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BUILDING. INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDi]N DELCA&ATION <br />I henhy amrm undf lcnrlry of pcljury rh0r I m crcmlr frorn lhc ConrHckm Li..n{ liw rb. rhc iollosina r.rsn (sc.7011.5 ' <br />Busin.\s and Piolcssion code) Any Cir, or Counry *hicn rcqunc$ Fmir ro connml. ollcl imPmvc, d.nknhh or rcBn y <br />sru.rua. prhr ro ns issuancc. ils lcquireslhc dpplicanr for \uchFnhir to lilc a sisned sltlcmn rharhco.shc n liccnscn plr anr <br />ro rhc provhion\ ofrhc Conkr.lors Lic.trscd tnw (Ch.rlcr 9, Comnrcncnrs wirh sccri Tu)O of Division.l or'hc Btrsincs ,trd <br />Pn,fc\\ions Codc) or thd h.orshc ncrc rplrhcrclronand lhc hrsi\ forrhcdllc8cdcrcnllllion Anyviolart,nofScdionT0:11 5hy!ny <br />lnDlicont lora pcflnil suhjd\rht aptli.itrr ro a.ivilFn,hyorn( nF.dhan fivc hundrcd dollnn (S5fi)) <br />l. n o*rcr ol lhc proncn y- .r nry crylo)tc\ silh wrr.s trs {hcir dc .onrFns ion. will d. rhc ktrk tl Ih. slnEtuE i\ nor <br />inr.nk or olta.cd tor sk ( sd 70,14. Buiir.* rnd PmlcsJbn. Conc Thc Co tactn \ l-icctr{ t-.w des not 0pplv b M o*ncr or <br />rhclfi)tEny sh huilds o. irq8Ns ltrrmn. snd who rlms \kh tr n hnnsclf.rhc6cltorrhmulhhkorh$.-ncn[loyccs <br />p'orilcd rhrr su.h nllrmenrnr arc nor iDrcnderl or dw for {tr lt tuftvr. rtE build ill3 .r imPrnwnr n$t]Fihir.m]sr <br />ofcorylcrhn- rtrO*ner Boildcr will hrw rhc burd$ ol pruving rtul lE or shc rlil nor huiu.r inPrcrc lhc PDPcny for rhc rutli$ ol <br />,. \ o*Rr or rhL tr()dy. i r cx.tu\nlly conlra.r ins + irh li.cnscJ .oit&kn s r. c.n(rucr I hc pmiccr (sK 7o'r'l 8nnN\\ <br />rnd Pn)hsanrCodc'lhcCo.e,ctr'rl-i.ctrsct.trwdo.\noi.p!lylontro*ncroipn,F-nywhobuikkorimlrovc\rhcrcon. <br />rtrd kh..otr.rshnrhrtro]cds$ilhrConlmcro(\)liccnscdpur\rinrbrrrcuDrrtn\t,kctrsLrt) <br />I rn crcn,pr rndcr Ssrion tl & l'{ lnrrhi\ rcr\ni <br />w(IRXFIS, (:()NtPFNSA tION <br />DECIA.IAIIA! <br />I hcrch,rlfir undfi p.nnllyolNrjuryoE.llhchl[,sins cchrrrnnN <br />-l <br />hnlc aJxl sillminrain, CcdifErlc oiCon*nr ro Sell lnsurc fir workrr L .o nr!.nsal nnr. $ lmvided lor bt sc.lion l70o ofrhe <br />lzhorGxlc, rorrhcpdrormkcof rhc*ork for whth lhc Frmil i\ ksucd <br />$hi.h rhis p(n,ir n i\sd.d Myau ..nlrnr i({ iNurxNc raricr ,trxl [)li.y Nmhcr ir. <br />ftn Q."1- \-r 3 <br />I ccnify rhrr in th. Nrlormrncc oflhc sork ior shich rhh pcrnri i\ is\u&t. I \hall nor cnrnloy Jny Pc^.n iD 0fy nrnmr <br />$ N tr) hcconr subl.d lo lhc a.rkcs .omFn\dn,n l.w\ oiCrlintrnii. atu u8rcc rhrr ifl .hoxld h...m nrbiccl lo rhc <br />roik.n' comtcnvn ion pDrisnrn\ of s.cr ion l Tfil of rhc Lrtrtr Gic. l shrll. ni hsirh co Dly Rtrh llF{ nolnnrns <br />TVARNII\iG failuE b Ku. trlxk ri conecnsarion corsa8c il utrh*fr| $d \hnll \ublc.r .n cmlloycr b.rnninrl Fnrlri\ and <br />civil lincs uI n) on. hundrcd rhoula,rd doll0r lJl(X).fix)r. irl iddirn,n t, rhc.o{ orcoDrcnslrion. JrnuScs !( fo\idcd lo. rhc <br />sc.,'nn l(,76urrhcrjLb.rq{Lc.inrcrci JnJ <br />5,",",5-\\-\9t> ^_,*l iOrnae*<b\AA <br />Lrt FNsEt, (:()NTR {cron <br />lecLAEdIIA! <br />I hcrchy dllinn !.d$ Fnahyorp.rjury lhui I !n liccnEd undcr nnvhn r orCh0Prd 9 (comnEncins wnh s.crior 7(xxr) oiDivilion.1 <br />o, rhc Busincsrsnd Pmf.siorr Codc..d my liccnE t in lallli)rft .ftucr. <br />l*"e <br />\s'. I <br />C.cl rqsb <br />IONIIBIJCUANTENDING.d(iIN(I <br />I hcNh, arlirn undcr Fnahy of tcrjury rhdr Ihctc i\ n cotr{ru.iir bndi',C a!.tu! f.r rhc l.rionnancc olrhe *olk fd which rhis Pcrnrir is <br />nrucd rsN :]ty)r. crv c r <br />AfIIJCANLDECIA8AIION <br />I h.d,y 0ninn undcr pcnalry ofIftrjrry.n. ot rhc inlkJwnrB dc.lnrationrl <br />D.nxnirion P.rnrir!Asbcnos Norifiurion Fcd.'al R.Sulntb.s rTirlc 4tr. tun6) <br />R.quncd kttcr ol Nolilicolion <br />-l <br />ccnity rhlr rhc acdcBl rcsxh..n( r.Sddire $hcsos rcnntr.larc norrnpli.rhl o rhis troi{l <br />.tn)vc f,flionod nhltny ld ir 5{Hr <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/lnsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lVlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req \ <br />Deputy Final Report <br />Engineer Final Report <br />FINAL 1-2c-t' ././rlat"r o <br />Certif icate of Occupancy <br />Notes, Remarks, Etc. <br />s. <br />Erection Pads <br />Flood Zone Certil. <br />o+4 So\CI./^ <br />s B <br />tt