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BUILDING- INSPECTOR RECORD
<br />SITE-WOHK DATE ID/SIG.COMMENTS OWNDN BUILOER DF]T,CARATION
<br />I h.rcDy .risn u dci p.i.lry or Friury rhar I tun cr.nipr rnnn rhc c{)ntrcrorj Li.cnsc Llw lor rhe rbllosin8 rc!$. (Sn.- 7011 5
<br />Bu\inc$ nnd Pnntssion Codcl: Ary Cily or County *hich rcquircs d pmril l(, cor(ruc|. allcr. improvc- {knoli\h .r rcpat rny
<br />iflcrxrc, rrir kr irl ts!oc..lhortquiesrhcapl,ltarrforsuchpc.nrithfildrsigtud{lnrrrhartf,.rdrirliccnsdNrsuanr,
<br />lo thc pmvtios of rhc Ctntoctols l-iccnrcd L,w (Chaplcr 9. Co.nnclcins wilh Scclion 70tu ol Dirti.n .l or rhc Busi'rcs\ rnd
<br />Pnrcsio.sCoJcJ orrtar hcorrhe nercmpr rhcrcfro ud Uc bnsh ior rhc aucscdcrcnlnn,n nyvi.hn.nol'sc.riotr70ll.sby,ny
<br />,tpli.anr roraFr6ir \rhj.ch lh. rptli.ad ro r.ivilFiatryoftror 60r.rh fiv. hutrdrcddullls(551x)).
<br />-1.r\otrncroilhcprorEny.'nnyc',pk'yccrwilhwa8$u\lhcirsolc..mp!.n(ii,n.silldorheork,i
<br />rh.nMmnRn
<br />i cndcd or ori.r.d tur s lc l So.7IH4, Bu\inc* rtrd Piofcssn'i\ Cdtc: 'I h. Cotrr rcri s Li.cnsc liw docs ml a|)l)ly to !n owrcr ol
<br />rhcpmFny wio hoilds o. i,q'mrcs lh.mn. ad rho drcs srh wo* hiDscll or hcr\cltor rhmu8h hn or hcr own cmpby.c\.
<br />ptuvidrd rhd \uch nq,okmnrs m nor inrcnl.{ or olTcri ftr s,b ll how$cr. rh. huilding or i'r{rolcmnr is y,ld wilhi'r onc )td
<br />ol.onplcri,n. rtEOwncr AuiBcr willhr\r rhc hurJcn orprovin8 lhd hc or shc dil nor bnild or irprow lhc pDpcny r'or rh( pu{D$.f
<br />I. h .*n.r or rhc pft,ldy. am.,.lusivcly .ontrci i.! $irh li..n{rl cDntrt,6 ro .onstrucr rhc projccl (Sc 7044. 0uiincs
<br />,nd ADf6si.n Code ThcConrrucnnsLiccrscl-awdocs.oraptlyloun.*ocroaploEnywhobuild\orimpolcsrhdco!.
<br />I *ho snihcr s ftr su.h pdi.( wirh r C. a.trG) licco\.d lu^und t, rh. Cofta.ktr s Liccn€ trs )
<br />IrNcrcnit,u crSc.tn ,B &PC lnrrhisr.an
<br />Ormr:
<br />IIOAffAILCOMTETSAIIO!
<br />DI!;LAAAIION
<br />I h$cb, !finor undcr ri.nalrrorpcrjrrtonc ofrhc r,rl,,*in8 ncchrarions:
<br />-lhlvc
<br />IwillnBn dn a Ceniti.atc olconscnl h Srlaln\urc tiri vorkcE cofi,cns $n.us Drovidcd lor byStrridn lTtx) ofrhc
<br />tih1r Cod.. aor rh. ,rrormn.c ol rhc work ror whi.h rhc pdmir n issucd.
<br />-l
<br />hlvc rnl $illnuinr.in workcn co,np.ns!ri,,n insuraNc. !s R\utcd br Sccrion:l?01)orlhc Lzbor Cod.. rrtr
<br />'hc P..fonun.c ol
<br />rhc work tor whnh rhi Frnil is tsxi My{orkcn conrpc,sarion insuEme.:dcr ud Policy nunh.r dcr
<br />-ExPnes
<br />I.cnifyrhdri.rlrltrforrtuncc.frh.sorkfrwhi.hrhi\pcr i n h\ucd.I shnlnotcnUloy ny pcson in ony nranncr
<br />v' r ro icom \uhr{l lo lhc *orkcr' .onrpcnsd iotr hw\ or C iri) ria.!Mlsrccrh it| \hould bcconr sol,jcd k'rhc
<br />*orkcF c.npcnsalion pnvisionsotSeciion.l?Olrolrhc lnhor G c.l shrl1.lonhwirhcomFly wirh rlx)* pmuiiiotrs.
<br />WARNINC: Iiulurc lo e.urc workcri .ompcnsali('o c.vcnAc i\ unhwh'1. trnd shrll \utrFr rn cnl,tolrr k, mmDrl Ntrrlrar and
<br />.ivil nncs up ro onc hund,ed rhou\and dolh^ (Sl(xl-i{x)). ir rddirion t) rh. cod or co'npLnsarion. ddntScs r\ froridcd li't Ihc
<br />Sccrn,n.lllT6 of rhc ttrhn. G .. inrcrc{ Md ormr'r flr\
<br />ur!!$lr0NrBAcroa
<br />DICI.ABA.IION
<br />I hcrcbt alfrm undci r..,hy ol r.rjury lhd I aD li.cnk]d urdcr pmvision olChitlcr 9 (enrmn.ins *ilh Sc.ri.n 70OO) ofDivk,on 3
<br />ot lhc Businc$.nd Pmfcssion\ Codc, and ntylic.n{ i\ in lull forc.urldflccl.
<br />C( }NSTRT'CTI(IN t ENDIN(; ,{(;ENCY
<br />I hceby ditm undcr lEnaht o! lErjury thst lhd. is ! cotrsrucriotr lctrdioe qcncy |or ltc pcrfo rnEncc .f I hc wor* ror which rhis Fanrir (
<br />i\sucd rsc. 3m7. Civ. C L
<br />AIILTANLDECIAAAIAN
<br />I H,y allrm undcr pcn.hy oip.,juryorc ollhc followinS dechrntions:
<br />Dcnxnirion Pcrmils.Asb.(os Norifrari.n rtd$al RcEul.lio.\ (Titlc,lO. P! 61
<br />,Rcquncd L.rlcr ol Nolifrotion
<br />I..n'tyrl r rh. l.lcrrl ,cguLri,,tr\ ngrrJrn! a\h.(o\..nr)ulxr. mr q,flxnh. ri Ihtr fxJjc.l
<br />-l
<br />ccn iiy Ihar I lulc rcd rhis amlicrrin ud srurdhur tlr rborc inlbn'ur ion is cotrcr I rgru b co.Dly wirh ,u Cny a.d Counry
<br />uldinanccs und St{rc Llws rclllins ro l,uildins consrrucrion. und hcrchy lurhori4 rcr,.eorariv.s orrhis Cnymd counly lo cntcr uFrn thc
<br />ihovc nrhrnd ttupcny tu
<br />.\DDli( ntor1!ul Sirn rurr ?lrtu ".,.<:/5/Zt7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<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 />Engineer Final Report
<br />FINAL I lqln T vnl..*xf 2h)
<br />Certificate ol Occu u\:pancy
<br />Flood Zone Certil.
<br />Notes, Remarks, Etc.
<br />tf,nd.'-\ AdJ...
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