|
BUILDING. INSPECTOR BECORD I
<br />SITE-WORK DATE tD/slG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby alfifln undcr pcmhy {'r p.rjury thnr I m.kmfl r$'n rhc C.nlr0clon t-iccn{ Ij* ftr rhc rolbsire rclsn (Sc(r03l5
<br />Brsirc$ 3nd P<,rc\iion c.d.): Any Ciry or Cotrnty shi.h r{uncs a t^-mir lo con{ .r. alrcr. nryrovc, dcmolish or rcran uiy
<br />sru.lurc. prir o n( fiune. 0l$ rcquirc\ rhc $llicanr tor \uch Frnrir ro fih . r8trcd slalc,rcnr rhlr hc or rh. s li.cns.d puruanl
<br />ro rhc F{,!i\nr.s.rlhc Cotrtacrols Li.c.*d ti* (Chopt$ 9- ComN.tuin! wirh sccrion 7uJ0 of Division I orrhc Businc$ .trd
<br />PmlcsnnrCodc).rlh.thcorshciseicnrflllrrct.nsndIhchrrirtarrhctllcS.dcxcmllion. Any vdarn,n or Ssrion 70:11.5 b, try
<br />JnSltrod r.r ! F.n'ir.uhr. \,hc ifflrcrnrrur,rvrlt.nrlryrlrurmrcrhJn'it.hdnd'cdd,llr.'S50o,a\-/ \
<br />9!(* ,,"*' r," ,-*"y. o, n,y cdnloycc\ q {h I aacs !\ rhct {,L.\mPc.snrion. willdo [r sor{,.d th. nm(ur n nd
<br />-llicftlc'l or.,lcrc{ tu slc(Sr 704.1, Burncsi .l Pturc\sions Co.lc: Tnc Cotrhrroir l-iccns. llw do.r nol a,,l'ly to an o*F or
<br />rlrc noncny wh. build\ or improvcs rhc@n- ud who dixs soch kirl himsclfot hcsclior rh.ouBh hn or hcr owncmpbyccs.
<br />nmvid.d rhd ru.h i'nlrn)vcmnh m mr inrcndcd n oficrcn in {h ll lnwcwr. rhc hoikiirg or inpmknEnr ( $[l wirhir onc tcr
<br />olRrlllllcridn, rh. O*hcr auillcr qil hr{ lh budco ofpovirA rhrr hc or shc did hor buiu.r irproR rh. ProPcny lor rlf, PUrPr ol
<br />l.r\o*ncr.frhc!n,pcv,nrcx.h*ivcly.offr.lirAqirhli.cn'cd..nrrrktr\t,cod{nr.rrhr1r,Jc.r(Sc.7l!,l.ln^iDGi
<br />xt tt\rLs*'nCodr'lh.Conrrrctr'\t.iccDscl-a(,br\norrtfltt'r oNner.ftr.n.dy*hobuild\ori'nr('vcsrhcrcon.
<br />rtrd Nln co rri.. tur uch pmf.rs*irhr (ir rrckn(r) licctr{cd funHnr ro rh.Contn.rr'\ Li.cn\c lj*)
<br />l sd.i.nrnr r .i Sc.rn)(,"*9-rrrL
<br />Drctdarrla!
<br />I hrrcbynlliiinun cr |{Nll) oincrjuryonu of rhc f{,ll,,trin!n..hrrrnrN:
<br />-lhrvcmd+,illrnoinrainrCcnificarcofCon\.nir.sclflnnrcturworkcrq,mncn\!ri,n.astmvid.dfdbySsliu:l7lx)o,rhchllr Codc. Lr ir prrlormrccollht wort in whichrhc pcrniir is isucd.
<br />-l
<br />hrvcrnd will nui' ain $.rkcB ..nD.nsirion iNurincc. is rcqrhd nys(rnD ]TLUnfrh. L.ho! (bdc.lirr rhc p.rron !tur-nr
<br />rhc *ork lor whi.h rhhNnnir is i$ucd. My *qkcis conDctrr0ri, in\urrn.c .tiircr .nd l[lEy nunrhcruc:
<br />r\/d
<br />1 F-z I .cn'ly rhx r ir rh. NrlnnnrNc oirhc (ork nrr *hi.h rhA Nnnir ir N{rcJ. I shull nol cmpl,'y uy pc^on in rnymrnner
<br />c rfilr ifl \h,!ld tf,.om suhjccr Io rhc
<br />h*irhcomnly wirh rh.* provisions.
