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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.owNER ltull-Dlifi DaLCARAI toN
<br />I hctbyrlrlr tndcr p€nalrr otFdu.y rhrl I am cxcmpl lrcm rhc Co racroF l,iccnsc ltre forrhct Uowin8 tulv,n ls.c7).115
<br />Ausincs nM Prof.\\ioi Culc): n, Ciry or Couiry which lcqutcs r Frnrir io .onq cr, rlrcr. i F)rc, d.'n hh .r rpair My
<br />nru.rurc. nrnn ro its isnutre. also rcaut r th.,rdicrr f(tr su.h Fr.'ir n' ul. r siS cd idc.rc,r rhr heordr ir licciscd !u^u,nr
<br />l. rhc ,hvisioN of rhc Cl.ftn !r's l-i.cn{d L'! (Chrprrr 9. Connn.ncing wnh S.crn r 7l[)0 of t)ivision .] of rhc Bu\i'lrs lnd
<br />Pmic$ions Codc ) or rill hcorshc hcxcnfl rhcrcfro$ and rhcbrsi\ for rh. dlhlcd .xc'nprion Atryvt,lDrionotSc.riotrT0ll5hy.ny
<br />applicur rbr a Frnril ruhjcct\ lhc lttlicunr lo ucivilncnrlryol trot mrcfion fivc hutrdrcddoll.r iS5($).
<br />frl\, a" o*i., ,,r rhr Imriy. or m, cmpk,ydc\ wnh w,s$ a\ rhct vrc co'npcn\rrn,n. sill do rh. $ ork rRl rh. nmrm . d
<br />i"rcndct rollcrcd for $k (S(.7O1-4. Au{rcss rtrd Profc$trN Codc Th. (btun ttr s Li.cnrc Lrw docs nor lPplyh o\rftr.f
<br />rhc pbp.n! who hrikh or i'npr.ts rhc(r. dd who ,rc\ n'.h sork hinNcll o' hcrcllor lh(n'ai hir or hcr own cmpi)yccs.
<br />proviJcd rhlr su.h imnnivcntrh nc rmr i .ftl.d or ollarcd {or sk ll hoMrd. rhc } ildin8 or ntmvc rnr is {,ld wirhir on. $
<br />ol.onDldion. rhc Oqncr Auih$ rill ha\r rh. hr&n of poving rh3r hc or \hc did R trildor ilnl ovc rhc pmlcny ti,r rhc purlr)s of
<br />ffi:xx:lrl':u::,;,;H::l'ir;rr:Tli:ilL",:Ifii,,"::::r{:;:;;:'r}'fr"liT#r'fi:'.',,i;,1'f.ftH:
<br />rnd *ho conlmch {o! such pmJc.k wir[ icrM.dnnl) lic. \cd
<br />I hcrcby rilnn trn .r p.ulryof Frjr'tnm.l rft ftn[Nirr dcclt
<br />-l
<br />hsvc ondwill mlinrain !Ccnific colconscnrroScli.lnsurcforso crl compctrsotion. as pmvidcdrorhySccrion3?O0ofthc
<br />L,bor Codc.Ior lhc p.rfon mc oith. work i.r which rhc p.rnir h isucd
<br />IhilcandwillFniniainworlc'! compcnsarinn insunncc. !\ rcqln.d h, Ssiio..i70O narlr Lzt*, Code, f.r rhc p.rformnc..f
<br />th. rorl forwhi.hthk p.nnir is issNd Myworkc* .onrpcdqrioi insutunc.ariui rnd l.licynunrb.rr.:
<br />Cuicr:-
<br />l\'1i.yNtrnrhcr Ertncs:r\
<br />Eit hr rr rnr ,n rtrc rrr.rm{Nr,rl rhc s'trt ,nr lhtrh rhis pcrmir is issucd, I shallnor cnTk)y my pcrson in..y mnncr
<br />\l'i7n ha, n c \uhtfl | r, rl. tr.4c'\, rn,|($ariotr |.,tr. oi( trlrf.iinJ.otrd rErcc rhr ri I "hnuld t("m \uhjccr r.r|i.
<br />sorlc^ comnrnsari,nn()vi\i,,tr\olSrcri,nr.l?(lO.IrhclilxtrC,d.-l ll. hnhrirh.on,flv rvirI rln'{ Irrvi\i(tr,\
<br />IVARNIN(i |rilur. r, {.tr'c sorkcr'conmcn\rri,r..\.'fu. '\ r lirl- ud \lnll {l,].ct !n cn,rhy.r i, crimnrl t^-.mhis md
<br />.tr I lnr\ up k, of. htrnd'cd rhotr\xnd nolh \ r1l(x).(nx)r. iD x(l,l h rh. .on ol .on,lrn\rri,n,. drtrx€r\ a\ t)r,vnld ,nr r[r
<br />:::::'i";-D'14"
<br />I hcrchy rlrtnr undcr pcnihyoip.ryury rhd I rnr licctr{d uMcr taovhior oiCh.i'rcr I
<br />of rlr Buenc* d Pturc$n sC.d.. dd.ry li..nsc n in fxll torc. r!]rlfccr
<br />l-iccnsc Ch*
<br />-Licctr\c
<br />Numbcr:
<br />-
<br />D.l.: Contractor
<br />C(INSTRU(:TI(IN I F\DIN(; A(;ENCY
<br />I hcrct y irfirnundcr p.nrkyotll€rturyrhal thcrc h 0 consrucrhn lcndin8 r8ercy for lnc pcrfommc ollhc *ork tor which rhh lc nir is
<br />issucd rSc..1097. Civ. C.)
<br />aftrtc NrD[clll[auo!
<br />I tEEby irlnn undcr lcnllry ol pcrjury om olrh,lollowirg dcclmrnnN
<br />D.nslirrnPcnhirsAsh.{orNorifi.urbn Fcd.ral R.$ldions(Tnb4l), Pd6)
<br />R.qurcd lrncrof Norifi.uhon
<br />-l..nilyrhar
<br />rhc lcdcr rcsuhri{nr rcsndins ast sosrcnnrval.rcnoralplicxt'lcr.rhhpnl.cr
<br />H*r 'ly rhn 1 I'x\c 'cxd rh \ rft,li.rr(, r rnd rhar rh. ih,!d irloi,Mrion s conccr I +e lo comply wilh all Cil y and Counly
<br />trtiDtr. d hcr$yrurlntrizc rcorcscnlarivcs olrhis cir,0nd Counrylo enrcr up.tr rhc\rfd Sr c ltrtr\s rhrirf r, hrildrtr!
<br />trbort Nntoi.d pn,t. y f(n nisFari,nr
<br />,,,,",, iltzt&Appli.ont or A*cnl SiSDrlua:
<br />P.nnil.e nanP (pnnl): A
<br />/-l1/,
<br />a.--
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Exl./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />De puly Final Report
<br />Engineer Final Report
<br />FINAL 7-2? -/€J/e!il ,-(O\
<br />Certificate ol Occupancy
<br />Notes Remarks Etc.
<br />-{
<br />COMMENTS
<br />Set Backs
<br />Flood Zone Certif .
<br />*" 'E /tz I
<br />%r - * *,,^ ^*, ",,,*,,^ ^,
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