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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcl,y ifinm undcr rEmlry or Frjury rhar I am.x.mpr rmrn rhc Conlrick,F Liccn\c tiw r.r rhc rollowir8 rc.en (Scc 7Oll5
<br />ll \incss rnd PR,ft*n,n C.d.): Any Ciry or c{nrdy whkh rcquir.s ! pcrnrir i(, con{fl.r. ,lrn. irrrovc. dcmlhh or rcIlIt nn,
<br />in.rurc. prior fu il sulncc. dlso rcquircs lhc cpplicanl n). such pcrinir I' tilc r siSNd tutcmnr lhor hcorsnc i\ li.cnsd puho r
<br />ro rh. f.vision\ dr rh. conrisctors Liccnscd lj* (Chrfl( 9. Comn]cncina *irh sedn,n 7mo or Divisnrn I or lhc Bxsi"cs rid
<br />PmtlsionsCodc).rrhrihcorshcisercmrrrhcrrrcnndrhchlskr(rrh.Jllf.icxcmplion.Any!t'hli('noisc.riotrT0llshyan,
<br />ellicanr lorapcn r rubjcchrhc rmli.nnr b r.rviltcmkyofnol nmrc lhnn livc huMr.d dollds (s500).
<br />_1. as o*ner ol'rhc pn'Fny. {n
<br />'ny
<br />.nnl.)r{! wirh urlcr as ihcn sob .onFn{ol ion. $ill do rhc *rk ,n rlr itrrm is ml
<br />inrcrtkyl or.lT.dd f.r sl. rsG.?01,1. Busi"c$ nnd Pnfc$ions Co.lcr'I'hc Conkrc(tr\ Liccnsc Law docs trot mrlt lo ano*rcr ol
<br />rhcpmFny who hu ilds or irprolcs rhcmn. ud wh dmr ch*r)t*hinsclro,hcr*lforrhrouEhhisorhcrowicmnloyccs-
<br />F)vidcd rhd su.h nnrroEnEnr m nor inrc cd or otttEd tur L c li h,wnur. ttr hurtirg or iqrotcnErr is bld *irhin rm rtJr
<br />olconrbrnrn-rhcO*mrBuilddwillhavcrh.bualcnofnmvin.!lh.rhcorshcd nor build o. inpn,w $. tmFny fot r puqn{ol
<br />-l.
<br />osD.'oIihcl,(,rrn),rrcxclu(ivclycotrn'icrin8wirhllccn\qlconrracknsk,conn.trhrf,n+.r(sc.7(l1,l.Du\incs
<br />ifllFtlixshtrC.dc1[cConrrrcrolsLiccn{l-a$(n)c\n.rapplyrJiiowDcr.lnropcnywho6uinkori'npmvL\rhMc.i.
<br />rnd sho.otrrBcr\fdskhtnorcrwirhiConrrdr(\)licenscdpur\urdn)rh.Contd.roasLcctr{.lja)
<br />I rn) .\cf,!r uD{i.r S..fo
<br />Dore: Oroo:
<br />woRxl.rRs' (.l)trlmNs^TloN
<br />DTI;IA8A.I,&N
<br />I hcrcby rflntrrxndcr p.Mlryoi|f,rjryonc otrhc inlbwinB dslorurirnr:
<br />I hrrc.r willnrnfuirrCcnificarcofcon\cnrioScltln\urcf{rsorkcd conDc strion.as proridcn lnr hy SL{nJn l7(Irofrlr
<br />lahtrGxlc. fu rhc p..lod tr.collhcwork for $hich lhc lrnnn h issucd
<br />-l havc udwill nuinhin *orlc6 .onrr.n{rio i6$rumc, N rcqun d $y Sc.rion lT0Oorrhc bt'.r C.dc. forlhc pc,torroncc o,
<br />lhc sork i{, Bhich rhiln rmi( is hsucd. M,w.lkc .rn{Ensalion iNurrn.c c rif afiiFlicytrumb.r ac:
<br />PolicyNun ,q-Exptcs
<br />I c.difyrhrr i.thr p.rfoi,runccolthc qorl fitr whichihh pcflnit i\ i\su.{t,I \h,ll nor cnllrloy any I'c6on inanymann.i
<br />$ N ro bcconrc sunrd ro ric workds d,trt .\!ri.n hwsofcllifoiin!. aM,8rcc rhtrr ilt \hould t{conr subjNl ro rh.
<br />qor*cn srmFnsrrion povi\ion: orSe(i.n]]m ofrhc ljt r Codc. I sh.ll. lonh*irh sdply tnh rho* tovisions.
<br />WARNINC Fdilxr b qurc workctr' conDcns.rion c.\cm8c h lihetul. md shru subjccl !tr emtloyer ro mninal p.mlris afrl
<br />civil finc\ up b oi. hu drcd thous.nd dollor ($ll)0.0(x)). in addin { .rconFNntiotr. du{Ecs !\ providcd tbr rh.':::;p);*i' crc{ rtrd d.nry's lir\.
<br />I hcmby rffiruutucr pcnnltyolFrjoryrha! I m li&n*d xndo pmvition ofCh!flcr 9 (onftking wirh sc.rhn Tlxxjl ofl)ivision:l
<br />o, rh. Bu\incss and PNfc$ions ("odc- ut nry liccn\e is in llll fod and cfiitr.
<br />I tr,L-by.fiinn u crrrnrlryofncrjtryrh rhdr. n r .ond ru.lotr btrdin8 !3crc} tu ric PerrdrroNc or rh- woik ior shich rhi\ Irrnrir i\
<br />i\{ul tScc r09r.Crv ( r
<br />IITPUIINLDICLABIIION
<br />Ilf,d)ydtnnu d p.nilry olpcrjury onc ofrhc lnlLNin8 dslrinN
<br />Dcnmlirion Pcrmirs A\hcior Norillcdion Fcd.ftl Rrgul!rnnN (l irlc.l). P n6)
<br />R.quncd t r{{crol Norirl. ri({l
<br />-l
<br />ccniryrhli rM icdcrulrcluhrnff rc8nrdir8 t\$.qos rcnmvil irc nor ipPli.nhlc ro
<br />'hi( lnrc.r.
<br />l.('rilyrhar I htr{ rci lh^ L'IJi cxri,rrnl(xr.rhnrfuxhno l,trn 0r \.or..r I 13'.c ri, conut * hnllcir!rtrd (-,rrry
<br />trrh rirr(0d Srrr lr\r\n:lIitr8 ki htr l,li',9.i rqnc\cnlili\c\ ofrhi\ ( irY rid C.
<br />xho\. nrnrurcd f()l,ory lnr
<br />Al)l)li.inl or \xml Si,:nrh,rr
<br />4{uavz.-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq .f{,r/r{?bftLltb
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />FINAL 5/1 ,tl/'6 1.'-ffiuiql <4
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Subf loor/Vent/l nsu lation
<br />I
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