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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER AUlLDER DEI,CANATX)N
<br />I hereby annm Dndcr pemlry ('f Plrjury rhar I on crcnfl ln,'n rhc C.nra.ron- Liccns tiw rb, rhc followin! rciion (Scc 70.ll.J
<br />Bu\iir\\ r'rd Prufc\sioi C(x1c): An, Cny or County whrh rLrtuncJ r rrmir ro conddct. alrcr, impovc, dcnmlisn or rcn]t rny
<br />srru.rurc. priorro ns hrurn.c, rho rcquies rhc q'tlicanr lor ch [Ennir n, lilc ! sir cd {rrcm ll[l nc or slE t lic.n\cJ tursu:or
<br />ro rhc provist,ns otr& Conruckn s Lic.nsd lis (chnprcr 9. Commcmirs Nirh S.cln,n 7UD of Divirion .l ol rhc Busincis rM
<br />Pn,rr*ionsCodc)orrhd! h.orshc iscxcmpr rheNfro'nandrhc si\ rbrlhc xllcccd cr.nyrn AnyvnnationofsdionT0lll5hyany
<br />atllicanr rorapcrn rsubjcchrh. aprliclnr!oacivilpcnllrrornor rmdDn fivc hutrdrd d.llam I $500).
<br />.l
<br />I. N osncr of rhc |n,Itny, or nry cmf,olBs wilh saScs 3s lhcir slc .oBpc.s n , will do rh. work ud lhc slMr@ is ior
<br />i cnlcd or ontrcd lor $lc (Sa 7014. Buircs ind Eotc!\ions Gdc Thc C{,.trdois Liccns L,w docs n l amly h,nosffi ol
<br />rhc pnlicdy *no hrilds or impm!.\ rhtu,n..nd who &f,s such ao* him{lfor hcrscllor lhnuAh hh or lr-r owncmplnyccs.
<br />prclidcd r hdr such inrlmKnMa @ mr iNcnd.d d oltmd tu $h li how$cr. lh. hiklin8 or tnpmrcftnr i\ $ki wirhin onc )t
<br />.f.ongkrion. rh Ownd Buildd vLU hrvc rhc bu' dcn of !i(,vir! rld hc or shc rlii mi n,ih.r in!,ro$ rhc pmpdr li,r rhc txlB,s ol
<br />I. r\.wnfofrhclrofcny. rmcxclNivclyconrr0ctins $ilh li.cn\cdconkr.n,^t)drnifl.rrtE trojcl_l (Sc. ?()4.1. Bu\i'tr{
<br />xna Pll)assiotr Codc -lhc(:otrlract, s t-iccn\. LrN doc\ norryplyb dsncr.l fr)prrrysho huikl!or inrtn'vc h.rcon.
<br />rnd sh..ontn.rsi(rruchflojccBnilha(-odmdo(9liccn*dpurruxrrr)rhcCotr.rtrrl-i.cnsct;rw).
<br />I mrc\cnrln uDdcr sc.ri,
<br />o*ner
<br />UABtrD&ICI'UIENIAIAN
<br />D1](:I ARATI0N
<br />I hcrcby alli.nr urdcr ncnrlly of p.riury onc olrh. loll,,*ine,lc.lrrrion\
<br />I h.vc rxlwill nEintrir rCcnlficllcoIConsctrlroSclf.lns!rc tor *orkc6'coDpcnrdrirnr, as lr.vidcd for brSccrion:l7OO otrhc
<br />l:b culc. n,rrhc pcraonMRcofthc wolk lorwhichlhc pcrnrn h issucd
<br />-rhNcrtrdwillminriirwortc6rcompcn\arnnrinlurin.c.r\rc+n.dbysc.ri(,n17(x)olrhcLrhorCodc-to,rh.lLrirn!tucorrhc $ork n, shich rhhFrmir is is\ocd Myworkcrr compcn\rrnr in\xtutr.c.dicr dna t'olicr oumbcr arc
<br />Poli.y Nun$dr-Exnno\
<br />_lceniriih0! inihc pcnbrnBtucotrhc w.rk for whi.nrhk Fnn[ h n{rd.l shrllnot c.r oy nny pcnon in any mnDmr
<br />s as k, b..orm suhj.tr b rhc For*cr clrpcnsirior hws icrlilomi!. lnd !!rcc rhar ifl \hoold trcoft srhjd x,ttE
<br />sortcF conrpcNiliotrpmvnion\ofScclionlT0(,ollncl,onrrOxL.l\hll.ronhwirh..mtlywirhrho*pmlhiotrr
<br />,lxtrrgr\ rr t)nrnlc(l tur rhc
<br />rm!i\n,. ur C hrprd 9 (.onnrcnci.g $irh Scclion 7([o) ofDivnion.]
<br />or rl[ Busims ind Prolt$iorN Codc. ond nry ltcnsc h in
<br />s?
<br />""r",4
<br />M.r Nndllyol Nrjuryrhdr I i,r8 lgcncr ad rhc p.rtann,n...irh. rork lor $hich rhn p.rmi n
<br />i\{'c(ltsc. .1097. C'v ( )
<br />AfTLICANLDE(IAXAIIA!
<br />I lrtiy rmnn undcr pcirxy oit'.rlury onc otihc ftllowinS dccl0rrlion{:
<br />Dcnn,liiion Po(iB A\b.no\ Norifi.arion F.dcrul R.8uhrn,n\ (Tirlc ltr. PM6)
<br />R.!utrc'l t ($ of Norlrcariotr
<br />rctuul dc ..r applicrblc lo lhis prcjNl
<br />lbovc inrbmdi.tr h colBr.I a8re bcnmplywirh allCily!trd Co
<br />hcrchyaurh.riz. rctrcsdalnc\ ol thn Cily and
<br />::,SYJ mi 1,&
<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
<br />Shear Wall
<br />Framing
<br />lns u lat ion/E n erqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL rillm t1 ,^rrrlt ^/-zD). r -!rrCertilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />T-Bar
<br />Flood Zone Certif .
<br />{'bl.cr .nltlo)ar r) .n nml Nnn[n'( rna
<br />D 0'\u,
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