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BUILDING- INSPECTOR RECORD
<br />COMMENTSSITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathin
<br />Shear Wall
<br />Framin ,/
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Mason
<br />T-Bar
<br />Handica R
<br />utD Final Re ort
<br />ineer Final R ortE
<br />Flood Zone Certif
<br />FINAL
<br />Certificate ot Occu anc
<br />Notes Remarks Etc.
<br />OWNER BUN-DER DELC II TION
<br />I tn-rcby affin undcr F,nally oi lcriury rhd Ln cr.nfl fm.n lhc Conra.ioF Liccnsc liw ror rhc tallo$ira tu'$n (scc'?o'll 5
<br />Blsii.ss ,M Profcsion Codc): Any Ciry o. Cou y qhich rc\]ltrl, Fnrn ro con{rucl. x&. improvc. dc.rlGh n rq{t an}
<br />{d.rurc, ri.rlo ils issua cc. nho rcquncs rhc trpPlicMl lor \!.h Frnil io filcr siEncd {drcmtrr lhar heot fic i\ liccnscrl Punuanr
<br />lo rhc ltovixions orrh( conr,clois Li.en*d llw (Chaflcr 9. Conrmencin8 wirh Sccltin TlXx) ot Division ] olrh' BL\in'\{ 'nd
<br />PmlesnN Cotu) or llur hc or shc ir.x.nu lhcrclrom llrd rhc S{si\ tn rhc rllcEcd cxctrPrnnr Arv viollrionotS..rk r703l5 hv Dtry
<br />{tlic,nt fn a p. rnrir subjcch thc .mliclnr lo a d! il pctuky .r not nuc Ihan llrc hundrcd dollm (S5tD I
<br />-l-as
<br />owM. or rh. pn'tEn y. or ny cnplort \wirhs08.soslhcnwrbconDcnsrli{r! willdo rh. edk od thc d Nmt 'i'ncMcrl or oficlcd for solc (Sa.70.14. Busitrc$ ond lrofcsi,na cdc Thc Conrtlc!{tr\ Lirrns liw doc! nor 4!lvl' !n o*ns or
<br />rhc pEpcny who hoilds o. i,qn)ts rlEN . lnd wtto dms sch M* hnnself or hcr*lf or rhmuSh his or h.r .wtr c,nnlovc's.
<br />providcd rhar sr.h i,nfmvcrEnrs E tur intnd.d ur olTcE{ lor elc lt hoacvct. rh. buillirg or inpmrutnl is Yrld wirhin orc }!s
<br />;r &mplclion. rhc O*;r Brildo sill hnvc rhc budctr of pmving fid h. or shc dn nor build ot nnprole rh. Imtrnv for rhc lruqxr{ of
<br />l. $o{ncroirhc pmFny, r'n.xclusivcly.onrr&rins wirh li.cn{.Iconrrrct s i..o.srrucl lhc tr,jdr (scc 7(,{4. Bn'i**
<br />nnd PFtL*ir cod.r Thc Contr0ckx'{ Licctrs. Lrw docs nol mnl, b m.wn$ ofrropcny *hI) builds or imlpvci rhcr.o[
<br />dd wkl conlrack tor such l,(irB wilh 0 Contracrorl g liccn*d punuanl ro lhc Co.li,croi s Licensc L3w)
<br />I n rcxcnll undcr SLdn,
<br />Dol.
<br />-
<br />Oqn€r:
<br />IIII8f,E&LCOMTENSAIION
<br />DECI,ITBA.IIO!
