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BUILDING- INSPECTOR RECORD
<br />.I SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf Ioor/VenVl nsulalion
<br />Rool Sheathino
<br />Framinq phz lrl I Y /. C)s,,zos ,*.€**<t .,LIA(O
<br />lnsulation/Enerqy
<br />Drywall'Eiiltnt.
<br />Lath ?t lo \rB \ r.c,)1,1//{ A)
<br />Brown Coat
<br />l\ilaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cedil
<br />FINAL
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />OWNFJR BUII,DI.:R DELCANATloN
<br />I hcrcby lifi.n rndcr l)Cnrlrt ,, Frjrrt rh,l I m cxcnU ,i!n rhc Cotrlm.n)F l-ien\c lrw la hc rollowirs rca$n (Sci 70.11 5
<br />Busnrss rlld Pnrlcsn d)dc) Any Cily or Counly whicn rcqutc\ 3 pcrinir k, .otrsfl.r. rhcr. itnPnu, dcnn,lish or tlln iny
<br />srrucrure- prtn ro ih i\surrcc, !lv, icquitos rhcamli.rtrr fd so.hFnnir ro ilc o si3lcd dar.n.ni rhd bc ot ih. n liccnscd lxrrmr
<br />lo rtr pmvisiotrs ollhe Conirdckn r t,iccnscd u* (Chaprcr 9. Cormcncing sirh Scction 7(Ix) ol l)ivi\i.n.l .r rhc Btrsinc$ rtrd
<br />Pdi$ions Codc)orrhartE o!\hc i\ rrcnDr rhctuli. Md th. hr!i\ r(rrhc {llc8cdcrcmplion Anyln'hrn ofsdi(in,0.11.5hyany
<br />afllicrnr fornpcnnir subj<h ihc ipplrinr b r.ivilpcnrlry.fmr nore rhan fivc l ndrcd dollr\ l$5Ul)
<br />I. ,s uwn.r of rhc prcIf,nr, or nry cmployrrs uilh $!scs !s lhct y,l. .o rFner ion. qill do lh. so* ad rhc detft n mr
<br />inEnk or oticrcd fr sle (56 7014. Bu\inc* Md Pof.$i,ns cdlc: Thc Conrrhis Lkcn* ljw d{$ nor ilrly r. ioowmr of
<br />rhcrmpny qhl hoilds or i.Itms ltE@o. old wh. dms sKh so* him\clloi horlror through hn or h.r own.npl.yces.
<br />prcvidcd rhar such nnprcv.mnn src nor inrcndcd or offcr.d for $lc li howNrr, rhc hitling oi i'rll)mrcmnr is sld eirhin , 'm ]t tr
<br />olconplclion. IIE Owncr Buil.tcr will lult thc bunlci or !r.!inA rhd hc or shc dld nor ttrild o! impmec rhc loFdy fot lhc luq{s ol
<br />-1.
<br />rs owE of rhc l,rrpcny. !n dchsnrly c.nhcring *irh li(nscd cotrtr.cnrn lo connrud
<br />'hc
<br />pmi{r (srt. 701,1. Businus\
<br />md Piofsson Codc ThcConrra.iolsl,icclscl,ordoesloropplyror..{i.rofptol/- yuno huildsor i.,pmvcs rhcrcotr.
<br />ud sho cont&t fff ruch pnrF.c wirh ! c.trltucro(9 liccnscd lunuanl lo lhc C,n fucttr\Licc.rkw).
<br />I n'n crenltr utulcr scclion-- B. & P C. tu rhis trs
<br />\l2adlilsllJuflNslru()IDli(r t1 -!!Q!
<br />I hcrcby rnnnundcr pcnlhyofFrJurlonc oirhc iollowin8 dcchFrtn'\
<br />I hav..nd will tuinrain NCcdilrcrrcofConscnr ro Scli'lnsurc for sorlc^ .onrNnrrtion.as Pn,vidcd fotbySsrion]7mofrhu
<br />ljhtr Codc. tu lhc pcrtolfucc or lhc wor* ror whi.h rhc ldmir is hsucd.
<br />Ihrvcandwillhnihrdnworkcrs conDcns ii irsmncc..s rcquircd $ySccrion:17{D.frhc trhor Codc,lor rhc Pc.iontu..c.f
<br />rh. work ror whi.h rhi ,.anii is krucd. My $o!kcr' compcn\rrion insurrnce.aricr srn poi.y numbcr &c:
<br />Poli.y Nu $cr-
<br />-l
<br />linify rhll in ihc pcrrontu cc.rrh. work n, whi.h rhi\ F. nn n i$ucd.I shlllnoi cnphynnypc*on in..y mlnner
<br />v, Ntu tr.o f, suhi.r ro rhc {orkcrs .omncn\ari.n la$s olCllilhmir. ud a3d rhri if I should b.tom suhFlr b rh.
<br />wolkcrs conrncnnrtion tmvGio.s o! Scclion lTlloollie lihr Codc.l shrll, rodhwir,r.onrdy wilh llt,s rr.vni.ns
<br />WARNINC Fnibrc ro sccurc rorkc mmpen\ iotr covcragc $ unlasfol. and lhall subjc.r itr ctrlPlo]ct ro doinal Fmhics Md
<br />.iuil lincs uD lo onc hutrdrcd rhouland dolltrs ($100.000). in ddnion b rhc.us ofcomlEnsllnrn. dzturc\ rs jtrovidcd,nr lhc
<br />SRrr{ lu.6,.l rhc lrtry C.d.. inrc'c{ Jnd rrom) \ f..\
<br />tlcEtrrLcaNrxAclaf,
<br />DECI,AEAIIQN
<br />I hcrcby rffiri und.. lenalry or lcrjury dar Ln lianscd undcr B)vnion of Chrprg 9 (mm rmnrS with Sdion 7(xn) or Divnbn .l
<br />oI thc Busircs and Prctc$ion\Codc. drd oy 1i...\. ir h rull tuie dcflel
<br />(IINSTRUC'TIoN I tsNI)II\(; AEI'N(:Y
<br />Ihrr.byrflirft!ncrpcnnlryol,)crluryrharlhcr.isrconslruclionb irgrg.cylarrltpcrionnrrccolrhc*orkf(trthi.hrhi\pcanilis
<br />is\u.d (Scc .l{D7, Civ C.)
<br />l.cnilylhrr lhc lidcrnlrcsuhri,)n\ r.!rding n\bc\t^ rr n,vrlrrc nor 0!pli.rhlc !,rhis poiccr
<br />l.cnnirh.r I hn\r rcld rhF l,rpli.!rion and \llrc rhar rhc rh,rc innrmrnr s.on$l I aarelo.o,.plysirhillCtrrnd Counry
<br />onlirrtr.cs and Srntc Lrqs rclarin8 ro huildinB conntucrion. dd h.ftbt aurhori^ rcfrcscnrdivcs olrhn Cir, and c.untyh cnlc! uron rhc
<br />ftovc r t rd rotBdy for ins pccl io n purposcs
<br />AU,lic,nl or ,\q0l Sis rltrft
<br />I'€mrile nanF (prinl);
<br />I
<br />Shear Wall
<br />t ndcis Na'm'-
<br />APIIICANfI]ECI.ATAIIIIN
<br />I hcrct y.trrn undcr lcnolty ollcrjury orc olrhc ldlowins dal&rionsl
<br />D.nhliriod P.rmirs Asb.nos Notiiicltio. Fcdclrl R€BUla'ionsOnt 40- Pd6)
<br />RcqLtcd lJ{i.rorNo fi.dion
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