|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BU!LDEII DI]LCA8,\TION
<br />I h.r.by nfllr undcr ,.mlly of pcrjury rh l nm cxcmpl fmm rlk G,ntr.tr,F Liccnse Liw lor lhc nrb$i.! &a$i'(s( 7011.5 '
<br />Busi.cs rkt Prolcsion Codc), Any Cn, or Cuumy whi.h r.quircs . Frnil lo con(ocr. 6lrdr, i.l'nivc. dcmlhh nr rcNn trny
<br />ntocrurc- 0ri( ro its i\suakc, also lcquicsrh. upplic{nl ior suchFnnilro nh, rigtud {,rc rtrr rh hcorsnc n liccn{d Purulnr
<br />b thc pmvisions orrh. Conrrncror's l-ic.nrdd lrw (Ch,fl.r 9. com,rcrcirs wilh Sc.rion 71Xx) of Divi\i.n I oi lhe Burincs and
<br />P$lcssions Codc) or rhrr h. or shd i\cxcDpr rhrrcfromMd rhc bNis forthe illcscdgcmplion A.t ri(,l,rionoaScclion 70115 hyany
<br />stpliclnr li,r d p(mir subj * rhc np0licrnr lo. civil pcMhyofrcr nnrc rhln fiec hlndrLd dollxG ($5uD
<br />-1,
<br />$ osncr oilhc pmpcay. (tr mrc'npk))tcs wirh wn3.s rs rhcir \,lc conrFnsdiof. willtlo lhc work {xl tu slnr.rm is ml
<br />inrca,lcd oroalercd trslcISc..7Ol4, ausinc$ rd ProL\\iotrs Cod. 'l hr (iikactr's t-ic.i* L1w d.cs nor optly b m o*tur of
<br />rh! rDpcny who hilds or i'nt(,v.s rhd . axl *ho d c\ sEh $.rt himscll or hcr{ll or rhrouFh hil or hcr own cmPn,yccs,
<br />pn,ridcd lhlt rrch iDrovcarnh@norinrcndlalororTcBlf$s,L.ti,ho*cw.rhchuillngoriDrlovemnri:$klsirhinoN)Er
<br />olcoi{'Lriur rh. Own.r Bxiti.r willhdk thc hudcn o, |n vr8lh.rhcorsh. r]il nol huil.l or inDtuv. rhc,nFny hr lhc,lrrxxc.f
<br />l.,sowmrorrhcpmlr y.oflcxclusivclyconrrlcrin[ *irh liccn\cd.onnRt*st, cor(rucr rhc Proicllscc 7014. Bosnc$
<br />ofll lhicsionCodc:ThcCohkn.ror'\Li.cnscLrwdocsnotapplyr' .wncrofprop.n,sh{, brildsoi i P(Nts rhcr..n.
<br />.id who conrn rs ror such lmjccls $irh r Conhcro(s ) liccnsed puslanr t, rh. cofta.ky's Liccne h$)
<br />I n11. rJ,r undd S(rtr,n Il & PC lnrrhi. r.rvn,
<br />uaxrlSllraMr[Nsa.u!)!
<br />IIECLASTI()N
<br />I hcrcbr,fllnn utrdcr,rndlryol pcijury onc oflhc ln!lowir8 dcclunrri,,nsl
<br />I hrlc and will rtuimain . Ccd ifrlrc of Con€.llo Sclr.lnsurc lor *orkcrr codp.n\dn,n. rs provirlcd lor by Ser ion 37m or rhc
<br />titxr Co{c- fi, rh! psfornskd .f rh. woik lnl whkh rhc Frni! ii tsucd
<br />Iha$r $illnri trin sorkcrs conrpcnsolion in\uromc. as rcqutcd l,y S(rkn, .l7rn of th. trboi Codc. hrIhc I[.t nun(of
<br />rhc work lbr *h,.h rhis pcrinir i\ issucd. My u ortcr' onrFnsal ion insuranc. .rricr and Flicy nunrbcr rc:
<br />Cdicr
<br />-
<br />_Erttc\
<br />I ccnifyrhrt inrhc pcrfu,tun.c ot rh. trork f(tr whi.h rhnr(nnir is nsucrl.Ishrlltrorc'nnk,yrnyIf,ry hrnynhnncr
<br />v) N!)h..otrr suhl..r k,rhc $odcrJconrr^-on i,,n l!u\ olCllili,i,rir- rtrJ rtNrlrrifl should tt otrE{rhjccllorhc
<br />$.r[en co.rlEtrr{lior pmvi\i,,n\ ofSccrnn,:]700olrhr lrlxtr Codr.ldtrll. n hwirI conrt]y wirh lhos ftr,visi,r\
<br />WARNIN(;: Frihr. k, uur. rorkc$ .onDcnrdn) .olcrr8c r\ utrhwlul. !tr \hnll \uhjc.r ::.;Hfry:x:vx,#.ivil fiics up b o c hundrcd rhousrfti dollatr iS l0o.m0). h diiionk
<br />s.!rnr.rrr76 frrh.l xhLtr (1tr1.. i'rc'cn trldIrrcr- r,r.\ct-za-tg
<br />!ECI.d.B{IIQN
<br />I hcrcby rtlnm undcr pcnllly ot Frjurr rhrr I a'n liccn{d undcr Fovision ofChrtrct 9 (Nnrmncilr8 uirh SLtrion 7(xx, ol l)ivhim l
<br />ol lhc ausiNss rnd Pofcssi(ins Codc. nnd nryli(cns is ir rulln,cc afrlcilccr
<br />)
<br />, "",", q-Z*-tg /7
<br />COISITUCIION.LENDIN;J(iINCI
<br />I hcEby al6rnun3cr trnalry orFrjurr rh lhrc irrcon(ru.rion bndiBrBcmy lor lhc pc.i..nEnc olrhc wotk ior shichrhk Fnnir n
<br />isued (Scc 3097. Ci! C.)
<br />AITLICANLIESAAAU!,IN
<br />I herc{,y ullim hdcr pciahy ofpcrjuryotrc orrlr lallosi'rs dc.lnrnrirrNl
<br />Denmlirion Pcrmirs Asbesro\ Norillctrrion r.dfinlR.s!larions (Tirlc 40, Pd6)
<br />Rcdun.d l. .ruf Norificdi,n
<br />I cdnilyrhd rlr r.dcnl rc8ul{rions eetrdin8,sb.skr r.nDvll m mt {/icablclo rhis pmicl
<br />ordi'uncc\ lnd Starc lisr rclaringro
<br />rhnc mnrt)ncd rnncny lor insFcrw'w;p"^*22"":^""':":;:;);-
<br />\r'dic,nr or.1!.nr si!trxturr
<br />Ir€mrilee Nnre (p.inl )l
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing+ol '2)
<br />I ns u latio n/E ne rgy U
<br />Drywall Ipt 'l1ltg<i
<br />"'j)Ext./lnt. Lath UI
<br />Brown Coat
<br />lvlasonry
<br />T-Bar D/4.ts\- a I t(II lri D)
<br />Handicap Re!.tI \.i \
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL 72r)
<br />Certilicate of Occupancy t t tuL
<br />Notes, Remarks, Etc.
<br />I
<br />Pool Fence
<br />{l
<br />It-
<br />tArx€r.4,
<br />=
|