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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER $UTLDER DELCARATION
<br />I hcrcby ailrm nnder pcnalry .r Frjxr, (har I m cx.m nom rhc Conlmcron l,iccn* ljw r(r (h. inuowin8 Elson (5(.70.11 5
<br />Bulincss and Prurcssion Codc): Any Cily or Counry shich rcqutcs r Pcnnir ro cotrsrucl, 0lrcr, imP.ovc. d.dolnh or rcpdir dny
<br />$odurc, tlkr k, irs hvaMc. rho rqxins rh. 4flhi ntr su.h Fn,it lo rilc a rignen {llcmnr rhrr he or shc h licctrsd Pusuunr
<br />ro rhc prcvisions or rh. Contr0clols Liccn{d l-0' (Chrplcr 9- CommencinE rirh s..inr ?0(D ol Division :l ofrhc Bu\in.\r,nd
<br />Prorassi{)nsCod.)orrhdhcors[cncxcmfllhcEfronandrhcbori\fitrhc,llcgcdcxcmPlion.Anyvn,htionofSNrionT0]l5hr0try
<br />lmli.a lnra!.mir suhFcls rh. rpplicanr io a.i!ilr.n,lryornor Mrcrhin fivc hufldEd d.llon ( S5{D)
<br />Lrs owrcrollhcpopcny.or rytnrlh,y.crsnhw.!.rr\rhcir<,lcdnnncns ion. will do lhc sork rJl] rhc $Murc i( tur
<br />inrc' cd or offcrcd f(tr wlc (Se.7(r,l-1. 8uircs und Proic\\ions Cqh: Ilr C.nrrdrkr'\ Li.cn{c Ijw do$ mr +plt ro ri ownd or
<br />rhc pnpcny *ho bnilds or iqro!$ rh.d,n, dd qho des {.h tr( hnnsctl or hcrrlr or ihnrgh hh .r hcr oa. cnDlo}ccs.
<br />In,v cd rhd nrh imp ovcnrnls m nor ifrcndsl or o,lcrcd iff $k lli h.wNcr. rhc h^rikling o. inlPmtnEnl is ()ld Nirhi" ,
<br />'nc ]tr
<br />of co lPlcri.n. rlf, Own r Buikld *rll havc rtE budcn of povirs rhd h. or +e did Rn h,iU or iir{rorc rh. PmFny 16r rlE PurF,{ .l
<br />l, trs osncr ol rhc lln)tidt, rmcrclu\ivclycoturcrina $irh licctr\cdconlDcttr\t,ro.itucr rh. troj.cr (Sec 7(!44. Bu\im\\
<br />i hni\siotr (hdc: lhcConrroctr's l-iccn\c L!* d{r\ rcrarllrt, dnosmr oftnpc ystu buil&or i'nrri)vcs rhcrcon.
<br />rnd who conrEch nn \u.lr pn*chwnh!(t fttrcror{s) h.ctr\c(lpurulni nirhcCoDtr.ttrk l-iccnsc Ldw)
<br />I atrrcicnrpr undcrS.crn,
<br />tlatrxri&5:ro fIiNla-IIaN
<br />DIICLA.BAUAN
<br />I hcrhy !fin{ uDd.r r--nrhyorNrjuryotrc of lhc lnllowiry ncclnirions:
<br />I hrvcatrd sillnui ritr r Ccnlfic.r. ol C.nsctrr r,, Scll lnsurc lir NorkcF co tPctr\drior. rs fmvidcd lir 6y Sccrnr :17({) ol rhc
<br />trtxtr (-.xlc. finrh.!.rbnrun.cofth. so* tb. s'hich rhc lllirnir ir issucd
<br />lhrrcrfduillmxidrr*orkcrrconrp.\rrnn,nNxrni.r.dsrcquncdhySccri.o:17(r)olrltlrhrCotl..ktihcPcrlorrrunccol
<br />fo' r'i|hrhrpcm ^a.u.dMylmlc^'mn'pcn..nn'n.ur"n.c.rnic'fJnul'crnu'nbcrrcs+o+t +u^d
<br />42|b xl-1 S-7a tX
<br />I ccnift ihar in rhc l.rror.rftc of rhc q'ork for shich lhn Frnil is isucd.l <hallnoi cmployanyp.rson innnynrsncr
<br />$rsutconE{bjccrrothc$ort.r\d,6p.trsdrn,nhwsorcdlir.rnia.and!3rcelha!iilshouldhe.ormsxblcdtorh€
<br />$!rkcr{ comrcnsati.n lrovisioN or sc.ri(,r :r7m or ihc Ltrhtr (})dc. I shall. tunh*irh .omdy wirh rhos trorisions
<br />WARNINC Fdilur. r. s.urc qorkcN onrpetrsrrion corcnsc is tnlawrul. ,nd n l subjNt 0n cryrloF b crimin.l Fnollics ond
<br />cilil lin* W k, onc hundrd rhouktrd dollor (Slll).llfll). in addnio. k, rht cos olconrpcnrrlion. dlrs8cs 's fhrdcd lor rhc
<br />sc.1tr .n7r itr rh. Lh{ foi.. tr crc{ ond anomc} s rcc,
<br />,,,., S'zY l(Applicrnl:
<br />L!CENSFD CON'I-R C1'(IR
<br />DEIIATdIAN
<br />I hcrchy ,ntn undcr t nahy oi pcrjlry rhnr I o lientd ond& trilvtion ol ChaPIc. 9 (.1rmrmn.ins snh sdon ?(xlo) .l Divhion l
<br />or rhc Bu(ircssand P$fcssioruCodc. ud my liccnsc is ii,ull turcc md ctic.r
<br />t)
<br />^irL
<br />tbtl%b
<br />,.,", S"ztl. l<
<br />CQNIIBIJqIPNIENDINIj.dCENII
<br />l h.rcl,y rrfifln unddr p.tulryofpcrJuryrhor lhcrc is 0 on\rrudion kndins agcn.y fot rhc pcnnrflumc ollic *dr* ror *hrh rhh l)e .nil k
<br />hsu.d (Scc.l(})?. Civ C.).
<br />AITLIIA IDLCLAITIION
<br />I lENtry afinnr undcr nenrlry ofr'irjury oft.rrh. r(,lk,winP d.tldniion!
<br />Dcrolirion Pdnirs A\h.{os Norific.iion liedcrul Rcguhrions (Tirl.40. P n6)
<br />Rrquncd Irrrcr ol Notifi q(irr
<br />Ei,"",
<br />:.nil) rhrr rh.lo,l.rrlr.BrLinr \r.(rrdi|!i\l{{o\r.nurlrrc xn itf icrhlt r) rhn f'oE.r
<br />ilyrhd I hivc rcndlhn0npliclrn,i d dar. rhd rlt rtx,vc irnnrnl.,tn kcotrccr.Iagr(hLa,mply*irhnllCilytrtrdCounl,
<br />lh.'rh!rurturr. rctrc\.frrrnd. olrh \ (
<br />'rr"
<br />ri (i{! ylo.DrrruFnrrlf,oidmri.c(rtrd srric Llws rchrir8 ro ll ikliig
<br />knud-a
<br />Sr,l lg
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB FIoor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL b/u,/t,:bfl6
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />UFER Ground
<br />Sublloor/VenVl nsulation
<br />-k nrnrnnrd n(,p{dy fir
<br />\Dplimtrl r \[.tr] Siln lurr
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