|
BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS OWNI'R AUILDER DI1LCARAAION
<br />I hcr.by rrlnm undcr Nfl,lry oi 0crjurr lhar I nD cxcmpt fm,n lhc On r.ctor' l,lccn{ Ij* i.r lhc lollowins rusn lss ?l)11.5
<br />Bu\incs nt Protcssin Conc): Any Cily or Counly $htrh reluires r rEmir k' coi{rucr. dr(. imP!or.. dtn,li\h or rnrt aiy
<br />tucruE. r'ritr t' ih hsuncc. al$ EqriEs rhe applica tu \uch ltrnirro lilc r \ignrd {rrdft r rhar hcor \h. ilh.n\L{ lursu,nr
<br />l() rhc rnvhnnN of rlf, C.ntraclois Li.cna\] Liw (Ch.Drcr e, c.nnEn.ir8 wirh Scdn,n ?0u) oi Divnion I ol rh. Busnrc$ and
<br />,tofcsiil Codc) or rh"l hc or \hc i\ cictrrfl rncrcnonrr rtc hari\ lnr rh. illcgcJ crcnrtri{,i Anyvi,,Lrnnrofs..rtr70:ll5btetry
<br />ilpli.anrroatf,nnisuhjcchrh.omli.nnrro,.iv'lp.nrlryornornmrcrh fivc htr.drcd dollaF (5500)
<br />-1.asosncroflheDropcny.ormycmnloyccseirhwa8cs!sIhcnsohconrF.ns
<br />ion- sill do rhc work $d rrE iturm i\ ior
<br />iNcnlcd or ofiercd r(, \rlc (Se.70'14, Busircs nnd Pmr.\sn,n\ CGlc:'rhc Onnrr.ror's Lk.,rsc bw dm! nol0ttly ro m osNr ol
<br />rhcrnp.dy *lF 6uil'ls.r impoves rhcmn. !!d *ho des skh work himscrior hersclro. rhou8h hh or kr o*n.nTl{,rr.\,
<br />ptuvidcr, rhrr srh tntro(mms nE nor i, .dcJ d o,Icr*l fM eh. lt l.i,qcv$, rhc huikltrg or impmwnEn( is $h * ilhm om )ra
<br />ofcofipkrion, rl& Owncr Buius will halr rh. t{ cn ol pmviog iltn he or \h. did n.r buiU o. in tuR rh. p.Fny fo. rh. purTx'{ ol
<br />-1.
<br />alowkrofrh{ Dturd!. rrcx.lusivclyc.nk i'r8 *irh li..n*d.ontktrB ro con{rucr rhc p('j.d 1SN. 7llt.l, Bu\inc\\
<br />a t'nrf(\bnCodc'lhcConrmctn\Lic.n\clxvdocs.oirpplyiornosrcrofpnJt rshobuild\ornnprovcsrhcrcon.
<br />nnd *h. conr.ch lir su.h pr+.h wnh a C nkob(n li.cns.d l)llr\urtrt to rhc An r..rols l-icctrsc ltrrq)
<br />I r rcrrn,J, !tu|.r Scrri{,B & PC f{rrh'\ rcNrr
<br />DBl.: O*n.r:
<br />Ir035[aE!AI8ENliLrI0N
<br />DICLAATION
<br />I hcrcby rllnnr urdd rc kyolJicruyotrcofrhcl,rln*nrt c(laiiri(nr{
<br />-lnlvc!
<br />sillruirrrinr Ccnifiqrc ol'Conscd roScll:lrsurc hrwolkcm @nrpctr$rn,n-!s pn,vnbd ritrbysccrnr:17(x)ulihc
<br />ljh.r Codc. turrhcrdntrmRc ollh- wolk lor shichth. p..nrir n issucd
<br />-l
<br />hrvc rn! s ill mainhh workcN comncnslrn)n nNrrNc. ns rcqun.n hy Scct ion .1701) o, rh. uhor ( nh. r,tr ihc Ftunnatuc or
<br />rh. *.r* turwhichthis pcmrir i! hsEn Myworkcs cotrrpcn\ation insurrmecrEr xnd noli.y nu'ns.r rrc
<br />,',nir] Ntrn,h.r' E\tlr.s:
<br />I ccnil! rlrr h rhc l(rlonMncc ol rhc work ir which rin pcirnil i\ nsucd. I shillnor cmplol aly p.ron in any nrnncr
<br />v, sb hcmnt shFr b rhc trorkcn LrnFn\rri{,i h*r ofCrlilbmir- and rEE. rhrr 'fI sh.uld tx$m subiccr h rhc
<br />so cr'i comncnsdio.pnlisn,ns ofsccri.n.l?{x)ofrhc ljkn codc.l \hrli. fonhsirh..nrtlywirhrh.rpFvisions
<br />WARIIING rnilur. t, $urc workcrs conD.n! irr .u\c,rAc is utrl.qtul. md shrll \ut'jccr rn c.nrl(Dq l. ridinrlFnrlri$ and
<br />cnil fi.cru!k,otrc[tr r.d thousrnd dollrr (tl(D.lxlor. ir rdiliriinr !, rlc cost olconr|Enllrion. darugcs a\ pn*nhd f{tr rhc
<br />Sc.iion 1016 ofrhc Utr, Cl)dc. iN$c{ rfld fl.nf,
<br />",,". -rh$l t(, zuV
<br />DE{;I.ABAIION
<br />I lrrcb, lttm u e, pcntrlrrorrrrjuryrh,I an liLinscd rndcr pm!i\n,n or Chll)rd 9l.ommncifg wirhSsrirtr 7m0)ofDivision 3
<br />of rhc Busincs rnd Profc$nrnsCodc- md 6y liccnsc is in lullf{ne aftd cilcci -
<br />,",^73{ 24 --=C.- C-tlb -
<br />g]NEIAI,&U!]NIENDIB(i.IGENII
<br />lhcEbyafltmuDdcr Nnrlryoilcrrurlthal rhcrcis!.onnrucrion hndirsrAcncyforrhcpcrturmMccofllle work l(trwhichrhn Fnnn ir
<br />nsEdlscc 1097. Ci! C )
<br />AITUCANI.IT&CLA8AIION
<br />llrnbyrmnn undf tlcnrlryoftlcrixry otrc ofrhc n,lb*nrB dclitr ions:
<br />DunDlnion Pfinrils sbcros Notificdr n Fcdcnl Rcguhtt,nc (Tnh 40. P t6)
<br />Rc{lutcd trn.r of No'iflcotion
<br />_lnyril_v rhd rlN liJl.rrlr.rL'hr r\ rclrnii',9 r\h.no\ RIr,'vnlr'r nor xt)flicrhl. k, rhn f'ojrci
<br />I lcniry rMrI hrec rc l rhi\rpplicrri('ndxldrr.rlrrrhcrhn. inturn trn!i\.om{r litrNr..o ldy
<br />onli'un..\ rnd Sr rc l-N\ rchinit r i[nrgco irudn,n. k] hcrrhyaurkrrc rcprcscnhrivcs oflhF
<br />rlrrd n].Dri,,r,l n'onc'ry ktr
<br />\pplicnnl r (!.nr Si!trrl
<br />/u-Kl,slzwt +-"""?%tTz/t5
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />8//-/6 3b66
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />FINAL
<br />I 1',h''. \,1,1'"..
<br />----+--
|