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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.O1lNI]R AUIDER DELCAIIATloN
<br />I hcrdhy nrtrm unds pcnrliy ol llrjury lhar I 0n c\cmpt lrom lhc Conlrrk'n t,iccn* li* li,Ihc followiry rcrsn (Sec.?0:1r.5
<br />Ausincrs rtrd Ptufcsn r Codc): ADy Cir, or Counry which rcqonci , Frmir r, .onnru.r rlrm, impr.ve, d.m,lish r rcnJtr rny
<br />(rucrurc. fiorlo ils isuofl.c. nlso rcqutcs lhc ap i.dnr Iar sxchFrnir b filt. \rgnc{ sdcnrtrr lhnl hcor shc n liccnscd lursu r
<br />lo rhc fiovisions ofrh( Cotrh.n r l-i.cis&i lrw (Chaprcr 9, Conr ctrcilg wirh Sc.rn]i 7fiX) of Divlion I ofrh. Bu\incs rnd
<br />Pmfcsion( Codc) or rhat hcorshc is crcnpr ihcrcfron.M thc h is for rh. rll.ld .r.nFrion Anyvn,hrkJnofs..rk T0.ll5hyany
<br />omlic!nl for rt rmil subjc.lslhc rppli.a to rcivilNnrlryornor
<br />'norcrhan
<br />fivc hxndrcd dollin(Ssotr)
<br />l. \ osn . of rh. Imr--nt, or ut rryk'rccs *irh qar.\ r\ rhcir $lc .o'ntcf\rr i,)n. Nill do rlt sork ul th. {dcrm i\ frn
<br />lnlcM.d oroitlrcdtur!rl.(SR7O1-l.BusnrssdndPtuf.s\nnnC,nlcTl[C.itr..ttrst-i.ctrscl-rsd.c\tr.r{ptlyroxnorncror
<br />rh.I)Dn dy *hoSnill\ori'llnNuihr.rm.anJwhod,{s\trchtrorkhltrrsrllorhor{llotrhn,uShhNGhcr.wtrcflflo)tc(.
<br />t,lovilcd rh sDch nnl[ vcrEnh mc.or i,rtctrdLt or olhtut tur qrlc ll.howcrcr.drhrlklinRornnDnvcnr nhk$thironclqtr
<br />ol conThri.n, rh.I^!ncr Brik r rill hrrc rhc hutrlctr or proing rhl] hc or \hc dil ml huiH or i'nprorc rhc lmpliy fo! rtt purrxNc of
<br />-1.
<br />ss o*n.. ol'thc lmtl.ny. am exclu\irly contnct irs wirh licctrs.d contrNros lo lntrslrud trE proF.^r (Sc. 7(144. Uu\inc{
<br />and hr'rs\ir C{dc 'l'hcContldu s t-i.cn\c Law docs ndrrmlrlo trno*n.r.tt(,pc ywh. hrild\.r inlrrovci lh.ieo .
<br />aM wh. .onta.t for su.h ptuFihwnhdCo hcbrl9liccn{d puBurn r.rhcConlm.roas Li..nsc h*).
<br />I a'trck'nDr untlcr Sc!rio
<br />"","512t1 M,olt
<br />I h.r.by rffi r ridcr fi.orhy.f 0.rjuryotu ol'rhc tull,,rirg dlTlrltn'ns
<br />-l
<br />hr and tr ill auirrlin a Ccn ilrorc of Consnr b Scli'hsu,. ior rorkcn conDcnsorioo- is rrovidcn lor by Sccrion l?O0 ofrhc
<br />llhnr (odc. for thc !. onMflcc oI rhc *ork ror trhkh rhc l.rnit i\ ilsodl
<br />_l hivc rnd willnraintsir wor&c6 conrFN0rion itrsurun... rs rcquncd hyScdiotr 3?mof'hc tibor Codc. for rhc Frtrmrncc o,
<br />lhc work lbrwhi.hthis pcflnil is hsucn. Iuy w.rkcr' com,r.ns,r ion iNur0ncc ciris nnd plicy.unrbcr sc:
<br />-l.cniry
<br />rhrr in rhc pcrto.runc. orrhc work for shich rht pcrnrir is tsucJ. I shrll tror cnpbr rtry pcno. n' any n'rdncr
<br />w ast,h.o!r subjccr k,rhc qo*ch.otrrFns ri.nlrqs.fcrlifornid. rnd l8rcrh ii lshould t{.o rc suhrcd tolhc
<br />worknr.r'npcnsdnrnpovtn,NolSccriolTu)olrhctrhrcodc.lshnll.lbnhwirhconrllywirhtk)cprovilbns
<br />Dub: Z\
<br />illrc to scue r.rkc^ ompcnsatn,n
<br />, onc hundr.J rhourrnd dollrrs rSl(x
<br />rh.lrhtrG,'i inrcrc{ unJ di.rk! \
<br />LzzL6 ^,,,,*.,,
<br />{,hjc.r rtr cndoycr ro si'ni'rl ri.trrhi.\ rnd
<br />I hcrchy annm uMcr Fnahyol ltaury rhrr I rm li.cn\cd trndcr f{{irnrn ofChnfcr I (.om
<br />ot rhc Burinc*and Polc$ioFCode, nl n,! liccn\c i\ tu ll lore ud .l1iri
<br />nh sc.li.n 7(xxr).il)lvniqr.l
<br />(:AIEIA!qII()NIINUNC-&CIIcI
<br />I h..chy rffinn oid.r pL rlryofl.r]trylhnr ih.rclsa roi{fcrt'n Lndin! rgrncy trrhc |j.rtnrr .c.frhrsork lir $hichihi n rmir s
<br />i\sucd lSc.. .l{17. Civ. C.)
<br />lccnirrth l lhc ltdcr0lrcBulalions rcElrdins !sbcstos rcnFvalrr. nolrmlicrhlc rollrir !n,jccr
<br />l..nili rhd I lB\o rcxd rhG rpnlicrri,rrntl {rrcrhrrihcrh,E i'r{nndi,,n i\I agre ro coq,ly *irh lll ciry ind counry
<br />,iivcs ofrfiil cny 3nd c.u.!yro cnrcr nlon rtEoRh rD.c\x Srxrc ltrtrvs '.l itrE ro ntrlu trgcon{
<br />ltnn nEnti,,ncd Dml.dy for inspccrion
<br />Appli.!nl or ,\rcnt sirn.lrr€
<br />""-rn* **",rnr,, ' (c5+&
<br />S lzs l,b
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Bool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<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 />FINAL 6/t//, -wa)
<br />Certificate ol Occu pen"y ,7 ------7-
<br />Notes Remark s, Etc
<br />COMMENTS
<br />d.TTLICAIIDECIdNAII()N
<br />I hccby lfiinn u ndcr nc.llly ofDcriury orc oflhc fdloBina dcclrtrrlions
<br />D.mhion Pcnnils.Asbcstos Notilicarbn l,cdcrol Rc8ulations (Tirlc.10. Pffr6)
<br />-RcquiE{
<br />Lcllcr ol Noriricnrion
<br />Forms/Steel/Holdowns
<br />Flood Zone Certil.
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