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BUILDiI{G- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DEI,CARATIoN
<br />I hcrcb,,rfir undur lcnnlry or Frjury rh.l I am.r.nDi riom lhc Co ndos Licc.sc tnw lorlhe follo,i.s Eren (Scc70.115
<br />Busincss atrd Profc$i(). codc): An, ciry or counr, whi.h rcqutcl a pcrmir ro co druci. aher. impirrt. dcmlirh or rcrln nny
<br />tocrure, prior t, ils islec. \o Equt s rb. applic!.r lff su.i p..mir ro fiL r si8ncd {tc'mnr rhol lE or shc n licen*d p,ruul
<br />ro rhe Oovhions oith. Conlroctols Liccnsd L.w (Chaprcr 9. Commcrcins $irh Sccrion 7000 of Divhnrn I ofrhc Busincss.nd
<br />I,roics\ioN Codc)orrhat heorshc i\eienDr lhcrcfromlnd lh.bnsh turhc lllcsed.xcnprn n A.yvmlrrionofS.rrion?011.5$yony
<br />43ffiffi ;ffi*=#il;,''ffi ;.,i.'-',*i ***,'.*". ",rhc pmFny uho hilds or iqmkr rhtdrn. a'rd wts dss sNh $nd( himscllor hcrcltor rhn,ugh hh or hci ow. cmployccs.
<br />lrovidcd rhrr such impmrmnts orc mr int!& or oftcr]d ior slc ll ho$cts, rhc t{ildinS or imllnftmnr h s,ld wihin onc ,cr
<br />of.ompkri,n. rhc (^\rcr BliLlcr will hlt rL burdcn ol povins rht h.d\hc diil ftn t{ild or i,qmvc rtr popcny for thc pnrrEe of
<br />l.asosncrofrhenmp.ny,dr.r.lu\i!cly..ntr.rirstrirhli.cn€d.oftnktrst,)con(ruciihcriiiccr(S(7(N-1,B\i'r$
<br />o Pllri\sh Codc: Thc Conrrr.t{ r l.iccnsc l-a{ doc\ nol llplly k, rn otrncr oll)r.p.ny *h. huilds or improvcs rhctcon-
<br />rrd who c.ftncrs rd \u.h t'n+.r s qirh r Conrtutu(s) ltttrrd nururnl lo rhc Conllacror s l,icctrs liw)
<br />X;:nTe[''e:,"f
<br />I hcrcby.lfifln uM.r pcMltyoipcrjuryotrc oilhc inlkrEir8 d(hmln,nc
<br />-l
<br />hnvc ml will mrinroir r Cenific0rc of Con*nr ro S.ltnNrrc lbr $orkcr' comFn\di.n. nr fovdcd t{, by Sc.' io l7()() ol rlrc
<br />bh-rCrxlc. turhc pcraortun...frhd sort foi $hi.h rh. !.nnir is i\\ucd.
<br />Ilrv.rndwillnDi aitr uoricr\' conDcnnrlion insurircc. 0\ rrqtrncdhySLrrn,n.lT ).lrhcl-ihirC.dc.lorrhcpcd.rmarccoi
<br />thc $or[ lbr whichrhi\ p.rmit is is{'.d My*orkc^ compcn$rion in\urrnccodidr rx]lr!ry Nmbct irc:
<br />1$&..,, ,i',rhc|xnanutucofrhcs.rklnrrhi.hrhi\nnnir is i$.(1.I \hillnor.nrployxny pc^on inant wNr
<br />$ asio hcconE \uhjcd lo thc uoricr compcn$rion hs( otCaliiomir. Mlt lsm. rhd ifI \k,uld b.tdm suhrc.r lo llr
<br />sh cr'conrFn{riotrfmrnionsoiSccrionlTlDolrhelit rCodc.lshrll.lonhwirh.on,tlywirhrh.spti)visFns
<br />WARNIN(i Frilurc h *cure *orkc^ .onFn\mn,n co!.rgc is rnhsful, rnd shlll sunrccl rn.mtlo)c. lo riminal Ftrrkits md
<br />civil fincs rp k, onc hundr.d rhou\rtul dollnE l$l00.Un). in kldirnr h rl[..st ol conr!.n\alion. dtrnuscs r\ f(,YiJd f{tr rlt
<br />'i l;'txnC(hlc. i'ncrrn rnd rr(tr,ty'\ ftc\)'rut"-t*,",..ci(g tS 4W
<br />I ncrcby.lrrmundcr pcnaltyofrrjury lhol I an liensd urlcr pmvisnra olChdrr.r 9l.onMf,mine trirh sccrion 7fir)) oft)ivisn'n 3
<br />of rhc Businc$ rnd Prof.ssion( Codc, rd my liccnB G m lirll Iore a citur.
<br />A.TIIJCAXLDICLINAII(}N
<br />I h.NbyLIn rtrndcr t[Mlty oflr4ury orc oflhc ldlbwin8 dccldririons
<br />Dcmlirhn Pcrmirs Ashcios Norilicarion F.d.ful Rrtuhri('n\rTirlc,l0. l'ad6)
<br />-Requncd
<br />Idrcr ol Norifi .arir
<br />F**ffi ;ffi ;-,,rdffi r****-*i,*,,"*t*'nnr::H,,,"
<br />(ppltnnt or,\ecnr
<br />fi"*u"" n,n,",rnnu'hMf 6, an,{+,"5tolti
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath ,4
<br />Brown Coat Vz./.,.t ,4,?WL-
<br />l\rlaso n ry ,;4 7 ,/(
<br />Pool Fence E''
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL il////l -W'11,)
<br />Certiti cate ot occiiicy -' 17
<br />Notes, RerDarks, Etc. ,?
<br />L.iccnsc cL$:-Lkehr. Nxnb&r
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<br />D.le: Co mclor
<br />CONS:IASCIrcN,IINIINC.EGENCI
<br />I hcrby ![iin xndcr Fndry or p.rju.y that rhm is 0 onslocrion Lnding agcncy for lhe ,]erlomne .f rhc uor* for whkh thh Fmil is
<br />nsucd (Scc. :,09?. Civ C.).
<br />trhdcis Nomc
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<br />Set Backs
<br />Subf loor/VenVl nsulation
<br />T-Bar
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