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BUILDING- INSPECTOB RECORD
<br />SITE-WORK DATE ID/SIG.olvNr.:R BUlt,Dr.tR DDI_CAR ', ON
<br />I hcruhy ifl1fl undcr pctrdlry (,rNrjury rld I m cx.mt non rhc C nr..t. Lic.n\c li$ l(r ih. n,ll)trir! rcisn lscc 70]. 5
<br />Bu\i',css .rrl I'rolt*ion Codc): Atr! Ciry or cou y *[ich rcquircs a Itnnir k) .o inrcr. .lrcr. nDrovc. dcmolnh or Eltrli' u,
<br />dtu.rurc, r'i)rh irc h{ri..c. r$rcqnncsrhc.mli.inrtursrh!.rmnro ilc.siSncd rrircmnr rhrhcor\hli\lrci\cd ru(r f
<br />ro rhc povnions oi lhc C.nrEct.is Liccn\cd lr( (Chrlrc! t). Connncnciig sIh Sccri{ 7txlr oiDivi\ion:] ofih. Busi'jc* xil
<br />rtpli.rnr ror a!.rmir srhj.rr\ rh. rptlic!trr kJ {.iv'lFcnilrtornoi.xtrcrh livc hufdrcd nolktr\ ($5(x)l
<br />Las osmr of rhc potEny, rnly.mpkire\{irh*r8csr\rhcns,hco lrns mn. willd. rhc work md rhc sttrrr i\ trn
<br />n cklcd or off.nd ntr sh ( Se.7(|4,1. Btrsinc$ rnd Profc$ions Codc l hc C.nrr|doi s Lhosc llw docs nor +tly r. i. osncr .r
<br />rhc Impeny {ho builds or ir!tro*! rhcE n, and *ho d.cs \rch w'* hih\.lfor hcMlf .r rhii,uEh hic or hcr.sn cmphyccs.
<br />prcvdc{ rhnr n'.h irnpmvcmnhmnor iNcndcd or.rc&l tui c..lt tr'trcEr- rh. hritlinA or inq'nnrmnr i\ sklqirhihoi. tw
<br />.fcotrl|)lcri{r. rlE Owtrd Buildc. sill l[rc rh. hudctr nllIovnE llw hc rr $c dA Dol tfild or iDpror rhe pmFry r(t rtr rurF)$ of
<br />-l-
<br />as.$ncr.r lhc propcny. lnrcr.llsilclycontucrirg wirh licer{d contrckn\ h (nNfld (rE rm,cd (Scc. ?(}4J. BusiiEs
<br />rnd fttfcsbnCodc: Thc Cont rof1Li.cnsc Law docs not at)fltro.nowncrolnn)Ic(y*ho huildsor nrProvcs rhcrcotr.
<br />lnd eho c. mcrs lirr such pmF( {irh : Contncb(s r li.cnqd lur\oa rorh.Grnra.ktr'sLi.c.scLnw)
<br />I rr.\cn,pr trnJ.r S(ri0n
<br />Dar.: O*n8:
<br />W(IR(FIIS' (.[IPFNSATI(TN
<br />DECLASAIIA!
<br />I hdrcby afilnnxndo f,.ndlry oI p.rjxry onc or thc rdlo{in8 dmludrions:
<br />-l
<br />hau nl *ill muinroin B Ccdificlrr or Conscir ro Sclf ln\rrc ror workcN strWtrstiotr. as tmvid.d for by Sdini :17{x) ot rhc
<br />Lal'or Codc. for lhc pcrfornwrcc of rh. wolk fo. which rhe pc.nrir is hstcd
<br />I hrvcnnd willm0inrain worl.r{ compcnsarion nsnrincc. as rcqnncd hy Sslion 1700 oflhe t-lhor Codc. ror rh. p.rrormmc or
<br />rhc sorl for qhich rhh p.mn i( issNd My workfta .onp.neibn inslrarcc canicr $d tx'lty numl,cr s.:
<br />IccnilyrhrrinrhcPtrrarhr.eofrhdqorknn\hichrhisp.rmni\i({r.d.I$rlln.rcnlnoyrny|E6oni'rrn!trir.r
<br />$ A h h.dnR {bird h tk w.*cr\ conlncni n hws.lc.lilnrnir.nndnERalhliirl\houldh(o'c\Dl+.rr'llt
<br />workrs' ronr!. \rri,,nInrisi. sofS..ri(in 17(n.J rhr LrhrGxlc.l lhrll. li'nh\!irh .oD,rl) sirtih'{ nnrvnrois
<br />wARNIN(:: I'rihrc lri c.urc sorkcn' ronipcnsrri{rn ^ utrr$,11. rnd nrll{ihlccr in. d.$r ti.rin,inrlp.mlrir\ rxi
<br />cnil finc\ up h om hu 'cd rh.usrnd dolli^ (11(x|.lxxJ)
<br />s(rtr.10?6.1rhc lntx)r ('o<lc. inrcrc{ 3trd r(nmy \ ricl
<br />iri,,n n) rhc ro( .l co rrcn\ariotr. drtrrscs is nrritl.(l n)r r,r
<br />l
<br />I hcrcby rllinnu.dcr pctraltyofpcrju.y th{t I rnr li.cnsd undcr lrovision olChrprer 9lconntn.iis sirh S..rion 70u)) ofDivision:l
<br />ot rhc Blsinc\iand hnf.sionr Codc. xnd mylkcn{ i( in full fd& Md cllccr
<br />l-iccn{Clrssr-Lic.
<br />a.rt.r",..,K
<br />AfILICANLDECI"AxAIIO!
<br />I ls.ny anlnn uMci pcnaky of trrrury orc ollhc l'ollowin8 dclrdio.s
<br />Dcnolirion P.rnirs Arb.*x Norinc ion F.dcfllRcgul.lnnrslTitlc 40. P,trl6l
<br />Rdquir.d L€trdr.f lli,tifi carirr
<br />I..nil_r rlhr rh. rcd.nlrcEtrl i,,n\ rcrrding r\n{o\ rcBrvLnrr nolrt,Il](rn. r, rlri\ t)iiic.!
<br />I ccnlly rhxr l h3k rcrd rhi\ lptlic,rid Md {ar. rhnr rhc lr!. l fn,nrr i(in i{ .on$r l .gre r. ..nDly *irh all Cirf .rd Coutrly
<br />^trhnrn.GrJqrn.lr$src!'r'ngn,hu'r,i'ne(.nqru r{r xtxl hcrchy Nrk)rizc rcprcscn(lrnrs ol rhh Ciry md c()xnry ro cnlc. utxr rltr
<br />rhrc'mnrinF.,rll,ror)Lr'1.r,rionfuN. //).--
<br />^ppri(sn,or^,lrn,shno,urc-
<br />AJD*5- L *-'c..-..-- ,'"," 9- 7 -t *
<br />pem,Rntrm€,Dnn,,: JD,d,, Crqzlt tz
<br />,/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathing s 6lF YrraAL
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enersv
<br />wall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />w \lEil-Rl
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />q)NIiIAICIrcNIINDIIG.AGEITI
<br />I hcrhy ailn nr und$ lcn(ltyofpcriuryrhrr rhcrc n a con(nrlion kndiDs,s.n.y ror rhc tdnrrmn.. orrhc *ort,nr *hich rhis rernrir is
<br />r\sucd (sN.:r(r97.c,v. c ).
<br />FINAL U7 < lv<,
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