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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNDR B!IT,DER DEI,('ARATION
<br />I hdcby arm undd p.nahy of pdjury rh, , m .i.np( no'n lh. conr.cros' Licm. li$ for rhe lollowin8 r6on (5(.7011.5
<br />llusiis and Proasion Cod€): A.y Cily or Couniy shich rcquir6 a ptrnil to ..Nrucl. 5lls, inpdrc, d@ol6h or Ep{n a.)r
<br />srtu.tuc. rior b tu irqus.c. ,h. r.qun6 rh. +pli.et lor such Fnnir ro fi1. . si8n.d rarddr rhll hc or shc i licasd puEumt
<br />lo $€ p,ovi.ions ofrhr Coirackr's l-iccosed 12* (Choplr 9. Comn.ncing \virh Sdion 7000 of Division I of{h. ausincs dd
<br />Prcl€sions Code) or rll.t hc or sh€ is .remrl ll6.tron Md lh€ bais lor rh. all.g.n .rmlprion. Any \ iolation of Scd ion 701 L5 by an,
<br />lpplicant lorapmil subjslsthc applicflntloacivilpenallyolnolmo.€thanfi\chundr.ddou6($t00).
<br />,, l'
<br />/111f:*.."..rrh.r..Fi\..rm,emrl.rc{ h q 46 6 rh.n elc.on,paMrion. will do rhe wor! ed rh. srn,crue is nor
<br />intdded or ofl.r.n fo! ele {Sa.704,1. tt$ins and Prcfsio6 Codq ltc Coorraclois l-iccnsc Law do6 ndr ,pply h M oNn6 o r
<br />rh. ttrllcU who bril& oi inFov6 rhmn. ad\ho do6 such N* hnns.lfor h6.tfor thoush his.. hcr o$n.rploy.*.
<br />pR,vided rhar such i,npmvdmts &. nor inrdd.d or ofi6.n ror snle ,l ho*.d, rh. tdildin8 or imFolllMl is st Nnhin onc yw
<br />ofcompl.lion. lhe (lvn6 ltuildg will have Ihc burdm olFo\ifls lhd h€ or nrc dij not trild or iqJro\r th. I,npory lor $. porrDe of
<br />1.6 o\nq ofrhc pmDent. d erclusiv.ly comracling \irh lics.d $nta.krh b conntud rhc prold lS* 7O41.8usir'cs
<br />and htrasion Cod€r Thc contra{ors Liccns€ L.w do6 nor applvro an o$n6 olplops1y Nho builds or impord ihdon,
<br />and who.onrracKlorsudlprcj.{ssnhaCodt6.rN(s)li.o&dpuruanr('rlrd(onkec(,'sLi.as.L4N)
<br />*"T)ffi]"4",.. t-T,S"rttA
<br />D[(t BM!O!
<br />I lrrcb) a,linnundd Fndlry.rl)du1.nd.f rhr ldlo\vinSdc.lar.rn,nl
<br />I hirc dd *ill fraimain a ( difi.ale olconsr lo s.ll lnsure ior $rkds' c.hp.Ndbn. as Fmridcd ror by S..lion 1700 o I Ihe
<br />I$or Code. for lh€ pslonnance ollnc No* lor shicn lh€ p6nil is isucd.
<br />IhivcrDdryillmri'ain$o'koac.ft|{nrnrionfurncc.rsrlurrdb)S&rn{lr0orlrhcl-al{r(itc,lntiepdlonnanceo,
<br />tht \1d. lor s hi.h lhis pcnnir ,s issu.t My Nork.r s' rcn1p.rsar (.n iBur&.t .aid m,l Nli., n0nrlE fl c
<br />CariB:
<br />r/tflcd'rrrh mrhepsrormanc.otrhEqn rorqh'chrhisp€rmil!ksu.rl.Ishdllnormployanypd$.ihan)nann.r
<br />$ s ro b..onEsubie! to Ihc *ortm' comlsarion la$sof( aliaomia. md a!rce rlml ill should b€(omc bj€cl tolh€
<br />$a&ss.o'nptrerionpmvisioNotscdion1700oarh.Ijbor(ode.Ish.ll.tonh\nhcomplyrithrnosp,orisiotrs
<br />W &NINC lailurc to sue \orlcE comp.n*tio! co(sa!€ is u.lstrrul. and shtll suhJ(t & oplord ro dinri..llmaki.* Mrl
<br />cnil fines up ro onc hundrdi rho@nd doll6 {3100,000), in addirion ro rhc.asr of co,np..salion. dmrecs a prorid.d for rhc
<br />{Cr
<br />DECIJAAUOS
<br />I hoeby amirn undd Fnaht ofpcrjur! lhat I tun liccns.d unds provision oiChapr6 0 (com,nocins wilh Sation ?000) ofDivisio,ll
<br />oa th. aui.s &d PmfBioNCodc, ed mylicG. is in tull forc. and cfldr
<br />i::"ii-uae dq ".",..",".* llLqy{{ f,y*roq
<br />( oNsTRU( ',fl()N t,aNDtN(i A(:UN(',Y
<br />lhc'ebv rlnln! er rsahlofrerjL'r' rhar lh6e isrcoNrndnrn l4dinsiEeN! lor rhc rEfomance ol rhe*ork lir(hi.hr,ns ttr.nm is
<br />isn'cd (scc 10q7, ( ir (')
<br />I..1,1 s NJtr.
<br />APPLICAN'I' DECTNN,\'I]ON
<br />I l6*'y .iUnn uhd$ poalry of p.rj!ry on€ of rne folntrlnr8 delearions:
<br />D.molirFn Porirs-AsbdlosNorificatioo Fql€ral R€8ulations(lillc40. Pan6)
<br />RLrtrn.d t elrd of Norifi carion
<br />I csrily thar Ihc lederalr*uhtioB regrdint Nb€stos ronovaltrc not amlicibl. ro rhG pmjd.
<br />'fr
<br />_5-,r,
<br />'n* ,*,. '*U,nh apnhcdn,n dll sralc rhhrrhe ahrc innnnarion is cotred I aEre ro c.nply \rilh all ( nvand ( oun(y
<br />nrLjlnrn.6 anll\JI.l a$s rrlanns ro hu'ld'nr (nnnn'.rn,n. ud hcreby surhorize rel'*nlarir6 otlhis Cny and counryro.md lFh rh.
<br />atx\enHlion.d propdy fttr irsp{dio. puFs6
<br />,\pplic{nl or,\gut Sign.lu ," D(
<br />e"*.r* *^"ron*t, * y')l T,,ct!evxe\*",fi!"un+
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL /2/S//4.4 Yar-)IJCertificate of Occupancy
<br />Notes, Remarks, Etc
<br />-+
<br />Erection Pads
<br />Setion 1076 oltlt€ l-abor (.od., inrerBt and.lrorncy s ls a*,..-!:J!-.-$-!1 !(I
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