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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUIT.DER DEI-CARATION
<br />I hfch, amrd rndd,.nrhy (n Friury lhlr Ion.xcm fn,n lh. a.nlroclon Liccnsc Lau ior th.lo]lo*ins rcuv,n (s& 70.115
<br />Busincss aftl Piofcssiotr Codc) Any Cily or Counry whEh rL\luircs r [Ennil b consrtud. dlrcr. inDrorc, dcnmlish .r rcNtr my
<br />(rucrurc, n&,r k] irs issuoncc. sl$ req0nc\ rh. $plicrnr lor\uchItnnir t, filctr iiSicd sar.mf lholhcor shc h liccnrd !u^u0nr
<br />ro rhc rovkioni .l lrr Contruciols Liccn€d Llw (Clanrcr 9, ConrnEEins wirh Secrion TrXx) of Divtion I or(h. Bu\incss rnd
<br />Potcsions Code)ortlur hcorsh. isci.mpr rh.ftftom and rhc hasis ror rhc rllcgcd uxcnrfrion. Anyvn olionolsecriotr Ttl:] l 5 hrsny
<br />{prlic,nr ror aFnnir subi.crs rhc aftlic,trr ro acivilp.nrlryornor,mr.th{n fivc hundrcn dollan(S5Or)
<br />_1. rs o*ncr of rhc l,K,r*dy, {tr dy chployccs sirh wJEcs !s rhct !)k .o rrns,r i(,n. trill do rtE
<br />"orh
<br />oln thc srn!:luE is nor
<br />ii .elLd oi ofrcrcd tor ek (se.7014. Businc$ aM Pmlcrsiotrs Cdlc Thc corrmcror's Lietrrc liw docs nor aplly rri n ow.er oa
<br />rhc poFny sho buius or improvc rhcNr ard wh. des sNh sort himsclior fies.lIor rltoush his or h.r bsn cnployccs,
<br />Dbvidcd lhd Ju0h inDmvcnrit m nor i cndcd or otlckd n hlc. tl }x,*.vc!. rl* huitliq or imlmtc.Etrr is $ld rirhin onc ra.
<br />ofco.pLrk,n. rlt Ownrr auiLLr willluvc rh. huid.nofpdving rl[ h.d \h. il nor build or irNn)vc rh. tmlEny for lnc puqx]s ot
<br />l.dsowtrcruirhcpn,p.ny.rrcxclusiv.lycoftnritrBwrhli.cnrd.ontaclorloc.n(ru.irhcpm,ccr(Scc 7(!J. Bunnc*
<br />ond hnfc\sionG)dc:'l hc Conlrlclols l,iccn\c Lrwdoe\ nor upply b uowncrorp(,t ywh{i huildsor nnProvcs rhcrcon.
<br />a.d who conrnKrsrorsu.h ttu!{i\ wirl n co nrncron \ ) I iccn\cd Nr\urm brhc cin n.!tr's l-iccnse Lnw)
<br />-l
<br />amcxc.rpl u.dd SLrrion
<br />Dale O*ner:
<br />IVORKEeV CI),\t P6t{s,r'rOi
<br />DECLAAAIIAN
<br />I hcrcbyafiiirnu cr pcmlryolpcrjuryorc ollhc iollowin8dccLrolions:
<br />-l
<br />hrlc ondsill min'ain aCenilicrleotConscnrloSclllnsurc lor Norkcrs m'nFnrarn,n, ar nn,vidcdr.rb,serionl7u)oilhc
<br />Lubor Codc.lor rhc pcllormnce olrhc won( lor which lhe p.rmir n hsucd
<br />! hdv.alxl will nrinhin work&J comp.nsnri.tr in{nn.c. ds rcquncdbySccriorlTu)oflhclrhor(i c- ttrrh. Nd.ntui.c of
<br />lhc worklor whkh lhisFrmir i\ nsucd Mywo.kcs compcns.rion i$urircccnnjcr m<l pollc) numhcr s.
