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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS <br />FormsiSteel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/Vent/l nsulation <br />1/h/l* <br />Shear Wall <br />Framing <br />lnsulation/Ene rgy <br />allD <br />Ext./lnt. Lath <br />Brown Coat <br />l\4ason ry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certil. <br />4 t,t <br />FINAL A//z//4 ,/L7 D*.qu <br />Certificate ot Occupancy '[ ' / <br />Noles Remarks, Etc <br />oWNIiR BUtI,DER DEI-CARATION <br />I hcrchy rinn uMcr Fnrlry .f p.rjury rh l n excnfr fhnr thc (tnrrl(lom Liccnsc tjw fn rhc lolbsir8 rcr$r rsc.7031 5 <br />Busincs nod Pmlcssiotr Codc) An! Ciry or Coo y ohi.h rcqutcs r pcrn,ir b con(rucr. allcr. irrgovc. dcnxrhh nr r.r!tr . ry <br />nru.ro... prtu ro irs isnuk-^c. aho rcquncs rhc olplicrd for ru.h Fiinir k' lilc r signcd \r.rc rnr rhd t or shd i\{.ctr*d puFuntrr <br />lo lhc provisions ofrtE co.k.ctr\ Li.cnsd tjw (Chrprer e. Connencin-q $jrh Secrion 7(lD ol Diltion I olrhc llusinc$ aod <br />I'nnc$n,ns Cq,c ) or th0r hcorshc iscxcDrprrhcrcftofr.nd rhcba\k fu rl[ ll.g.d cr.nlrnnr Antviohrnriofs..riJhT0.ll5hyrny <br />aptlicrnrf.rnp.diriubjc.hrh.npplicrD oicivilpclrlryofn.rnrcrhxtrUvchutrdrcddoltrslS5{D) <br />-1. <br />xr o*ncrofrhc pmtcny. ot my emfloyccs with wngcs N rh& n,L snll.n\arnnr, silldo rh. work ard rh. ndm i\ n.r <br />inrcndcd ororcrd r{r slc (sa 7044- Busincssand Prolc$ioDsCodc rhc Contmdols l,i.ctrsc kN docs nor alply to an ourcr ol <br />rhc pmpcny nho tnrilds or in{,NrB rh.mn. dJld *ho des sxh wo* him\.linr h.rElfo. rhouSh hh or hcr own cmDloyccs. <br />lrovidcd rhtrr such i'nphrnrft m mr inrcrd.d or o,lcrctl n, sih. ,i hoEvcr. rh huiktin& or i'lqovcmnr n sut] rirhnr onc Fr <br />.f.otrDLrk o. rrE OBrc! lluilder will h!rc rhc budcn of pmvine rhn lr or rh. did frn buill or i.lpnrk rh. ln,l]cny nn r). ,rurF{ of <br />L rsorndrofrhc pmpcny. trm.xclusivclyco rndin8wfhli.cn\c.ollth.roNk,cotrsrru.rrhcfm]..r(Scc.701,1,Bu{ics <br />lnd ltlfssa,nCodc: Thc Conr r.fsLiccnr.Ijwdo€\lorlpplyloa.osn.roiprop.ny*hotuinho,inpror.srh.rcon. <br />rnd who conlndsn sucnpnjatswirhnOnr..k/(s)liccn\rlIUrsuMrrrlhca)nrack'sLi.r.s.tjw) <br />e.da <br />|ll:clixruax <br />I h..chy rlllrnrundcr !.nnlly ol !crtury onc olthc IolloEiDt dc.lrrat otrs <br />I hrv. md will mainlli! ! CcniaEarc of Conre ro Sclll trsrc fft s.rkcrr c. rr.nsario., rs lmvdcdforbyScdionlT00ofrhcIr&n Adc. lh rhc ,,.rformNe oI rhc uork l'or rhi.h rh. ncnnir t irsu.d <br />-l <br />hrvc a.d willmi.r,in wo c comFn\arion insrran.c- os rcquncd byScdi.n lT(X).frhc L!h.rCode.lorlhc pcrlor.Enccor <br />rhc work irtrshichrhs pcrnir i\ tsucd Mywork.rs comp.nsaiion insurriEc cod.r Irnicy nunthcruE: <br />I ctditu ihlr in rh. pcriormrnce {'llhc work for whi.h rhi\ r.rnrir il i\sucd. I shrll nor oryby ry Nron in any nunmr <br />b .s t(, tr.onf, rubjd t,rhc work.r\ co'nncnsarim laqsol Coliloni.. anrl urcelhrl il lshoukl tEonE {hjcd r.' lhc <br />eorkc^.otrtpcnqii{n,pmvi\ion\otscclt'nl70OofIhcht,(.odc.Ishall.lbnhsilhconrdyuilhrnorpflrvision\ <br />WARNINO: Failurc lo \.cuh qorkch co 1n.n$rn,n covcrsc is rnhwtul, ard \hrll \ul'icr rn .nrt,rrr to ri rintrl l.nrhi\ lnd <br />civil tn,cs !p ro otrc hundrcd rhousind doll0r ($100.(XX)). in r.ldirnD ii ih. con of c(nnFi\rrnnr. dri Ec\ a\ tr)vnlra ntr r[r <br />SNIiD J0?6 olrie L1try Coic. inrcrcn rM alrormyt fcc\LE1 "L%tc <br />I hcnby,flnmund.r pcnrlryorFrjrry rhlr I rm lieisd nndcr Drovhioo ol Chaprc, 9 ($nnmnc ins wilh Scclion 7olr0) ol Divnion:l <br />ol rh. Bu\in.$ and Pnntssions Codc. a myliccnsc i{ in rull fdir xl.ffccr <br />CONSIAIJCIION.LENDINC.ACD!(I <br />I h.rhysifi,mundcr pcnllty.t!.rjuryrh lh..c ir . onsrru.! i)n lcndinB UcR! for rhc p.rroflmmc ol rh. *Drk lor *hi.h rhi\ Fnnir h <br />issucd (Scc 1097. Civ C.l. <br />A[[I.IC.ANID[(LA.EAIIO! <br />I lr[hy innrnunncr ncntrlly olpcriury onc ol thc li,lloq$l d..lrfutn rs <br />l).B,liio. PcrmiN Ashr(.1 Noriil.rr iotr Fcdcril Rcerhri,,d\ ll irlc *J. Prn6) <br />-R.quncd <br />bllcr oi NotifMlion <br />I cdily rhar rhc fed€,al iegulaiions Esardins lshesros Emvll ff. nor .FlrlicahL ro rhh pmF.r. <br />-l <br />cmiiy rh,l I tovc Ead lnh E ,rlicalion and slate lhal th. rt v. infornmtion h .omct. l lgre lo smdy unh a City and Coutrry <br />n'dimnccs xnd Slltc l-n*sEhrins robuildin8 ir.s of rlris Ciry {nd Counry to cnrcr u,r'n rh( <br />$ovc nuli{nrcd rep.ny lnr irs <br />L s-a/o(r <br />I <br />Set Backs <br />UFER Ground <br />Roof Sheathinq <t\8 ,o <br />Policy Numbcr:_Erlircs: _