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BUILDING- INSPECTOR RECORD
<br />SITE-WORK IDiSIG.COMMENTS OWNER AUII,DER DEI,CARA TIoN
<br />I hcrcby ,rtum undcr p.nnlly of |rrjury lhr I ain cxcNpr ftun rhc Conrmror' Licctrsc tjs thr ihc h,lowiry rei{,n (5(.?011.5
<br />Strsincs rnd Prorc$ion Codc) Any Ciry or Counly shich rcquncs . ,)cnnn ro con(nrl. alts. inprcvc. dcnxnGh or rcp,n rny
<br />srrucruE. priorro ns nsuoncc- aho rcqutc\ rh. lp,rlicl.lI lhrsucn Frmir h fihn \i8rcd drrcmnr rhdr hco, rh. i\ liccnscd pusurtrl
<br />ro rhc F)ri(ions ol llk Co.trn tofi Li.c.Ed Law (CnlPrcr 9, ConDrnrin8 uilh Scdnn'7000.1Division 3 orrhc B,sinc\s rnd
<br />Prcic$ions Codc)orthal hcorsh. ircicmpl rhcrcironrand lhcb!(is ld lhcollcgcdcxcmPii.n Antv,.lrlbnorscciionT0Sl.5byrny
<br />,nlliclirf,pcmrii\ubjcc(rhcxttli.,nrr.i.ivilpcn"lryofnoinMcrhMfivchutrdrcrldolhrc(S5{D)
<br />-1.
<br />.s owncr of rhc I,()IEny. or my cmllorces lilh sr8cs n rhct $h .onpcnsr ion. will do rhc Nor[ ,nd rtr nturh n ft{
<br />inrendL{ or .lttr.d n, ut (S( ?044. Bo\iies ann Pmtcsion\ C.dc: the Contact, \ Li.cn\c ljw do.s .or Apl, ro an twrcr o[
<br />rhcFtutxdy who huilds or imttuvcs rh.mtr, and Rk) dr! \!.h H)rk hinr\clfor hcrcll.r rbouSh hk or hcr ow. cnr!l('ycc\.
<br />pror cd rhrr ech nnprororntr 4 mr inrc .dqortlartarsh ll ho$ctq. rhc h,ildin8 or inllr)rcmd nand sirhin,,ru rrr
<br />olcon{'hlt'n. rhc Owncr Builds willharc itE hurh. of lr'virr rlllr h or shc di trn buildor iq8rv. rhc pn{rcny ior rhc purlnE of
<br />l. rsosncrolrhepnpcdy, rmcrclusir.lrc.ntacring $irh li.cn\cd contr!.t)^ o on{ru.r rht pnicd (Scc 7014.8u\ir..\
<br />and Pn,Ls\.nCodcr ThcCotrraclois Li.ctrsc Lr*dds not rpplyb rtrosncr ol lnoprrlywh{' buildr.r im!ruvcs rhcrcod.
<br />rni who .onrrlcrllbr such pn'F.rs wnh I G,i Bcrin( 9 li.cnsc.l pr urDr h rhc (bnra.nn s Li.cnsc l-rw)
<br />-l
<br />anrcxeflrpl unds Serion-. B &P,C r'orrhtrc,soi
<br />tvaaaIillllaMfrNtalloN
<br />IECI.AA{IION
<br />I hcrchy afiirm undcr r.nohy.frcrjuryonc ol rhc nnL)wins dc.hrnrion\
<br />-lhrvcandwillrui
<br />rin a Ccn ifEarc oi Conrcnl k' Scll l trulc rirr $rkc6 coo,I)cnsarion.,\ rtrovid.drorbysdrio,rl?uloilhc
<br />Latu Codc. inr thc ri.rlbirMoce or lhe work ri,r shich rhc pcnnn is isnrd
<br />rh. suk tnrshi.hlhi\ p.nnir l\ n\ulyl Mysor\c^ .onr{f\rri.n insurrdcc.rri$ n' I!)li(y rutr$rr ttrc
<br />I ccnilyrh0r ir lhc !cri.rmncc {)trhc work rn. *hich rhn p.nnir is issucd- I \hrll nor cmploy any p.r*,n i" rny n'atrmr
<br />$ 6 b heunm suh]cd ro rhc *orkcri cohn nsrrion h*s or Crlili)rnir. rnd rERi rhd ir I \huld ti\n,r suhj..r lo rhc
<br />trorkcr{'compcn\arionpovi\ionsolSccrionlTfi)olrhctlhorC{xl..lshrll.k,nhwirh.omplyqirhrt$rJrrevisnN
<br />WARNINC Failurc ro kuic *orkcrL.omp.nsdn,n ovcrlr i\ unhstul. md shrll subjLrl ,,r cmpl,rycr lo simiulpcmlricr rnJ
<br />(iril linc\ op k,. c hundftd rhousrhd d.ll*s (51(x],(XD), nr rddirhr t) rhc .o{ ol .otr[cn\ulion, dunnS.s !s pri)vid.d lbr ih.
<br />,".t^^a1a<7
<br />!]Igi8j.tr]ll
<br />I lrtohy rlhnnundcr Ftrdhyoircrjury lhit LD licctrRl u $ ptuvhion of Cluplcr I (.onnmncira *irlr S(rir ?(xx)) of Division l
<br />ol rhc Bu\incs\ a Profcs\irsCodc. rd myli.cnsc k i'r rull nn.c dcftc.r
<br />6 <Gt,l-
<br />,,,,,ta^-1ZQ 2ot(,,,,,,,,,,,,,,
<br />IANIIAIJqIPNITNDING.AGINCI
<br />I hcNhy flirn undcr lEnillyolpcrjurylhol lhcrc h o con(rucliotr knding aEocy Lr rhc,rrrornr .. orrhc (ork lor which lhis rctnril h
<br />issu.d (Sc. :1097.C,! C)
<br />AIILIANLDII;IdBAIIQN
<br />I tf,nhy in utrdcr p.nahy .f Frjury onc of rhc Llbwnrg dNhr ionsl
<br />Dcmlirion Pcrnrih Ashesror Nori6cdt,n Fcdrral Resula'iols(Tirlc to. Pad6)
<br />-Rcqun
<br />d ldcrof Norifi.ari,n
<br />I.Lnifyrhrr lhclrd.fulrcguhltr'ns rcFddinS rrh{no{rcnn,vrl rc mr ntli.rhlc k,ihn rrlccr
<br />-l
<br />ccn i,i rhar I horc rcld rnn apr,li. ri,'. ord dlic rhar rhc ah,m inromd n,n is .orrd I rgiLi r, .o'ryly * ilh ,11 Ciry lnd c{'unly
<br />.nlrxtuc.r (l sr .l-r\\ k. tr'robrikli.gcon(rucrn,n.mlhcr.hyddirizcrp'$ctrhriv.sofrnisCityMdCounryroc.lc.utonrhc
<br />$t^r nuridEd pnrFnt ior n
<br />\d*f+-,,,,"t 1\2Y
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq ,a
<br />lnsulation/Energy (i-rt- to J ) c9olv @-,
<br />Drywall v l-5t-t? .t )tla*z (9
<br />Brown Coat
<br />It/aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />\-
<br />FINAL v-/ - /s J/.{Xa 'to
<br />Certilicate of Occupancy
<br />Notes, Bemarks, Etc
<br />DATE
<br />Set Backs
<br />Subf loor/Vent/l nsulation
<br />Ext./lnt. Lath
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