<br />d *hrll suhjcd an cnphycr ro mmiful FDahics ,nd
<br />.oi of.omFnsotion. drnE8e\ Ds tbvid.d for rhc
<br />s r\roluoN suhlc.l lolhc \!orlcr(..nD. \ari{$ las\ of Cdl'foatix. ani rgB
<br />trork.rs conDctr{ri(rrfDvisionsolSccrion.l?fi1of rhcl-rhtrCdl..l \hill. i,n
<br />W IININ(I: Iinilurc h {rorc rorkos,.onlrnsdi(rr.ovcrrlc ir uDhqtul. rr
<br />civil fitr.\ rt, i, .i. hu drud rhou{r d dolldr\ (SI00-(x)0). ir a(l iri,nr b rhc
<br />Socrtrr.ll)76 olrhc L ltr (idc. irrcrc{ xn(lr(1,"tuy \
<br />(,,", 5-t'1-\ Q)
<br />ut.lttB^-l&s
<br />IhcrcbytrnnnruodcrncmlryofpcrlurtthrrIdnhcctr*dtrMcrprovnionolChrtrs9(.onr.tr.ingsirhSccliotr7l)(D)ofl)ivisi,,n-l
<br />ol rhc Bu\inc$ and Profcssionr Codc. ml nry li.cnsu i( in irllfoN ldclltcr
<br />I-i..nrc Nu $cr
<br />-cQNljlBlcul]NrlNlMi.lli[rrl
<br />I h.rby rlltnn crDcnrlryoipcrirryrhdrhrrci\ic.treru.riotrlctrdir8ilcfcyi.rrhePcrturtukco,rhcworklor*|ichihi\PLnniris
<br />i\\!rJ lScc 1097. Civ C.)
<br />AITUCANI.I,EII.ANAIION
<br />I lf,rhyron 1u $lrcn.lryollcrjuryoncof rhcnnb$in! dcclrnri.nll
<br />Dcnmlirion Pcrmik Ashcdos Nori6.ilio. rtdcr.l Rc8uhlioFl'l rh rO. PJ16)
<br />-R.quift
<br />', tr .rrrN,irli!ari,{r
<br />-lccnrf)
<br />rhr lhclc,lc trlrEd'rr'an' r.!ddn8 rsbcno\rcnmrrl!T rnr nflhrJbl. !"hi.I'r,iccr.
<br />M -nr, ,n, , ** ."0 ,ns lnpl'cari,rn dd darc rhar rhc dh,vc inhnml ion is cotrccr l ,!rLt 16 .on{,ly wirh all c y and (i,u ry
<br />F?illiBRN;nd sritr h*. rcbrins ro hrrld'n! condtu.rn,n, and h.tchFUrh.rize rcprcscnrDrivcs orrhh City lnd Counryt,.nro llxln th.
<br />rh.k 'xnrhrcd poplay lar
<br />f,?,,u'*'
<br />I
<br />5-\r-\S
<br />.-.<.-
<br />nr." rpAnll, \f \ Y\\/"
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground )
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing qft-.,1,\l(bv ,),C,,.-L -5+o torlb6l
<br />Shear Wall blztll'g
<br />^^L<
<br />IA
<br />Framinq 7l-r*ltt -1M.@
<br />lnsu lation/Enerqy l.ti-6 ?r{zl)-
<br />Drywall 9lt{ftg '/.tW/L t)
<br />Ext./lnt. Lath t'l7Al'P -.(/t{Y
<br />Brown Coat J?4-/s$ 1.t1r1,t 8"7:t0 ffi)(<,c e-7','
<br />Masonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report \
<br />Flood Zone Certil
<br />FINAL //-/t-/8.tt'{'n rt ,-/e.r 9 7 2
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />0)
<br />0
<br />Pool Fence
<br />cri'
<br />-
<br />f-------T------
|