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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Shealhinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<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 />Enqineer Final Report
<br />Flood Zone Ceftif .
<br />I
<br />FINAL )/2,,;lt {
<br />Certiticate of Occu a
<br />Notes, Remarks, Etc.
<br />OlINER AUILDI]I' DELCARATION
<br />I h.nhy ,Iilrm und.r prMlry ol rcrju.y lhar I am.xcmpl linrn rhc Co.k(nx Lk.n\c Law ror $c followinS rcas,n (Ss 70ll 5
<br />Busin.ss and Profc$ion Codc): An, Cily o! Counly *hich rcqlirc\ r [rmn tr' .on{d.r, .hcr. im!ro\c. dcmlhh or rcpan any
<br />nd.turc, nriorro ih Gsu.ncc. llso cquncs rhe applicanr lbrsu.t pcdit b lil. r \i8rcd {drcmnr rha' tEor shc Ls liccnrcd pu^urir
<br />n, rhc Imvhions of rht C.nrr-'rols Liccnscd lns (Chlnrcr 9. ComnNncins uirh Sccrion ?(XX) of Divhion I ofrhc Ausitrc$ ond
<br />PmlbssiotrsCod.)orrhdhcors[cncrcmpllhcrcirommdlhcbu\istnrhc,li.gcdcn'nptDn./\.,violrlionofSccliotr?0:]15byuny
<br />rpplicrtrr ntr 0ri.rmirsuhJccrsrhc 0!plicanr i. acivilpcn,xyor.or morclh0n five hundrcddothr (5500).
<br />l.$oBncrofthelmn.ny.ornrycnrrlorlcs*ilhsrsc\arlhcirv,lc.o'np.n\ tr . wrlldo thc work ldtncsltrl!rci\Bn
<br />inrcMcn oroficrcdn lrlc (Sa.. 7l}14, Businesand korcsions Codd Thc G)ntactors Liccn\c ks docs nor lpply t, d oetur .r
<br />rhd pn,Fny *h huilds or nnfhrrs tlrBnr. md *ho docs \u(h q)rt hinr\cllor hc^clfor rhr.dgh his or h$ own ctnnloyccs.
<br />[ovnh riar uch irposnftddn id.nd.doroflt(n f(r {'lc lr, k,$cvcr, rh. ttrildrry or i.q]tovcrnr t $U sirhin ncEtr
<br />of.on{rLi ion. th. owmr Buit-6 uill t!!c lnc burdcn oi provins rhrr tc or \hc did tur build or inpmw rh. tmtEny for rh. purlEs ol
<br />_1.!sn$ncrolih.propcdy.rtucr.h\ivclycontadinEw[hli.cn\cdcorodoNlocotrslrucrrhLflorccr(Scc7044.8u'i,t.\s
<br />artrl t\ur.ssi C.dc: Th.Cotrt0ctols Liccnsc Law diics norntnlrlo u.wncr of prol.d y uh(, brildsot imPlorts thcrc.n.
<br />rtrd sho contmdst)rruchpricch*irhuGrnrEcronslliccn\c tnrrur.l ro rhc ct.tmctois Liccnsc L!$)
<br />I umcicrnbr undcr Sccriotr .8.&PC na rhi! r.r^a
<br />WoRK[RS' C(}IIIPENSATION
<br />DIiCLAIAIION
<br />I hc.cb) lf,irn undcr lcNhy of!.rjuy onc orth. folloqthe rtc.iurrions
<br />-l
<br />trvc d will Di'nlin d C.nifi.nrc of Conscnr t' Sclf.lnsurc for wor&cs ompcnslrion. as proeidcd fo. byS(rion lT0Oolrhc
<br />libor Codc. for thc pcrfornuncc ofrhc wof* r.r shich
<br />'hc
<br />p.nnir h issucd.
<br />lhrvc dnd will'n.n tr workcr\'compcnsntion insumncc. r\ rcqutcdhrSccri{'nlTf,Oollh.ljborCodc,IorlhcPcrli'rro.ccof
<br />work ror whi.hrhn Fnni( h i{sucd Myworkcrs n in\!rx'.t c,ri.r lxl Fh.y.unrbcr:uc
<br />oqott
<br />t
<br />_, ccnifyrhd in rhc Frlnr.hn.. of r hc s.rk for whi.h rhr\ tr.nnir h hsucd.l strllnor cmpk,y trny p.r$n in any msnrcr
<br />nr rstu b.om suha.r ro thc u.rtcrs compcnsarion hws olColilomir. Bnd lgN ihar irl li(,uld tE.onE suhicr ro rhc
<br />wolkcrs.onlEnsationrmvhionso{SsrionlT00ofrhcLltnrCod..lshJl.ronhwirh.ompiy*ithrhosnmvhions
<br />WARNINC: Foilurc ro wur. s.rkcB comp.ns nrn cov.fut. is unlnwful. ond shall subjccl {n c'ntlorr to dnniml Pcnohts lnd
<br />riril li B up r(r onc huxlrcd rl'ot\r J olln^ lSllX).(XXr, itr Jdd(ion r,nsation, dlmgcs .s ,'mvidcd for lfic
<br />:::]IJ;$L
<br />I hochr rllirm utue! ncnilryol F.rjtrry rhar I rtr,liccn{J utrd.i pn^ntr,n of 9 (comm.cir8 wirh SNrh. 70fl1) .f Dvision l
<br />or rhc BusmssaNi PmLssiorNCod.. ud nryliccns h in aull i.,e lnd.ffkr
<br />B o30
<br />(]ONSTRT'(ITI(tN LENDING GENCY
<br />I hckby dl6rn lndd Fn,lry ol pcrjury thot lhcrc is ! con(rurlior lcndifs r[.ncy ror rhc rcnoflrrrr.c olrhc sork io! *hich rhh rcrmir i\
<br />i\\td rscc l(r97 Civ C )
<br />AITIJIANLII&CUAAII!]N
<br />I hcrclty sfinnr undcr pcnalry ol fcrlury om ofrhc folbNnrg dNlnmtnrnr
<br />Ixnmlirion Pcrmih-Asbcslos Norificnrio. Fddoal Regul i(,rs (Tirh ,r0. P,n6)
<br />-Rcquircd
<br />l!rcr otNorincdion
<br />-lccn'ltrh rh. r.dcmlrcgulatnn\ rcgardinao\h({n.rcrmrrlrr. rt{ aldrdbh ro(hF pmFt.
<br />tal cci rly rhd I h!,c Ead rhr lpnlrarion rd idc rhir rhe ahrvc inhmra'n i\ coBccl. I !E E lo 6mpry e h all c y rnd uounry
<br />ordlfrn..s r Srd.l-.rsr r.Iritr! b huil,li',!.onntucrnr. rtrd hc,chl rcprcscnrorivcs olrhis Cir, and Counry ro cmcr
<br />alx,vc rctrrioncd pmr.ny f(tr irstB..rion purposcs.
<br />'\D icr.lor gehtSi*nilrrru
<br />lQu'n f,.Lz-
<br />U
<br />,&A
<br />-4
<br />d t€
<br />I'€nnnee m E (p.inl)rlt(_
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