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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNI]R IIUIT,DFJR DELCARA'NON
<br />I hcrcby rltun uid.r Fmlry of pcrjury rlrar I m cxc.lPr Ii!,n rlt ConLd,r6 Licctr\c l-a* ror rh. roll.wirrg rcastr (scc.7{r11.5
<br />Busircs and tronsio. Codc): Atry Cily o. Counry Ehi.h rcquircs a lrnir k, cotr{ru.r. ,lrcr. mfmvc. dcmohh or Nlrlt rn,
<br />dnktrc. riorb irs isur.cc. sl{, rdquncs rhc {dicrnr in N'ch p."dr n) filc, sr8trcd natm rhnr hcor\hc i\ li.cn{d furluMr
<br />lo rhc pmvisions oi rhc Cotrlradols Licen*.| ljw (ChoDIcr q, Conrmcncin8 wirh sccrn,n 7m0 d Divi\iotr :l ol'(hc llu\i'rds rnd
<br />PR,ri\sionsCodc)orrhl hcorshc t crcmpr rhcEfrona rhc bris fu rhd illc8cd cxcnrllion Anyvt)lsrt,nofs..rio 70Jl 5hy.n!
<br />alpli..trr lorr l.nnir subj..rs rhc {plicrtrl h r.ivil!.trrlryoln.rnorlhin ti'r hundrcd dolll (S5m)
<br />-1.
<br />!s oomrol rhcl,x)!cny. or ryc rlk,yccs wirhw,!.\ as rlrir $ lc .otrlpcnsarion. willdo lhc*ortudrtriMm n mr
<br />, cidcd or.ff.rcd tu \alc lSd.7O14, Busircss rtrd Pmfcss.trs Codc: ric Contrackr\ l-tci{ tjw dcs tror rt,Irly ro an owncr ol
<br />ihcnmpcny sho iDilds or imlr.Ks rhcmn. dd sho dms skh wo hiD\.lforhc^cll'orrhroulhhirorhcrowtrcmployccs.
<br />providcd rlui such impiovu'mms m nor mrc.dcd or oncnl ld srlc li howvcr. rhe buiktins M i'nFov.nEnr is stl wilhin E lcd
<br />ofcomptrion. rh. own$ Buildu will turc lh. brr dcn ol pmvinS lhd hcorsltr rlid 0or buill or nnrmh ihc pmtdy r'or rhc purporc ol
<br />L isowturorrhc pr.l.ny. dnrcxclusivcrycoDridir8 wnh lic..scd conlrrtnr b..nntu.r rhc ptujc.r (ss. 70,14- Bu\incs
<br />and ltnli.sionCodc:lhcConl,aclorsLiccn\ct-!wdncsnoiaptlykrrn.s.norpt{'pcnywhobuildsnrin,f(,vcsrhcrcotr.
<br />and who.onka.rsr$su.hpmjccrsithrConhcto(s)lianrnpurulnllorhcConlrrcllr'sLic.nttjs)
<br />I d .xc rrr u dcr SL\ri.
<br />I h.rchyrllirNUndcr pcmlryolpcrjuryoncotlhclollo$ins dslnralions:
<br />I hnv. Md will nnri, rir ic.nificnrcoiconsc roSclllln\urclir$orlcrrconllc\rrior.a(nrovidcdinhySalion]7(x)olrhc
<br />Llltr CoiL. ftr Ihc pdrrontun...frh. *Drk lo whi.h rhc pdNr is isucd
<br />I lrvc rnd sill nmflrir sorkcrs .onrpcnsrrbn iNuroNc. rs rcquircd hySccin l?0O.frhc tjhor Codc.lilr rhc t'crlomrn.e of
<br />rlr qork lor whn'h rhisncanir is hsucd. Myworlcm cotrrpcnsurion iNulanc. caFicr Md Ini.y nun$cr c:
<br />-l
<br />ccn,fy rlu ih rh. ncrfoirMh--c ol rhc wolk for which rhh fc nir is hsucd. I shrll tror ctrDk,t .n, lxron nr lny m Dcr
<br />v, rs ro tEco'E subjccr () rItr workcs conrtcnsalion llqs ofc,hforni.. ond asrcc rhrr ir I rhoold tf,cotu \uhi.r ro rlE
<br />{orkc^ .onrlcns im pnvjsions of Sdion :lT0o ol rhc ljt-r Codc.l \hnll. rodhsirh.o'npry *irh thos Uovisions
<br />WARNING F,ilurc ro scurc *orkcn compctrs.tion .ovcBsc is nnlrwlirl. and shrll sohjccr nn .mployct ro ri,nirdl pcnrhics on
<br />.ivil nnc\ up k, onc hundrcd rhrusand dollan (SltD.lxl0). in addition ro rhc co( olcohp.n\ nrn, d,mScs.s rrovidcd tu lhc
<br />\,lrq rr'?.,.r tn. Lt-rG{.. rnrcrc! JrdlnoirE} L rc.. A ,D.,.: no,,*",, Y\.1&,/([c&;&i:L,
<br />r xtNsF'rr,cdllTRAc, OR - a-pFdt-ti{^TroN
<br />I horhy lnlrn !od.r pcoahy or p.rrury llur I .m lian$d undft t$!i(ion ofChuplcr 9 (comrurcins wirh Scdhn 7m0l olDivhiotr 3
<br />of lhc Busincssand Pmlcssions Codc. und ny ltcnsc is inlirllrirrcc !rcar..r
<br />COIIII.UEI,&NIENDING]I(iINCI
<br />Ihcrchy firn undcr FnalryotFrjrryrh3r r)trc i\ r conntucrn,n bnding a8cncy tur rhc J[rloflru rcc oilhc *ork inr qhirh rhn |tnnn s
<br />issucd (Scc.3097, Civ. C.)
<br />AITIIIANI.IIESAAAIION
<br />I lf,r.hy li!'!undcr ncnrlry ofptrjury oic ofrhc finhui"e dc.lrnx.n\:
<br />Itmolilion Pcrmih Asbcnos Norificarbn F.dcrulR.guhrn,ns (Tirlc 40. P n6)
<br />I{eqrtcd I crrr., Norilicr.on
<br />! enifyrharrh.lctlcralrceul{rions regtrdinBasbcstosrclnov!1lrc nor aplli.ahlc b rhi\ pml.ci
<br />lccnifyrh3r llhlr..ld rhnrplli.urii rfrl ![c rhd rhc rtxr c innn d i( i\ .onc.r. I rgrN ri dnnply *ilh al] Ciry rnd c()!rr!
<br />ordinxncc\ rnd Sllrc ltrrws rchiing ro hrikl,trg conntu.riinr. r'xlh.rchyrurt{trrc rcprc$nr.rivcs r)irhis Ciry and Counrl h cnr$ uBr r)rx:xw
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation t
<br />Roof Sheathinq il lallD,,/41 nlfluy nr"
<br />Shear Wall 'tlut'v
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL /t-tsJ{,
<br />Certificate of Occupancy
<br />No les,, Bemarks, Etc.
<br />//t)
<br />Lxndci\ Addrc$
<br />T-Bar
<br />'z/D1C
<br />'i-?Ar \ , a) /-*/2"r-z/-
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