<br />r 4+J--,,c q Lo 1O >1'>L1'(a--.
<br />-l.cnifylhll
<br />irthc |E for.urncc ol lhc rort lor whichlht p. nir is is\uqt.l shall nor dn,lloy ny r.6.n ir rnynrnmr
<br />$ n\r, b.(,m rubarr rolhc sorkns con1l).N nr hwsorcalirdnia. nnd a-!rcclhd ifI sh.uld $cco* \ul,jecr hrtr
<br />wo*cr.onrNn{nrionrmvhiotrsofS.dionlTmollhcbhorGxlc.lshrll.nnhwirhcompl}*ithrhoscpmvtnd\
<br />WARNINC: Fiilurc ro securc worke,( conrFns.rion covcmse i\ tnlasrxl. md shall lubjer dr.mploycr lo dinirdl pchlrics rtrd
<br />ciril rines uD kr onc hundrcd lhou\and dolla^ ($100.000). in lddirtr ro lhc.osl oa conP.n\nrn,n. d,nuB.s ns pmvidcd |or rhc
<br />O^". :: t(' ( L, Appl r"-,,Xuu.5ll[llJrrxillui]
<br />DECI.ABAII(IN.df p.n.ny or pcrrury rh,r I m li&n*{ utriLr Jhvisn'n olCh.Frcr 9 (.onnrcrcirs Niln Ssrbn ?(r(J) orDivhion l
<br />rhc Bu\i'rc\\ r llol.s\i,,$ Co!I.. rftl D,, Li.ctr\. i\ i'r ltll tu'.. r,x!.l1i.r
<br />c-.3n e oco.t t t
<br />4'(?,'L y) (,,tr,r.dn x +--a f g---<-r-, Cs
<br />c()$ AUqIIONIINDIN.(j.dEENCI
<br />I hercby riirnr unds ,cn.ll y ol psju ry thar ihc.c n a c.trNrucri'n hndins !-!cmy tu lte pe{o.@ec olrhc work lor $hich rhh Peirnn ir
<br />is\u.d (Sc..:1097. Ci!. C ).
<br />t.ndcr's Addrc$:
<br />-atrtlc Nr.!EctA8a.1I0N
<br />I hcr.-6yrtltnrundcr pcnollr.f pcrrrry.nc olrhd following licclrrorio s:
<br />DcnDlirion Pcrmir+Asbcnos Norificarion Fcdcrul Rc8ubri{,ns (l irle 10. Pln6r
<br />-Rcqutcd
<br />lJrrcr ol Norifi clrion
<br />l.r lryrh rh. rcdfdl rcBU ldl io n s rc3lrdnr8 rsbcsros rcrmvllarc tulapnliclhlc
<br />'o
<br />rhhI]rrjc.r
<br />lluf ccnirr rh t hrvc rcad rhi\ trpplic ionrils crhr rhcrh,vc inronndiotr h corccr IrSretocomply*ilrrtrllciryand(i)rniy
<br />odinanc.\ rnd Sr c ljws rcbrine io buililing.unsh.rio.. d*l hcrchy,urhorizc rclrcscnrdives ofrhh Cil, and Cou,ryt, cmcr xF,n rr.
<br />nhovc Dcnri Nd proNnylhr insnccli{,n}rurross
<br />r\rDlionn or,\*on SiAnrlurr X
<br />p" ,i*" " ^" ron"l.l1- lz! /*vni.ttt !z-r v ,,-*-
<br />a -(b -(o
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing 7/w/tt Or,uDTrr-/07-
<br />Shear Wall
<br />Framinq
<br />lnsulation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />I
<br />FINAL
<br />Certificate of Occu anc
<br />No emarks,tcS
<br />--t
<br />Pool Fence
<br />Sdiotr]0?6ollhc titnr C.dc. intcrc( ond otroaEy ( ncs.
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