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BUILDING. INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG,COMMENTS OWNI]R BUILDER DEI-CARiTION
<br />I lrrcby nfinm utotdr pcndlry or Frjury rhrr I u crcmnt lnnn rhc Contruck,r Li.cD\c Llw forthc nnb*ine rclson (Ss'70315
<br />Busincss lnd PRnissioD Codc): Any Ciry or Counry whi.h rcqnn$ u p$nir to con{flct, rkci, i'npi{Nr. dc dhh .r mnitr Jny
<br />{tuc'@. prior ro irs nsulmc. rlso rclutc\ rhc aflrlicnnl for .u.n Frmil 'o
<br />fic a siBrcd sr cmtrr rh0r hc or shc n lic.trrd pursuanr
<br />lo rhc nri,vnions oi rh. Cont..tn s Liccnsd tjw (Chaptcr 9, Commncin8 wirh S..!nrn 7ffx) or DivGn,n.] ofrh. Aurin.\r and
<br />Pohsn,ns Codc)or rhrr tE.r snc h cicnrpl rh.rcrronr rnd lnc hosis n)r Ihc all.ecd cxcnrrlion AfyriolnrionolSccrionT0.ll5 b, any
<br />.nflicrnr I'or rlcrnrir subjN* rh. nftlicanrtracivilpcnalryolndr'frtr.rhr.fiv.hundr.ddolla*lS5lX)
<br />l. tr\ owE oi lh. popcrlr- or my emplorlcs * iih wrscs is rhcir solc conD.N.rion. I ill do lhc wolk 0fr1 llE iutuE n nor
<br />nc*lcJ.rolIcrdfu$lc(Srt7O{4,Businc\sandrt{rbssn,nsCfttcThcGnracroi\l-i.ensclj$d{x\noiapllybuo}ncrol
<br />rhcpn)!cn,shol,Likl\ornnprorsrhcrcon.rnd$h{)(|,f,\such$orihi,nsclfo'lrcrclf.rrnnrehhkorh.rosnc,rloyccs,
<br />providcd rhai slch in{rovcrL-nh irc nor inrcx6 or ofls!'d f(r rlc. Il ho$crr. rh. huildi.8 or impntrtnrnt is sJkl wirhin om }ra
<br />.l.onfhrnnr, rhc ostrcr Builld sillhf,t rhc hrrdcn olnmvins rh{ hc or sh. did mr blild or itrll,nrc rhc rmpoly Lr rlr pu.Frs ol
<br />-1.
<br />aso$ncrofrttr I,opcn]. rmcx.lusivclycontracrir! wirh liccnscd.ontrrckrs ro.onnrud rhc pmAr lScc.7(,14. Ausinc$
<br />mtl l\trtsiotr C.dc ThcCotrta.roasLi.cn*cLawdo.snorDpplyt,riownrofpn'Jrnywhobuildsornnptuvcslh.rcon.
<br />ud who conrrucrs lor such pnjcts Birh a Conh.b(, li.cnscd pununl rorhcConr&'ois Liccnsc Lrw)
<br />-l
<br />rncxcmpluMcr Scclion-, B & PC f(r rhN 'cavrr
<br />talr: Ovn€r:
<br />woRxnRs' (i)MPrNsA? rani
<br />DIIIAtrAIION
<br />I hcrct'y umrn utrdcr !.n!lry ol pqjury onc ofthc rolhsin! d.cle0(nnrs
<br />I h,v. md will'torinhii r C.nit].crc otConscnr 1,, Scllln{,c rbl $orkcn .onucnslrtrn..! pmrided [n hys.rrion:r?([olrhc
<br />lrEn aic.lorlhc|crfonnrnccoirh. work lbruhich rhc pcrn r is irsucd
<br />F'r,iri.i..d.nM)q,rt-'.,,,n'frr\r'.rt1.u'rlcd.Jnic'r,,i|..lic\nutr.hc' c
<br />G- f ,ft. FunolSl"t,tv*-
<br />\*,1l't boBi - L<r rj It e,
<br />I c.niry rhrr in ih. pcrronnancc ollhc work ntr $hich lhn !crnrir n i$ucd. I \hall no' cmpl,'y!ny pcron in rfy nruNr
<br />vi ns lo b.cotrE \ubjccr rorhcwtrkc .omlctrurion lnq\ol Crlilon,ir. rnd +to.ihd iflsh,rld hccotu suhr..rr,rhc
<br />*oAcn ..nrFn\lriotr rtuv(i.ns of Sccrnrn :lTl ofrhc Lfttr Axlc.l \hill. ronhwirhcon$lywirhrho{pR,vi\nnr\
<br />\VARNIN(;: Fiilurc h {curc workcr conDrnsnrion covcnrrc is utrliwrirl. r shrll $hjccr ur ulro}s ro crimi.rlt^-Drhic\ md
<br />.ivil fitr.\!pk,othu rcd rnousrnd dolhrs lsllx).(x)o). h ddilnnr lo thc.osl ol coml{nsalnnr. dtnrgcs r\ pmvnlcd t{t lhu
<br />sl!ri,,n]076ollhc Llhn C, c. inrcrc{ a a orrc
<br />\,,"L -l-t^nuot*,.C]t'l!C. tt4t-T N roJtl
<br />tllIjISUl-lANIB,!(-rAA
<br />DIiCL\&1lIUN
<br />R:"sf zt-1 r<,."^*.,,, (mc (ta' Cc*l-t. Tnc .
<br />qONEIAI]CU!]NIENDINGJIiENCI
<br />I hcEbyotfiimu crncmlr,olr.rjuryth.lrhqct.ronnrudi.nh inAr8cmylorrlEpcrformoccofrhcworiforwhichrhhlc.nrilis
<br />nsucd (s( ls)?. civ c.)
<br />ATELICANLIEIITIBA.IION
<br />I llnby dnm undcr pctrrll) oltxrjuryotr. orrhc lirlk,wing ddchdrnrn\
<br />D.fl,lirbn P.rmirrAstrios Norifi.rrion fcd.r,l RclllatioN lTillc 10. Pl.la,
<br />Rcquircd Lcu$.aNoriar.arion
<br />_l ccrriiyrhlrrhc lcdc,ll rcsuhriim rcB0dins ashc(osrcnbv arc nor ar ic$lcro rhh pmicr
<br />fi..trtt f?5 ;r
<br />asN k,.o6PI, wirh allcnynnd counry
<br />i!c\ ofrhh Cny ond Counry r. cnr6 !fl,n rlr
<br />,.," {f zuf tr,,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loori VenVlnsulation
<br />Roof Sheathinq
<br />Framinq
<br />I nsu Iation/En ergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cefiif
<br />FINAL
<br />Certificate of Occu nc
<br />Notes Remarks Etc.
<br />,,
<br />Shear Wall
<br />Ihcrbroffi,nundcrp.Mlrtofr.dury(hr(Imrlic..$dutldrnmvisioh.lChrtrn9(..nnhh.i'1gwirhS..riotr?(XX))ofDivhi.n.l
<br />.r rhr Busincs and Prorcsions Gdq d n', liccnsc is in lull ntre ofrt crt(r
<br />1oo117
<br />o tui..s xLSrr{c l.rss rulrns k,
<br />I
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