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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BUILD[N DEI-CARAT!oN
<br />I hcrchy iniirn undcr pcnalry t,r pcriury ibI I tun cx.npr iror lhc Contr.rod t-i.cnsc lrw lo. rhe tullowin8 r.n$n (Sc.7031 5
<br />l,usircs inl Porc\\ion Cdr): Any Cily.r Counry qhich rcquircs a Fnnir ro co.nru.r. aller inrti(,r. &mlhn or rclrn uv
<br />d .rurc, flnrtu irs is\uMcc. sho rcquirc\ rh.lpplicanr ld su.h!.nnir t. ile! \tncd (ar.'Ed rhd hcorshc i\ lic.nscd PUNUnnl
<br />h rhc pdvnt,n\ ol rhc C.trracroir l-icensEn li* (Chrpr.r 9. Cdm rrcirr! wirh Sc.rnnr 7Ux) of Divkion :] ol rhc Btr\ii.( xl
<br />Pn,icshnsCodc)orrhlr heor\hc iscxcmpr rlrrcton.nd lhc hosis lbt rhc rllcCcd crcn{rion Anyvi,'lark,nofSNlionTO.ll5hvrnv
<br />llPpli.anrfu l}.nnir\ubjccBlhcrprlicanlloacililIcnrhrorior'frtrcthrtrfivchuldrcddoll, ($500)
<br />l. as owNr ol rhc I)mrEay, or ny cmoloyNs wilh wts.s $ lh.t $,c conpcnsarion, qill do rhc w{,r( and rrr nMurc n nol
<br />ifllculed or oflcrcd n, slc (sN.7o44, Busircss .nd Pmtcssions C.xl. Th. conttcrols Licctrc ljw dtur nor arPly ro o oNner or
<br />rh.Fn,ltr, whr brilds or iqnoves rte@n, d {ho des su.h sort hin$.lf or hcnc}f or rh6u8h his o. h.. owo cnployes.
<br />provnhd lhal such ii{,rukm.rs m mr dcndcd d oficEn lor eh lt how.v.r. rhc l[ildin8 or imPmlctu is $ld *irhin "m F{
<br />of.oqrLrirn, Ih. Owncr ltuillcr *ill hi!. rtr hndd of prcvin8 lhd hc o! shc dA d, hoilil or i,r{mrc rhc PDFiy aor th. Puqns of
<br />l, \ o*Nr ol rh. F,rEny. an cxclus ivcly co.traclins wirh licctr{d co tr.ro^ t) (onnrucl lrE ,nojdr ( S.c 7(!'1. Bunrcs
<br />and lt'lcs\i,r codc lhc ConrRcrois l.iccnsc t-aw dtrs n rrttlyto !trowtrcrolIn)I'. ywho builds.r iml(Nts rh$con
<br />rtrd Rho cotrrmcrs l'or \uch pmJcch wirh n Conrtu t'(n Lctrscd |Umulnr ro rhc G,nhcnn\ l,iceNc lis).
<br />I r rcxctrrt, uftlcr S(tion-. B. & P.C. lorlhh rcr$n
<br />uoBfliaj|loutllNliaflQNDlll;lllS rlo[
<br />I hcrchy n,lirn unicr pcMlrr.rrcrjury otrc ollhc hlhwi.s dlclaBrions:
<br />lhrlcml*illmointiin!(tdificqlcofCoose roSelfln\rref.rworkqs.onD!n\aii,nr,d\ Brvidcd lir I'yScction lT0Oofrhc
<br />lrtxrr Cod.. tur rhc pdfoflMncc of rhc wo.l l'or*hichrhc psmir is nsucd.
<br />I lmvc rtrd *illmiint.in wo,kcrs com!.ns,ti,rn Nur.n c. trs rcqu Sc.rii :l7l()ol rh.l160rCoJ., rn rhc pcrlnnnan.c.l
<br />.r'rr kl,r,li.ynunrbrr rrc:rhc sork hr qhi.h lhis pcnnil i\ i$mJ [ry wotk.i( .ompctrsrt
<br />l.cniryrhnrrrhcFrlormarccoirh.trorkfor$hi.hrhisNnirisissucn.IrhrlliorcPbtrnyPcroninrnyn'anncr
<br />$NioI$onEsuhFrlorhektrkc.o'qr.sarionl.srofcnlir'otni!.utol+r.trlrrlfI\houldtEcom\ubidIoth.
<br />workcrs onDcnsrrion nFvnion\ utSc.d 1700 ofrhc bbot Cqlc- I \irll. n,htrirh sarPly wirh tlDs Pn,lnioN.
<br />\!ARNIN(: I:rilurc b *_curc qorkcs c.nlrnsalion c ir onhwtul, ind sh.ll \lbirr !n.mploycr h oiminllJ*tuhi\ and
<br />.ivil li r\ up ro ono huiJRd rhotr$trd d.llirs (ll in ldird! t, rhc con oi compcn\arn r, dinu8cs !\ pnNid.d n rhc
<br />Scrion ]076 of rhc Lah, f'odc, imctcsl and
<br />IIECLASAfIO!
<br />I hcrcbyul,lrNundcrr.nahyofpcrjurylhol I nn liccnsdlndcr pnlisn ol Chrucr 9 (connurcins wirh scdion 70Gl) of Divtnrn ll
<br />of rhc lrusincssond Pofc*n,ns Cod.,3rn nry liccnsc is intllll'olcc dcfl.d.
<br />7 6,/9,/2
<br />I hcruhyrfinntr dcr,rtrlltyolp.rjurythlr rhr.c ir rconntudi,,t hidiISrecn y lor lhc ncrlornuicc.lrh. sork li).rhichrhh t)cnni n
<br />issucd (Scc 1097.Ci! C )
<br />ATSUCANLDECI.AEAII!}N
<br />I rmh, nmnn undcr [lLnlh y or p.rjury oft or rh. rollowi.g delarnl ions
<br />D.nDlirion Pcrnir!Ashc(os Noriicarion FL\dcBl Rclul.rions (Titlc 40. Paao)
<br />Rcquircd Lcucr oa NorifEarion
<br />I.cnifyrhrr rhc Ldcralrc8rldi()n\ rcAarding trsh.n.\rcm)v l rc tr riPPli.ihlc ro lInr(tcr
<br />lccnibrharlhnvc rcrd rhirlprli.ahondt narc lllal rhc.hovc irl(trnBrntr' n.onccr lrArerocomPltwirhallCirvrDdCourlv
<br />or'rirrtr.c\ {nn Sr)( l.rw!rulrr !n)
<br />xh,vc nrtrri{nul Dr,!r'1y tur irsllccl
<br />ildine conslfl.tion. ffn ncrchyiurh{,nc E r.r6iiri*.+
<br />'hh
<br />Cily stul Cou.iy ro cnler ulon lhc
<br /> DDlirnnl or /1grDl Sirnrluru / -..- T
<br />1/zt/r<
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />^\\Framinq / 0-t-t Y \rj4-r6)
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\4aso nry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />A
<br />FINAL t0-21-l K x)4fi4
<br />Certilicate of Occupancv
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />",,"- 9f4//"
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