<br />Ih.nbyrfiirmunderpcn.lryorpcrjuryorco{lhcloUo*ingddl aliotrs:
<br />I hrrc {d will minrain a Ccdiric.lc of Con$nl to Sclr ln{rc lor wrkcrs comFdsarion- as lovid.i ror bv Sclion l7($ or rhc
<br />Luh, Codc. lor rh. FrformmE .f rh. work for whth rhc Itmn ic issu.d
<br />-l
<br />hlve und uill D|inrain qorkcr' conPe rarn,n insumncc. !s rcqrircd hy sEtion 3?m of $. tibor Codc. for rh' Fnoffic or
<br />rhc work 16! whi.h thh pcmir ir hskd. My qorkcB coryEnslion insnmne caftict and B,lhy numbcr arc:
<br />l.cnilyrhilinrhcpcrfo.,E{cr)frh.workli)r*hi.hrhnlf,ilnir i\ hucd. I \hrll nor ctrDlov xnv n odiI..v snncr
<br />K r\ ro bsow \lbjcci lo rlrc workc!( conrFns rn hwrofcllir'omir,aid4torrh il I\l'i,rk,h..otrtsuhjcclorh.
<br />wolkcr omn n\rr i(n l)n)lkhns ol SNr ion l7m of rhc tjt t Codc, I \hrll. tunh$irh conrPly * irh rhot Pmvisionr
<br />IVARi\|NC lrfllurc b k.!tc *orkeri .otrrr^-n\rri(r corthgc is unla nl dtul shrl! \rhjdr an c'nnk)]ur n' lrirnitrd F-'rlrici rtrd
<br />.iv I lirc{ u, k, om hundrcd thou\noi lollrr\ (Sl(D.otX)). ir addilnnr t, rhc ..( ol Lonrplnrrnnr' drnrgcs !\ lbvirl'd ltr rh'
<br />::TZ
<br />)lr1r l-rlbr Cod.. ifrc,.{ r
<br />:;:i:kLi?:,k,,__4e;
<br />Dqg.A.BAIIO!
<br />I hcrb, antrm undcr lcnallyofFrjnrylhar I 6n lienrn undcr rrovilion ofChaPr€. s (mmrcNin8,ilh s..lion ?0OO) orDivtion l
<br />of rhe Bxsiftss and Pmfcssions Codc, .nd ny li.c.* is in tull &tc t.d .fl'el.
<br />z- Az ->--
<br />coNsTRtl(:T!()N I xtlrlNc a{:t'Nct
<br />I hcrchy nfilnn undcr lfn,hroapcrjury rhar rheB i\ a..Nfl.rion lendins 4.Dcv 1or lhc Pcrronticc ollhc wo.k lbr qhich Ihh t,:nnir is
<br />n\ucd rs.c 3(I)7. Civ C )
<br />txtrd.rs AJJrc*
<br />A.ESLTCANIDICLAEAIION
<br />I h.n:by ollim undcr n nalry of rcrjut, oN or rh. rollowing d{l* ions
<br />Dcnolition Pcnnih Asbcskrs Noliricolion Fcdctrd Regrlrrions (Tiilc 1(r.l'n6)
<br />-Rcqnncd
<br />lxtrcr.r Norifl cdion
<br />-l
<br />o.niry rhd th. fcdcnl rcsnlarions Eqsdnr8 lsbcslos tcmval arc nol aPDlicahlc tu rhis pmlccl
<br />-l
<br />ccnilyriar I &vc rcad rhis applicllioh aid narc rh rhcabvc infu@rion ircond I [gc b.omFlv uilh nll Cnv ond Counlv
<br />ordinunccsind Srtrrc L,ws rclilini io huildi.S .onsruclion. ond heEb, lurhorizc rcEcEntariv.s olthn Cilvand Counrv lo cnts uPotr rte
<br />.'tx^c nrnrioncd nmmdv tor imrion nllrs6;;,;,;.;.,;."tr/a4.b.t-- D,,. T":/,a
<br />Subf loor/Vent/lnsu lation
<br /><Nkk
<br />lnsu lation/E ne rqy
<br />Drywall 4/2R/ro
<br />^e4
<br />Pool Fence
<br />*4ftloln t,e
<br />l/w, I a <\6q,
<br />R,licy Nrmh..-ExPt.\:
<br />-
<br />+,L
<br />-T
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