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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BUII,DER DI]I,CARAToN
<br />I hcr.b, nrfirn und.' lcn lry .r prrjxry rh,r I m .rchDr rtun ihr cotrtrrcrod Lncnsc Liw lor lhc tullowi')r r.rn,i (sc. 70rl 5
<br />Buriness Md Prolc$ion Qxlc) Any Cil, or county which rcquircs r Fnnir h (n(rucr. alrd, inr!tuvc. &mli.h or rcp.n rny
<br />srDclulc. n iorto irs hsuancc.0l$ rcqutcsrhc rpplic{trr rbr such pcmir b iilc r \ia'rd ( c rit lhd tror shc h liccn{d ponu!
<br />ro rhc lJlovisions ofrtr Co.kr.roar Liccns.d hw (ChrIcr 9. Com,ncncins $irh Seclion 7u)0 of Divi\i.. ] ofrhc Busincs and
<br />Pmfcsnns Codc) or rhm hcorshc kcrcnrnt lhcrclro odthchasislorrhcollcredcrcq,ion. AnyvidrrbnolSccli[T0ll.5tyony
<br />aarliclnt for a pcmrir subjcls rhe amlicur rorcivilpcnlhyotnor morcrhrn nr. huMrcddollrr (3500).
<br />l. owicr of rhc ptuIrn y. .r my.n'tlo)ru wirh qrlcsasrrrir v,lc.onDctrsdi,nr. *ill!o rh(wor[xnd rh. {trhrc n or
<br />i uxlcrl or oficrcd for slc ( Ss.7()t4. Ausnr$ dnd Profc$ions CLt. Thc O,nrructtr s t.i.cn\c lrs docs nor nptl, lo an o*ner ol
<br />rhcpot--ny wlm boil.k or iDpn,v.\ rh.rd,n, arl wtu do.s \uch krk hn sclforhc^clforrhnn8[htorhcrownunfk,y.cs.
<br />providcd rhlr such inllovdrnh e nor imendcd or olhcn lor eh ll how$cr. rhc huik]in8 or ihln,vc't r is v'kl wirhi'r.tr. ]'u
<br />ol conr{rcli.n.lhc Owtrcr Burllcr *illh!rc rlE tanlctr ot pmvin-a rhrl hc or shc did tror hild or i'nP(,vc ihc FroD<ny lor rhc PuqDt of
<br />-1.
<br />!\osncrofrh.p!,ncny, !'nrich\ivclycontacri,rs wirh li(i\cd .onrr&rors lo cotrslrud rhc pn,j.rr lScc 704.1, Bu\h_$
<br />.nl Pir,fssx Codc ThcCotrlmcktr s Liccns. Lrw doc\ n l.rplyro !norvnc. otfn'penywho buildror imprcvcs rh.tcon-
<br />!n( who conxa.hlorsuchprojcckwirhaConracbn9liccnlcdpu*uadk,tuG,.tcroisLi.cnscL!w)
<br />I dNcx.,npr undd Sc.rio
<br />]IOBrIBS]I;OIIPINIA.IION
<br />I}ECI.Af,AIION
<br />I hcrcht.tliro undn lcn.lryolpcrjuryonc of Ihc l'ollowiry dccln ion\:
<br />rd witl tuinrxin r ccnificni. of cuns.nr ro scll In$n lor *o, kcn conlEneriur. !( Fn,vidcd lor by s..rion l7u) of rhc
<br />f{n rh.!c'lnnnmr ol rh. qork lor*hirh(hc t)cnnir it i{nrd
<br />workcrr.omBrrtlli,n itrsur.tr.c. r\ rcq i'cJ hyS..ri,nr.r7O0rn rhc l.nhor Citlc.li)tlhc!crlonuncc.l
<br />nnpc.\rlion in\urrN. uricr rtrd Ix lic, ntr'nhcr r.
<br />/ L'?r7-)L
<br />)-o a
<br />I ccdift rh r in rlr pffonrun.c.flhc work {or whrch rhis l)tnnn t tsucd- I shall Nr cmni,y rny p.rron tu rtry nanm.
<br />er .sro lx$N subr.r ro lhc sorksl conrpc.erion lnws ofcalili)roia- and alrm rhrril I \k,xld b..onr suhj.rr lorhc
<br />workc6' ompcnsar ion F)rniors of Ssrion 37(xr .l rhc ! itn. Codc. I \hrll. n,n hs irh co'nl)I, w,rh rhoc Ptuvisions
<br />WARNING lirilurc n) Burc sorkc6'.oD'!.n$ior covcrrAc $ unl k,ycr io diminrl pctrllrics and
<br />drnD8cs as pn,lidsl i, rhcl. onc hundrcd rho!\rod Llollir\ (Sl(x).(xx)). i', rddiri(,
<br />qY'nr?
<br />I hcrby rllirn uklcr Nnalryol pcrjuy rhd I aD liccn vi\i{rolCll:lnrcrqIco trmi.i',!aIhSc.lon7{{x))o
<br />of rhc Busincss md Prolc*ions Codc..M myli.crsc is ir full ibrcc rnlcflccl
<br />I ncrcby afinmundcr pcnallyofr.riury rhat lhsc is u c(
<br />issucd (sN.1097. civ. c.).
<br />rhc |tllu'. r.c olrhe Lvork,nr trhichrhN t^-'r[ n
<br />AITLICANLPECIANAIION
<br />I hotty amm !nd.r pcnalry orp.rjury onc orrhc rollo*in! d.clanlions
<br />l)cmolirion Peflnils AslEsro\ Norilicsri.n Fcd$rl RcCullrioor l'lirlc 40, Pafla,
<br />-Rcquircd
<br />L.ttcr ol Nolifrcllion
<br />l.cnifyrl,rrihc ridcrrl (guhrnnN ftgrdur! n\lr(o\ tutrnrrlflc trornDt,li.irlc ro rhn fn+cr
<br />rlyrl[r I havc rcdd lhi\ lpplicalia!ft1 turn r n..nc.r.I a8re b com0ly*irh allCiryand Cou ry
<br />hori2c r.r.rnrnrivcs olthis Cily rnd Couniy kr rnrn uljon rhc
<br />,",",'1'26 '&
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq , a/rl t 6,rttvt'lor-l
<br />Shear Wall
<br />Framing
<br />lnsu lation/Eneroy
<br />Drywall
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL hltsl*6vywyt+/tD-
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Ext.i lnt. Lath
<br />Flood Zone Certif .
<br />c
<br />tt
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