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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE rD/srG.COMMENTS OWNER BUILDER DELCAfuI'IION <br />I hcrcby iffifln undcr NnalryorP.rjury lhll I m cxcnul iror rhc cofta.un l-ic.Nc Lrs rot rhc ioll{,win8 rci$n (scc 70315 <br />tlusincss od Pn,f.$n,n Cdlc) Ary Ciry or Counry *hi.h rcquncs I Isrnii k' .1nNruct. alrcr. iarProvd. dcnFlGh nr rPrt rnv <br />{fl.iu(, prnrb ns ksuaDe- sl$ rdquircs rhc tPIli.ant lor {rch P(nnirb lilcrsisncd nrrcnEnr rh{rhcor shc n liccn\cd lur\udnr <br />lo rhc InNiln'n\ of rh. conraciols t,icen*d t-aw lch Prcr 9 ConnncNing sirh sccrion 7(x oiDivi\n'n:l ofth' Btrsincs rtrJ <br />Pmrcsdns Codc ) or th3l lEorsh. is cx.mpr rltmno andrh.lEsntnrrhc,ll.Scdcxcnrflion Anyvirlariotrolsdi).70.rI5hvrnv <br />aftliconr ior o pcmrihubjcc6 rhc q,plicont lo rcivilPenalrrorn.i nrrcthan fivc hundrcd d.llds l$500) <br />l. r D*ncr ol ihc Dnrrly- or my .n9nrycs wilh wascs is rh.n vnc conlpttrlaliotr, ! i]l do lno w.rk dnd rhc srulurc is ior <br />icn&l oro,Ie.cd nn salc (se 7(}14. Busincsslnd PmfesionsG)dcr TtuConrrlcroi\ Liccnsc l-rq docr nor oPPly nt owncrol <br />rh.pn)Fny sho hoilds or in{rots rlrfr)n, !d Bho dG suc[ s()ii htnsclfor hcrcll.r lhrolgh his or hcr oEo cnDlov.cl. <br />nrovidcd lhlr \uch inrpmkn*ns N noi intctrdc or ollctd fot vlc ll hJwcvcr. thc &ildilu o' imptuvcmnr $ skl sirhii otrc ttrr <br />of.onDlcrion, rhc O{rcr Builds willhdv. rlr bordcn oftroina rhrl lt or sh. did mr ttrild or in{'nNc rhc pmlh} lor rtE puq-*of <br />-1, <br />is owrcr of rhc nmp.ny. ,fl cx.tusncly co rscrin8 sirh li.cn\cd.oMacrnn lo coi\l crrlrnrcrd(Scc 7(xr. Bx(in'{ <br />sid Ptulir\k$ Codc: Thc Conlrenr\ Liccn{ Ln* d.c\ not rr)oly b u osi.r ofPrcl.ny qho huilds or inrpii,vcs lher..tr <br />.nd who conrEcrs r{tr iu.h prcjc.h $ith a Conhcttrh) li.c.icd Pusuanr ro rh. Conrdoas Liccnsc ll*) <br />. B &Pa tcrrhFrcJ.,in <br />UA8trIIEIAITPINIAIION <br />DECI,ATAITO! <br />I hcr.by ifll.nundcr pcnrlry ot pcrjury ooc orrhc follosin8 dcclutn,ns <br />-t <br />hiv. $d will minrnin r CenifEarc ofConsnr ro S.lf.lnsurc fo! workda .oqEnsarion. as lrolidcd for bY Sccrion 1700.f rh. <br />t21,or Codc. lor rhc p.taolfue of thc sod< to. which rh p.r.rir is hsucd <br />l\-/irlf hvc dnd srll nEmrlrn worku*' cumpcns$on msu,ancc. !s rcqxiEd by sNl ion l70O oa rh. bbor Codc lor rh. Fn'mm' or <br />rhc wort lor which lhis pcmir i3 hsucd. My workes .ompcnsarion insumn.c cr cr and Flky nun$cr {c:tz-v <br />-! <br />ccnily lilr in rh. rcd.nrEtrcc olrhc work rbr which rhil t*nir h issucn. I shrll nor cnllllov.nv pcF.n in rtrv matrncr <br />v, rsro hc.om subrccr ro rhc eortcs con{c.\arion ldwsofC.l 'orniD, rnd Ngrcc rh.l ill should b..onE subiccl l. rlt <br />workcr\' c. r!.ns,riotr lmrhions ol sc.r ion .l?m or rhc Litrt Cdq I \hrll. nfhwnh omPl, {iih rhoc pnvniuN <br />NARNINC: I{ilurc b *ctrrc wurkc.(.onqEnsllii'n coecBE. i\ utr1.wtul. nnd \hall \rbirr .I emplo}[r r..rimnr0l P.ulric\ and <br />civil lincs !p k, o.. hundrcd lhousnnl iolla^ ($1fi),0(x)). irr tddiliotr lo rh..o{ ol.omprnsurion da iaC.s.s pmYi'lnl r;r rh' <br />::;:}/,2H" <br />DESLAE{ION <br />I hcrcby amrnr undcr rE alry nr,r.rjury rhar I im lien{n und.r FJlirion ol Chlprs I (em,Exins eith Seclion 7m0) 'r l)ivtion :l <br />ol rhc Busines.nd P,olt:iions c.{.. d <br />'ny <br />lkcn$ n in tu ll rd.c ,nd ctl'$|. <br />e3 zs((7e <br />COISI8I"LGIruN.LINDI GAGENCI <br />I hrrcby aflli,n uMcr Fnolry oi ptrjury rhar rh.rc h , co.idclbn lcndin! +.ncy l'or th. lErlhnture ol r qor[ li, *hich lhis ,ictnril k <br />isucd (Scc 1097, Civ. C.) <br />AIILISANLIEII.ASAIION <br />I rlriby nmnn undcr lcnall, orp.rjuryonc oflhc lollowins ncchrdri.n\: <br />Dcnshi{,n P..Dn$Astrslos Nolificarion F.dchl R.Sulatio.s ('l irlc 40, Pd6r <br />_Rcqrncd llrrf oi Notifi calion <br />I ccniiyrh rhc rrdcrrlr.suldi('ns rcsddirs ishc{os rtnn)val arc not.t'dilhlc t'rhn p(+rl <br />ordimr.s dd Sl c Ij$ rclrtin8 t, tu <br />Jh\r n'ctrri.n(! nnncny f.r in9ccrion <br />^p',rio' <br />m <br />^smr <br />sismrun )L <br />Dd nnr and hcrcl,y Duhoriz. eprcsctrfulilcs or I <br />", n**.,on^,. /Z.&y' fr4>.'zz/-S- <br />::;ZDi <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Roof Sheathino c t-11-ty h.wu <br />Shear Wall <br />Framinq <br />lnsu latio n/E ne rgy <br />Drywall <br />Ext.i lnt. Lath <br />Brown Coat <br />lt/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Depuly Final Report <br />Enoineer Final Report <br />Flood Zone Certif <br />A\ <br />FINAL 0 -zs x-\P+Jd <br />Certificate of Occupancy \f <br />Notes, Remarks, Etc. <br />Sublloor/Vent/l nsulation <br />g fu=-. <br />I