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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenVl nsulation <br />Shear Wall <br />lnsulation/Ene <br />tlD <br />Brown Coat <br />Mason <br />Pool Fence <br />T-Bar <br />Re <br />rtEnineer Final Re <br />Flood Zone Certif <br />FINAL <br />Certificate of Occu n <br />Notes Remarks Etc <br />()\r \t.ti Bl ll r)[R t)l I ( \R.\tl():lI hr€by a[r,n undd psslly ol r€rjury dlal I m cr€,npr nom lhe coirado^ l-ic.ns. Law for ihc aolto$ins rcNn (Sec 70.] t 5 <br />uusinBs dd Prol6io. Codc): Any Ciry or County {hich r&loir6 a pani ro construcr, rn6. nrprove. dsnolish o. rerEn dy <br />shrdurc. prn lo iis issue.c, d& reluir6 ttc rpplicar for such pernn ro 6lc a sisn.d staronmi that h. or shc b lic.N.d puEumr <br />ro rhe pblisioN ol0r Contractoi3 t-ic€ns.d Law (Chaprcr 9. Commocins with SErion ?ool] orDivision I otrh. B6m6s md <br />l'rcfcsions cod.) o! that h. o. sh. i! .xedpr rhscEom rd rhc basis for th. atl.!.d .roption Any vi.larion otsrthn 701t 5 by any <br />appli.a.l lor a pmir suhrds the aprli.e o a civil p."any df nor nore rho tiv. hundr.d doles (t500). <br />l. s o\v"r of th€ pmp.ny, o. my inployG snh w,r6 d lheir $tc coDp..sdion. wil do ric wor! ed rh. srndm s noti dd.d o! o fided ror eL (Se 7044. Bcin6s dd Prolsions Cod. Th€ Conlr.clDr's l-icc6c L.w do6 nor appty lo e o\rn6 of <br />rhe lropcly \ h. hrilds or improrB thd6E drd who do6 such wod himsetaor h€rtf or throuSh his or hcr o\q cmployc. <br />p.ovid.d rhrr such improvmts d. ool ir od.d or olfdej tor sk. r[ ho$6,a. thc buiBin8 or inFovaftnr t $td Nirhin on. ]@ofompktio.. rhc (rro Builds will hiv. lh€ hrdd oalrovinr rhd he or slp did @t huitd or improv. $. popdy tor rh. purpo& oa <br />-1.6own.r <br />oathc prep€ly. sb.r.[snrlycontradin8 wnh c.ns.d contr.clors to con$tucr th. prejd (Sa. 7044. BG,n*dd I'ilEsion Codcr Th. Cont,.ror's Lice.se Law do6 nor atplyro m os,n6 olprop€ny who 6uirds o, imp,ov6 rh(6tr,and who conrr&ts tor such lroj<rs $nh a CofltBdo(s) liccfls.d ptruMl lo rh. Co.lracrors Licmk rjs) <br />-" +?(q -B <br />IICIA.BA:IIOT <br />I hde6y afinn und€r p6ahyolrsjuryoncolth. lollownrs d{tdario6: <br />-Ihal€adsillminlaioaCerlifi.at.olconsdlloSclilns,tr.lorworl.rscon'p€nsalion,rsproli.lcdtorbySdionI.TOOofrh.tibo. Codc, tu th€ po{ome.c ollhc nort for stich rh. ldnir is tsued <br />_lhav€andwillmaimainwo.rs'conp.roarioninsumnce.srcqutrcdbyS€tion1700ofrhcbbd.Code.forlhcp6tomM..oa <br />th. rvork for $ hich lhis p.mi b i$ued. My qorkds' compdion isurtucc c6is rd poti.t .umbs dc: <br />-l <br />ccnirylh.t in rhc pdrorinsnc.oarhc Nork lor which <br />'hk tmil is issur{. I shaltnor .mttoy any p6on in any rnMncrs a u b€comc suhler lo the workrJ compNrion laws otcatifomi., dd Acd rhar it I should b..of,. subid lo rhe$^ oL,nmrNrionpro\tsn,6,,tStrhonr?O0,,,rhcLborrod..tshr .f,,nhNlh.ornptt{rrt,ro*pn..",o^ <br />WARNING: Failur€ Io scue wort6' .oBp.nsarion .orerdre i5 untastut. .nd shatt strbjer u onptorE io dimin,l pdatriG udcnil ntrcs u! ro on. hundred lnotrsed d.ll6 (tloo.L{ti),p.n{L.n, dmaBes 6 proideJ ior rh€ <br />seln n 1076 of rhe Lah,r Cod.. inlq6r ,ld .]rom.r's <br />I hqeby artrm undd poahy o l psjury rhar I an ti.€n$n uod.r prori\ion ofctnplg o (com,n .ci.! w h S€rion 7000) of Dirisio. lof thc Busi.6 ed PBfsioN Cod., rnd 6y licc is i. lu tt tu(e snd eil6r <br />LiccM Cl6s:_Licc6. Numbd <br />D.r. Co r.ctor: <br />coNs'rRuc'noN LFTtDING AcFr\cv <br />I kr.b, aJtm undd p.n.ky ol pcdu.y thal lhe i! a coctru.iion kndinS almLy aor thc prtonmc. otrh. *o.k aor srich rhis Fnril is <br />i$u.d (S( 1097. Ci!. C.). <br />A'PI IC{NT DF( LARN ION <br />I lEd,, afm undd pdally olpgjury one of rlE aollowins ddled io.s <br />o.molirion Pnnirs- sberos Nolification F.iaal Rerut.tiom (Tnl. 40. pan6) <br />-Rc{uted <br />trtre o t Nolfcation <br />-l <br />.dliay rhar dre f.d6al r.luhr ns rcr dins stcbs removat . nor appti.r6tc ro lhis pmj€d. <br />Icdiryrharrh.vcrcadlhsapplicarionandsrarerharrhc.Urveinlonnaln,nN(or4r r c.-pllrYnh\n Ciiy and Cotrnrl <br />his Cily md ('ountyto drd uFn rhcordinanc€s md Sr.re tAs eldinS I <br />rbo\e mdrioncrl rroNny lor <br />Applicntrt or A[cnr SiAral -( <br />Fn. d n.r.b, adhonz! rcpr6 t.tiv6olr <br />4tr' <br />Roof Sheathinq <br />Framinq <br />Ext./lnt. Lath <br />Handicap <br />Deputy Final Report <br />/ <br />PolicyNunbd: Epircs _ <br />n",- lt44 -( I <br />Leid.as Ad&e _