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BUILDING- INSPECTOH RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS OWNER BTIILDI]R DTJLCARATION
<br />I h.rchr rtln undc' I[mhy or p.rjury rhd I an cxcnu liom rlr C.frra.km l-icc \c t-rwlnrrhc ri,ll.wilrs rcr{n, (s(7l)ll5
<br />Bu\i'rcs{ nnd Pn'fcsrn Coi.f Any Ciry or Counry *hirh 'cqunc\ r ,rnnn nr c.nsrruct. 3lrcr. impn,vc. d.nd,\h or rct)ltr atry
<br />rlnl(nlc-rrdhns is\uitrcc.rhorcqunc\rhcrmli.rtrtrcuchnctinirt,flct\iSrd{Ictnrrh ltorshci\liccn\:dPursurti
<br />n, rhc pn,visbns ol Ih! C.nrracroas t,iccn\cd ltrr iChrttrr 9. Connncn.i.S qirh Sc.rion 7(xx).] Diri\n,. ] olrht Ilsinc\! yd
<br />rpplicanr larJ pcmir \uhlc.8rh. rpt'licanl b acivil|cNllyolnor nnncrhri ti\. hundr.ddollrr r55U))
<br />-
<br />1. N o*rcr ol rh! ri,Fny, ,tr .ry c lPlr')Nr snh $l!cs rs rh.t $lc conrpci\ln,n. will d. lhc work u lh.(urknnor
<br />i'nc ldl orofll d for srlc (S(.704,l.llusincs md t\ofcsions Codc lhc An r!.roi s Liccnr I rr ikrs nor amly ro rtr o$ncr ol'
<br />rhcrmncny who huilds or impnivcs rh.i([. {rl llN,l.s $.h $nd hnn\c]for lrcR'lf.r rhroulh his or hcr o*n.nrloyccs,
<br />ptuvdcd rh.r $ch imrrtrlmn\rcrn irnc cdnroff.tu1hr qtu ll ho*cu.rhc hxildii8or i,qr,vctrrnr i\ sokl wirhi" ft )trr
<br />ol(unptrid rh. OsNr auiklcr will hrvc lhc h'Rlcn ot prorins rh,rl hc or nt did n.t bnild or iryrov hc pmFiy ror rh. PUln$ol'
<br />LrsosncrofrhcFopeny-rn,.ichsivclyroiti.ril!shli.cr\cd.ofrBcnrsbcon{.rrlt!'oFr(Scc70t'1 Bu\in.\
<br />r Pmfs\ir Codc Th. Cotrtacntr s Liccnrc Liw(l{Es norrpplyro osncrolnlofrryshohui!{l\o!inrPiorcsrhcrL\nr.
<br />.tr'l who .\n mcrs li)r$ch prcFch wirhrCotrr'r.bnr) li.cfscd pur${nr rolhcG,ntactx s Li..flsc Ln$)
<br />!rl!r.!8lruI
<br />I hcrcby nlltrfrntulcr pcnnlrj_ ol'
<br />-lhrrcardNillmainrainrccnifi.rrcotconscn!hs.lll$urcfin$.rkric.'nPcis.r.n.NPmvidcdturl,ysorn)nl70oollh.Libr(Glc.lbrrhc pcriormrce of rl[ r.rk r(n slri.lrrh.trnit is issu.
<br />-l hlrc adwillmrirrai'r *orr.s ..nlrnsrrio irNurancc. as rcqtrtcd hysdion l7(rool rhc Laho!CoJ.- fdrhc Fnann.n.c ol
<br />rhc sork li)r *hich rhisr.rn r is ksucd My$ukcN canlEnsatid in\u'aicccnicr rxl Pli.yrunrtut (c
<br />I.cniryrhlirrhcpcrln rncc,r rh! $ork tur shrh rhrs Nnnir ir il{nl. I \hrll nor cfllll,)y lrry lxr Rr ln n nr_ nrnNr
<br />vr rsn)t{.om \rl,jccr t)rhc $orkcri..nrrcn{ ior hwsofcrlinrtrir. x lstot rhrril I shdlld tf,cotrf, {'hjc.r n)rlr
<br />tror[c^.otrrp.tr\rri(ufmv,sion\olSc.r]otr.r7(x).lrh.lrhorCodc.lnu,ll.ndh\rir[(orf]ysihrlm{0'o\ni(nr\
<br />WARNIN(; I irlu. r,) \cruc *orltr^ con,t).i\rri(r, co\rrr$ N u inl. ud 1hrll nrhjc.i xn.ilroJcr ro cri'ni'rl p!trrlrics rnd
<br />.Nil {n,.\ n r. .n. hundr.d rhonsrhd
<br />Sc.rion 107( ol rhc Labor Cndc. inre.cn
<br />r, rh. ..n ,,1 .orFnrdnnr, drmrlcs rs tnnid.d kn rhc
<br />I l'.'rlr! i lrir n,!trd tr xr,, tr!r, 11 |'o\6iu r rn ( hrtrrrl) r..nnn.f(in3 wirlr sr.lDn 71xx)).1 l)nnii),.1
<br />of rhc Burirc$ rM hnfc$ions Codc, aftl myliccn\c is i', foll nn.c l.ffccr
<br />CONIiII!I:IANI.DNI)INI;JCENTI
<br />is{rcd (Sec .1097-Ci! C )
<br />i fILISANIIII;LAS{IIOI
<br />I tm6! rrfirn uDJcr |t rlr y or Nrjury otrc or rhc i.llo* ins d..nmrn,n\
<br />l)cnFlirionPcnnit ArlxiosNurifi.irrn l;cdcral RcEUhrntrs(lillc40. l'rn6J
<br />Rcqutcd lx crof Norifi.dirrr
<br />-lccdi,yrl,d
<br />rh.lirlcrrlr[ulariinr rcSirdnr! i\h.{o\lcrx]vrl)rc tror rrnli.16ll t) rhi\ fn'i..r
<br />rtu rtx,vr i'rlann n i\corrccl l a8rcc L)romnltwirhnll Cily!trd Cotrnry
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<br />*"'""'"'*'^"""**'*'",.-.lu/4rg -
<br />""**'.,'ffirda
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cerlil.
<br />, -,
<br />FINAL o //,?/// fr.hurL'-/lt--./-
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />I crkrcr \ \,ldrc..
<br />Set Backs
<br />UFER Ground
<br />Subf loor/Venl/l nsulation
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