarions:
<br />Ilr.vcorlwillnrintriraCcnificorcolCon{nrt,sclflhsunfitrsorktrs..mpcnsarion-0s pmvidcd loi bysslion:1700 ofrie
<br />bhor G c. forrhc pcriornEmenflnc 16rl lor ![ti rnc pcnnir i\ trucd.
<br />lhrvc nnd will mrinluir rork.rr c..rJx.\tridr iDsufuftc,,\ rcquncd Sc.rhn:17(n ofrlr t-'hi, Codc. li,r rlE F-rturnhNc of
<br />coricr $d lfolty iunrh.r sc<.C.I A
<br />7 0 '?,SZ :
<br />l.odifyrhxrinrhcncrliirnmncoilhcqorktur$hichrhnIri,irnnsucd,Ish{llnolcnrPloJ!n,p.r( irrnymrtrncr
<br />c, Ni)h.onm \ubjd ro lhc sork cr' .on,pcn\rr nnr hw\ olCdlrroani, ttrJ rsrcc r[d ilt dr,uld b...m suhjNr ro rhc
<br />$ orkcs' mmNtr{r ion novisio.s ol scctn,n .1?(D . r rhc Lf,trr G{lc. I slnll. hn h$irh .1nnfl, q irh rt(,{ Pmr nion\
<br />IVARNINC: liriluE k, {curc workcrL..nDcns irr.orcriB. i\ unhsltl. r'td shtrll nrbjccr rn cnlloycr b rifrii lF.* ric\ rtrd
<br />civil lnrs ut, b onc hu d,cd t 'd^'lla^ (Sl(x).(Xx)). i', rJrliri(rr n) rlr.o{ ol .onrt--n\dion. drnuSc\
<br />Sccrn$ 10?6 ul rhc Lrhtr (i)dc
<br />"",",4t
<br />t,t ( 1.\x\rl0\
<br />of rhc Busircs\ i.d Profcs \ io n\ Codc. md mt licn\c n ntfolltu(a d.,licr
<br />Cto 7{/t( I
<br />coxuBuquoNL[NrlNc crNLr
<br />I hc\*by rfi nundn |Enrryol'n rjuryihllrh.rc i\ rcon{tucri lcndnrtlgcmyiorrhcP.tirrumdofrhcwotkfor$hi.hrhnP.n!in
<br />hsuen(Scc,1097.Civ C.).
<br />tJtrJ.is Nam:-
<br />ti dc': AJdrsL-
<br />AITUQINLDECI,If,AIIO!
<br />I hm$y ol[,m undcr penrllt olpcrjrry.nc orrhc r.lk,win8 dcclurrnnrs:
<br />D.mlirion PcirnirsAslE(os Noriliclrion ttd.rrl Rcguldi(ri\ (Tirlc.l0. Pan6)
<br />R.qun.d Lctrcr al Nolilicirion
<br />k ntunn i.n isc.rcc! I agrehco 'vw
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorivent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />E-ruCt
<br />FINAL
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Flood Zone Certif .
<br />7-lJ )?
<br />_lc.rriiyrhri lhc fcdcrxl i.eulnriotrs r'Ardnrp ish$ros rc$ovllUc n.r rt)pli.nhL ki ihis!rojc.r
<br />lccnrli rlrr I hn\c rcrl rhi\
<br />.',ii'ri(c\ trdSrnrcl-r(s
<br />rhr. unrirnrd p'fltn\ ntr
<br />A1-t-t (
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