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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS oWNER BUILDER DELCARATION
<br />I hc.c$y aftfl undcr t ndry i,f p.ilury rhd I m cxcmfr from rhc Conrnckn Li.cns kw lor lhc follosio8 ..4$n (s..7011 5
<br />BusnNr (xl Prolcssi,r Codc) Any Ciry or Coury which rcquits 0 Fanil io con{rucr. olrcr- nnptuvc. thnrolhh nr E|]in rny
<br />nruclurc. orto ils nsoancc. also t qond{ Ihc.pplicim ror su.h Pciinil lo nh s sisncd sh.mnt rhd fuor shc i\ liccnscd nrrrinr
<br />ro rh. pmvisions orrtk Con[a.lois l-iccn\cd Law (Chrrro 9. Conmcnc,n-P silh Seclion 7fin.r Division 1of lhe Ausirtc$ !trd
<br />Pn,fcasions Codc) or lhir hc or shc i\ crcnrpr rh.6rn,m rnd rh- hnsk lor rhe allcscd cicmprion Anyviol ionolSccri{,n70:ll5hydny
<br />appliLrnr(,rFrmnsrhjcchrhcamlicanlloacivillctrlllyolnormncrhanfivchu.dtdd.ll$(t5OO)
<br />-l-
<br />!s o*rcr otrhc pmp.nt, or ry cnlpbrr.s with MScs as lhcn sh c.n, istri.n. eilldo lhc sork and rhc {odm i\ nut
<br />inrc' lrl oroff.rcd r{tr elc (Sr 701-1. Busims ond frof.ssiuF C{}d.r Thcc.nt0 otsLkcn\cl,!wd{E\nol,pllyr.inoNncrol
<br />th. tmlIny who irilds or inp(nBrlrrsh. arkt wha dds \sh s* hinscll'or hccclfor rhn,uah his o. h.r owtr enrPloytcs.
<br />prt,rnhd rhrr such nnpmEnrnrs ec mr inrcnd.d or olToxd ri,r slc. Il howcE . rhc tflildin8 or in{,nrcfttrr is srkl wirhm om )ls
<br />ol con{lciion, rhc O*n r BuilC.r will h{rc rlrc tdrdc. .l pmvins rhd h. .i shc drl mr huild or iqnow rhc Pn,Fiy fot lhc turDoE .l
<br />L dsowncrolrhcfioDcny. amqclusivclyconrdcrins *irI li.cnsdconrrncroFro.on(fl.r rh. lojLtr (Sa ?044. Bt\ims
<br />, l\.tlshnCoJc: lhcContmror'sLi.ctrscL.$docsnollpnlybmown(ofproFrlyuh.buildrornrytravcsrhcrcon-
<br />nnd who conrRcts lor such !nir( (irh r G,nh.nrnr) li.cn\.{ punulnl lo rhc Contn.trn'\ Ltcnrc t w)
<br />lrncrcm uMcrSc.lion
<br />I hc(by trfllnnundq En$lryolFrjuryotu olrhd follo*irA d..l0arions
<br />I cediiylh.t ir rhc pcrlorrokcofrhc w.r* forwhi(hrhi\ ncirrit is i\st.d,I \hrll n.t .trD|,)y rny Pcron inrnrmMmr
<br />q, ns t, h..r'ft subjc.( Io rhc $frkcr ompcnsarion lass o{Crlifomir. and Urcc thir ifl sln,lld h..onc suhJccl ro rhc
<br />*.rkc^' conpcnurn,n [ovhions oi Scclior .]7(x) of lhc l-rh, ad., l \hrll. fonhwirh confll sirh r h sfr.vision\
<br />w,lRNlNc: I,rilurc i, $ctrr Ro'kcr! .o pcns (r
<br />civil fircs up n) .trc hunnrd rhorqid dollrn (Sl(X
<br />Sc.rtrnr 1076 ollh.lrtxtr G{tc- inrrrdn nid rnoaty'\
<br />l. rid nrall suhjccr rr cnpl.y.r b cri'ni' l tf,inlri.\ Jnl
<br />rhr."{ dlonllcN. }n. drtrrlc\ r. rm!'d!d hr rh(
<br />I I'rruh!rlir utulc' t,.trrlr!ol r,.rjrtryrhrr lxr ll.cDrl lcrp'ovnrriolClrrincr'rlconn,(mi',!* hSc.riorl(xx))ol I)ivi\irr:l
<br />ot rhc Businc$ and Pror.$ionsCodc. ud,nylicensc is iI
<br />l-i.cric Nunh(r:
<br />COXiISUEIX}IiIENDI G. iENII
<br />t hcicby lllin undcr peulry ol pcrjury that rhm is a con(ructi('n lcndins usun.y rot lhc l)crform0ne orrhc *otr 6r Phich thk rnnil n
<br />issucd (S.r.1097. ( iv (')
<br />AEILICANLDELLABAIIAN
<br />I h.nby rninn nndcr Fcnslly.fpcrjnyorc.rrh. r.llo*ir8 dcchrrrion\:
<br />D. i,liiidr P$nrils- shc{os Norincarn,n FcdeBl RcPUlItrn\ (Tnlc,10. Pan6r
<br />Rcqurcd Lrr.r of Nolifra'krn
<br />I.cn y rhdr I hlr. rcad rl-F,nrlrrri,.n and {a!c tJr thc ah'vc,nrornD!tuo
<br />nrJ'rrfr.c\ arkl srdc L1* s mlar ins ro huild'ir .oNrrfi nn. 0nd hcrchPUr6r vc
<br />rh^. mnu kd.m*nt f.r hsKtruuNE/
<br />^'*,i."" - ^,,''-*.-l 4)245
<br />PE rh.e*d.(Drrnr': ( '' --Z-,-
<br />ir c.A.r lietrr i, on'nly tr irh rllCi'r rnd Counr\
<br />rcflr{cnr trcr nl rl'r C y zn,t Ci',ir} rn.nrcr uF,n rhc
<br />z _/d
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />llq\ t8 .<,t(l(rqt
<br />Certiticate ol Occupancy )
<br />Notes, Remarks, Etc
<br />DATE
<br />Pool Fence
<br />Flood Zone Certif .
<br />FINAL
<br />I hdlc dwillmrirhin0CcnifEarcofConscnrroSeltl6urerorworkn'do,nPcnsdion,dslRrvidcdlorbySccrionlT00orrhc
<br />Irbor Codc, id rh. lclformiroc olrhc sork for $ich rhc Frdir is hsucd
<br />I havc and will minrain $orke6' conn nsarion inrurdtu c, as rcqDird hy S(r ioi 3700 of thc L.hor Codc. aor rh. l.rronm cc ol
<br />rhc uork for shich lnis pqnir ii hsu.d My wo.ksC conlcnsario. insurucc Ladi$.nd lBlicy numb.r 6c
<br />Liccn\cClos:-
<br />Drl.:
<br />-l.cnllirhai
<br />rhc rcdcrnlrc8uhibnsfrsrrdirsrshc(o\ rcrxrrldd troliftl.nhl. ro rhnf(Id
<br />f- -r
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