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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS OWNER AUILDER DELCAIlATION
<br />I hcrchy otfinn undcr ncntrlry oi lerjury lhd I uar cxcmpr tonr lhc Conrru.bn l.iccn{I-wr rhc rollosire,c!$tr {Scc.70ll.5
<br />B!!i'rc$ and Profe$ion Codc) Any Ciry or Co!trry {hich rcqunc\ a Fnnir k, .oi{ru.r. dt.r, impNrc, dcnxni$ or EpJ n,
<br />{fl.rurc. pri.i ti irs nsxzfrd, also mquios rh. apdi.dnr r.r\urh Fnnir !) hlcd si8trcd futnEnr lh{ lrorshc n lic.n\cd l)u(trrnr !
<br />n, rhc p'.vhnnrs oi rhc Co rscrois t,iccn{d Lrw lch,prcr 9- Commcnci',9 wirh Sccrbn ?([0 of Divtrion .1 of rhc Busincc\ rtrd
<br />Pnicssior\C,nlc)orrhnrhcorshciscxcnfrrhcrcfron.trdrh.hr\islorrlrcullcAcdcrcnrrlion.AnyviolorionorSccrt,nT0ll5hyan,
<br />appli.rnr lq !pcmit suhj.c\ rne trpllica bacivilFnalryofnornxxcrh!.lilthundr.ddouds(3500)
<br />l,.s owncr oirhc pmFny, or mycmnloyccs Rith wl8cs ns lhct solc conrlcDsllion- Billdo lhc aqk urd rh. nfldun is ml
<br />inrctucd oroltc,cdtbrslc(SaTO44.BusincsandProtcsn,nsCqlc'thcConkactr\l,i.rtrsrljwd..strol.pflyrornow.croi
<br />rh. nmFny wln b{ilds or ir{'m'q rhcmn. a.d who (16 qEh wo* himsclror h.rrlfor rhmuAh his orhcroqn cBphy.cs,
<br />Frovidcd rh,r srh nqrokm.r3 m fr, inr.ftldl or ofltrxl for eh. lt t$wcvc.. rh. builliB .r iq,mwnrnr is skl wirhi'r onc $a
<br />.fc.'rphiiotr, thc Own( Buildcr willhxw rhc hdflLn of pmving rhd lt or shc did n.r build or inDmvc thc tln)Fny fo. rhc puqx,r ol
<br />-1,
<br />rsowRrofthc lrolrny. amcxclusnclycofi.c,ir8 wilh liccmBl co.rrocloN roconsrocr rlE prnJKr lScc. rO44. 3usft$
<br />Md tkfs\hn Code: The Cnnklctr's Licc.se Lrw d,f,s nor pply b an own$ of proJ)cd y qho builds o! impmle\ rhcrcnn.
<br />rtul who.onlrdcf(trsu.hpnrrc.kwirlracoftr.kr($li.cnsed|)UrsumltorhcconrrucrffiLiccnschw).
<br />I an.xcnDr undcr Sc.u0
<br />I hcrcby.flinn und& lEnalry orlcruryotrc ofrhc roln'si.8 d..lnr,'ions:
<br />hh.r Codc. ntrrhrl)crformrdc orrhc $o nr shirh ihc pcirnir n nsucd
<br />ltuvc and qillnDinlli. lorkcrs conrDrnsari{r nNurnncc. ns requtcd hySocrion l?(Xroftlr lrhorCod.. fd rhc lcd.rmncc ol
<br />rhc wo,k to. which this pcrnit is hsud. M y *or*cm conFnsal ion iNurancc crtric. ud F,licy nu frbfi ttr
<br />-l
<br />ccnily'h0r inrhc o.rtnrro.ccol rhc work {or *hichlhn ncnnir i\ is\ucd- I \hrll nor .mpht rny I.Aon ir (n} mrnncr
<br />v, r\ b hc(mf, srbFr b rhc workcri .o,q{nsnrn,n h$s of Calirarnir. and rER c rhar if I shuld bccom subFci t, ihc
<br />qorkci\'co'nFtr\arn,npn{i\n,nlofSc.rnnrlTmofrh.I:tltrCGlc.l\hrll.frfhRir[.otrflywilhrh,spmvkn,n\
<br />W RNINC I'dlurc ro s.ur. workcrs c..rrcns{i{r ..vcnr8c i\ unliwlnl. nl lholl \ubjccr an c'npkJytr t, di'nml pcmlrics rtrd
<br />.ivil fircs utr lo onc hundrcd thouslnl dollas ($lu).ouj). ir rddirirnr r. rhc co\l oi cotrDcnsrri{,r. drmgcs,s tirovidcd lor rhc
<br />sNrion 1016.frh.l.ktr (.dc inrcrc( rn atormv ( rlcs
<br />Ihcrc$yaltt utrd.r p..olry .f p.rjury rhnr I dN ltuRtl otrJr pr.vhion .f Ch.t c! 9 (..mrmnc in8 s'irh SNrion ?m0) ot Dilkion l
<br />oi lhc Ausirc$ trnrl Pmltssi.ns Codc. lnd my liccnsc h in lullrorcc andcfic.r
<br />l;l]ILSTBlJCuQltrENluNCiliENCr
<br />I hcr.by rffirnuMcr ncnnlry olpcrjurt lhd rh..c is r.onsru.ri.r htrdir8 r8cnc, tor lic pcdo.roEc ofrhc w..k li)r shi.h rhi\ Fnnir is
<br />i$r.{l is.c lo9?. Civ C )
<br />AITUIANLIIEIIASII,&N
<br />I lucby dnnn undcr pcnrlry ofF jtry onc otrhc dlowin! d..lfarn,ns:
<br />D.nNlirion PcnnirlAst $os Norihr ion lcdcrulRcrullriors (lirlc 40. Plaan
<br />-Rcquncd
<br />L clrcror N.r if"_arion
<br />I..nirrrh
<br />'hc
<br />riridril r.Aulariotrs rc8trdf! rllr osr.ib!,ldc norrl)l]lic0blclo rhisurojecr
<br />ordinaE_cs md Strlc Lnws rcllrin8 ro l,uildins connrudior and hcrctyrullxni,. rcpr.\e y rtrd Cou.tyro cnlcr urln rtE
<br />rlx,vc trf,nr(,ncJ tnrPcdy tur i,r
<br />Appliuntor,\sr l Si,t Hltrru ," a:fl'18
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall ,r'1.
<br />Ext.(lt.Ta-Ih.'l'3-17 W;ll llal^L,,A ow b".rL.
<br />BrownE6Sf-../
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Ceflif
<br />FINAL 2-%41 V,lM
<br />Certiticate ol Occu nc
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Forms/Steel/Holdowns
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