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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWN!]T BI]II,DI.:II DI]I,CAI(A'IION
<br />I h.rb) rffilm und.r peoalry of p.rjury rhll I mr.r.m frlm rh. Conlm.roo Lic.n$ Ilw for rh. follovin3 r.arn (S&7031.5
<br />Iiusincss and P.oli$ion C'rde): aiy Cny .r Coudy whi.h r.quircr a Nrmn L' .on{tucr, alrcr, i'npr.v.. doml,sh o. rcrN a.y
<br />shrcille. Fric b ts nsuare. otso EquiE\ rG appliQrr lo. su$ p.m ro 6L a siun.d srar€rrmr rhd lE or she it li.cnsi I'u6uad
<br />h rh. tovisi.ns.frh. Conkkror'r l-ic.nrcd lrw (Ch.ric.9, Commi.in8 wiih Ssri.n 7(xxr ol Diviion I ol thc Busitus and
<br />Pro|rlioisCod.)Drrhrrh.orshds.r.mttrheBlio rndrlpb.s$turlEullegedexen$ion Anyvioht.orS.crionT03l5hylny
<br />npplic.m f.. i pentrir subjech rh. loolicior r.0.r!ilp.Dilryolnor mr.thrn five hundrcd dolln (r500).
<br />_1. d .rmr oI rh. fiq*ny, or ny .mpl.tr.s wnh w.Bci ar rh.k sL mmp.n.dhn. will do rh. wrt and llt {M@ is mt
<br />inre'!.J o' ofiercd ,or sh (S* ?(x.1. Busncss and Pmlcsions CdG, Th. C,nkcrols Lic.n* L,w rt B nor apply ro an own., o,
<br />rhr ropeny wlh hildr tr iqroE rtlre( etl wtr dG reh k)* himr.la o. h..&lf or rhre4h hi\ o h.r om.n Plor&s.
<br />provid.d rhar sfth imFrEfldsm mi i^r.nd.d oroff.Ed IM srL ll. h*M,0E huildina or inpFEmd is sld *iihin od rtt
<br />of conphir\ rh. (}/*r Build.r ,ill hrE rtr buda of pmvi4 rhd lE or shd dtJ d hliB or trnpr!rc {E poFly lor llE pu+os of
<br />_1, !\ownerolrhc pmlEny. !m.rclusivelycodrsding wirh li..n*d .onrebn ro ltnntucr rh. prcj..1(S( 7l},14, Busincs
<br />arl lk L\\bnCodd ThcCo ra.(tr\Li.rtrs.Lawd(Bnorryplyt'm,'wtr.i.flln,!.ny*hohuildsorimproverrher.on.
<br />and sho .o.k.(for$'.hpn'icrs*irhiComm.h(s)lrcn*dpusum|.thC.nradols Ltcnsc kw).
<br />I ane\.npr unJ.r Se(rui .l &PC r,rr,LNr.so
<br />t!0ts[E8!!J]IrEtr{t!!)!
<br />!]E(I4.BTI!OI
<br />I hcr.hyrllnmtrnnrrp!nrxv.,tfl iurvunco,rhcnilll)uirgd..lr rk r:
<br />I hak and will ntrinr.i,, r C. r,lc . ofco'Mnr h S.llln$r t{, }.rksf d,op.Narion. a\ tovid.d lor by S.dbn 1700 of rh.
<br />l-ahor Oiq lor rhd r..londtc or
<br />'hc
<br />woA tu! whi.h rhc n.roir i! irsu
<br />_l hav. and willm inrrin work.B rcnrp.nrdbn in\urrnrc, a\ equired bySecrn{3?0Oofrlrel-ahor(id., finrh.n rtomu,&ol
<br />rhc rork ltr which Ilih li.rnn is isu.d Myworkcrs onrp!trsrrnrn insurmc cmici dl policy Nmbs m:
<br />_l ccnili rhd in rhc lt.ifornrB. ofrhc work fd whrh ills Frmir ir bsucd. I shall rct cmploy any p.rbn in any nrnNr
<br />$ ar r. hc6m suhlcd ro rhc m.t.6 c.nrp.nsa!.. h* ol C.l' lo.nE, an<l igr. rhar if l should b.corft subiccr ro Itt
<br />*ort.6 coqEnsrian povis,ors of Sdriotr 3T0O of rh. bbor Codc, l dEll, fonhwnh luply wiih rhos pmvnio6.
<br />WARNING FriluB h scur worlc* onr.tuarnrn covcEBc is lnl.wtul, lod sh l suhjcci e cnploy.: io rinin:l lfnaLis dd
<br />civil lin.s up ro on hundrd th.us d dolld* (S100,0(l(}). r iddnFr ro rh. con of conr0.neriotr, da'u8.s ar provid.d for (h.
<br />S.crion 10?6 ol Ih. Lbor Lod., inr.r.r aftt a oft! sI*r
<br />LlcENtp-llllNr&lcrcB
<br />t][(La3a1l()!
<br />I h.r.by.lltmundcr pculry.l Ocrjury rhlr I a'n lian$n undc.ornvi{i.n olChaprs 9 (.omm.cin8 vnhSccrbi 70n0) ofDivisi.n 3
<br />of rhc Busimsand PtuLsriotuCoJ.. d! nry lic.ne n D tull fd.. dl c ll.cr.
<br />Li.enlcclr$ Liccnr. Nu'nh.r
<br />(oNiurrtrouljsltNqclNc!
<br />l h.Ehy dilrm undet F.alry ol perjury tlu(h.rt i\ a corjn'cridr k' ins rs.rcy n{ rlt ptttornEN. ol rh. *o.[ lirr whth rNs !,.Brir is
<br />ilsucd(Scc 3097, Cn C).
<br />Lt&!clllpre!4!a3!!I!
<br />I lRby rllmr utrder penilry orltriry otrc ofrhe n'lrownU d{lintri,trx
<br />DenBlirion Pernnrs A!ht(os Norificrrion F.d.ml Rcsultlions (']-,rl€.10, Pd6)
<br />Rclut.d l.trer oaNolfi.d'on
<br />_l c.nify rhd rh. f.d.ril r.grl3rioL Egrd,n! Ah.sros r.m,! rE ,xn ,m)Hbl. ro rhis pmirr
<br />_l cenify rharI l*v. dd rhn rppli.miondl rdc rhd rh. rv. nfomrDn N.orel. l ag@ ro rcr,lly witb dl Cnl and Coumy
<br />oiliEtrt.t r Srd. tjrs Elariryio buildtr,g co'$rucrnnl dl lH.byrurlrrie rcF(*d.rv.s olrhrsCtry and Counry ro.nr.r lFJn rlE
<br />$o\ c nnr iotual prl|i ny for iNlerion ,uqtes.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\,4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL -7/9/ru --MCertilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />Rev. 08-07-2015
<br />Lc*hi: Ad4!s'
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