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BUILDING. INSPECTOF RECORD
<br />SITE-WORK DATE ID/SIG.OWNIlr BUILDER DELCARATION
<br />I hclcby aftnr undcr pcn,h, or Frtwy rhd l dn cx.mpr liorn thc Conrrd.,s Liccnsd Law ror lhc rolloli.S E&)n isc.70ll.5
<br />Busincss d.d Pr.rcssiotr C)dc) Any Ciry or Counly which rcqtiE\ r Itmn b .otr(dcl. nlra. impn,vc. d.nn ish or rcfrt rny
<br />slrudulc. nrh.lo ns hsuamc. als rcqoncs lhc,ttli.rnr ror su.h pct.ril lo filc 0 siatd dar.nEnr ih,t lror shc h liccn*d puruanr
<br />ro rhc pnrvisiotrs ofrhc Conllrcr{tr\ Liccnscd hw (Chrprcr 9. G,nnrn.i.8 uith Scclion ?fin or Di!i\n,n 3 ofrhc Busincsr rnd
<br />P!fts\ionsCodcrorrhdlltorshc is.xcnrrr rhcrctmm Md rh.lnsh lor rhcallcscdcrcmprior. Any viotrlionofs..ri( 70:ll5iv.nv
<br />atnlicr.r ror a p.rfril suhjeh rhc amlicanl lo !cirilpcnrlr)ornor nn,rcrlrtr rivc hundrcddollfl. rSStx))
<br />-l-
<br />!s o*nc, oarh. poFdy, or mycnlphles Nilh wases rs thrn M,b c.ml.ns,l,.n. Billdo thc *otk ud rhi {mrm i{ mt
<br />inrc,rLd oroUtrcd for slc (SN 701-1, Brsincss and Bofc$n,d Codcr Th. Cotrtrrctor'{ Liccnsc tre does nollPplyro in oarcr of
<br />rhc F)pcny *ho hdild\.r in\r(xs rh.ren. !.d wb dmr $ch k,rk hin$clfo. hcr*llor rhr.r8h his or h.r ow! cmPkDt.s.
<br />provdcdrhrt slch improvcmnis m nn inlc .d or ofitnn for eh. ll. hoscvci rh. buildine ot inpmrcmnl is sold whhin.nc ,c{
<br />or.or9Lri.n. rh. osncr Builhr sil horc rhc t{rden of l,oins rha hc or rhc dil nor build or irlll,rorc rtc poFiy for rtr pulrc oi
<br />l. rsowncrolrhcpmpcny. amcr.lu\ivcly.oilradnrs sirh li.cnscd cofll racloF ro co i nru.'
<br />'h. Pntlccl lscc. ?014 B!\idx\
<br />oRl hrlLssnn Codc: Thc Conts.roas Liccnsc L,w docs nol 0l,ply lo an osncr or ptul.dy qho builds o! nnPr.v$ rhcrcotr.
<br />und who co 6ds ror su.h rrqccIs wilh ! conkekrc) liccncd l)u6uanr tu rh. cbntrnctols Li.cnsc L!*)
<br />_l inlcrc ,pt u doS$rior
<br />Drle O*ner:
<br />woRKFks- iralrPr(\ATt0N
<br />DECLA&U&N
<br />I hcrcby i,-iirn utrtjcr ncnrllyotrsiury oi. of rlr tul.win8 dehmrions
<br />-l
<br />h3rc ..d will roinrain a Cedifi.rrc or con$nt b sclr. losurc lnr wor*cd &'npcnsdion. !s Providcd for l,y s*itun l?0o ol thc
<br />tibor Codc. for lh. pql'otrr]me or rhc wor* n, Rhi.h rhe t nnit h issucd.
<br />0 rl{tr\rri(fi iNurikc 1!rcquired nyS.dn lT(X)ol rh. Lrhor Codc. n rhc pcrloflnnn.c of
<br />hn ifturanc..nricr mdjlntynun r.r m:
<br />I
<br />t ccnifyrhar nr rhc lBrL mnccoirh.worki{trwhichrhi\Fi,niihi\srcd.Ishrllnarcmployrtryp.rn,nnrrtr}manmr
<br />so $ Io tr\orN suhic' ro
<br />'hc
<br />work.^ .o D..\ario.l.ws ofcaiiri)tni.. and a8rc. rhar irI sk,xld t co'rc uh]cd t, rht
<br />s.rk.isdnnnrr\artrpRrvi\i,)i\ofS..rtr:17(XrofrhcLrhtrCodclshrll.a{nrhwirhcotrt)lytr
<br />\YARNING frilurc hr *curc *ork.ri con,Jrnsrri(in.o!crr!t i\ u J'k'tcr ro dmirl txMlrics Md
<br />.iv'l turcs ut t,.ic hu rcd rh u\rnd.tollrr\ lSl(X)(XX)). r d[rnnr. dr trAcs as pr,lidcd nt rhc
<br />.2 ?-
<br />I li.rhyrft lndf F0rlryofp.rjury lhar l,m llccn{rl undcr nn)vl\Chrptcr 9(conntnci'rg silh Sc.lhtr ?Ox)) olDi!i\i,'n.l
<br />4nzr<rb7
<br />IA! A]]l:1loNIDNlING.dqEN.cI
<br />Ihcrcby iflirn u crncnrlryolp.riuryrhrrrhcruNa..n{tucr.nL.dinA{8cm)(tr(hcP.rfonlh.colrhcsnrkfi,wh'chihitFnniri\
<br />irsu.d rS.. 1097. Civ C ).
<br />AfilrraNfDl:ct &a.trQ!
<br />I hcftty rninn !ndcr rnrlry.lp.rjury onc orlhc lollosins dccldrrnntr:
<br />Dcnmlirio. Pcrmirs A\h.{os Norific id kdcralRc8uldiotrs (lirlc.lO. Pan6)
<br />-Rcquircd
<br />lJ[cr of Norii.nrDi
<br />l..ailithat rhclcderdlrcsullrion\ rc!&li',r J\h(iu\ tunn)vnl r' c hr rl'Ilicihl. ri rhl\ Pnij.rr
<br />_lccnilyrhur I E,vcrordrr'i\rirdkarionturlinrcrh corl{r l.ELr ro co plywirhnllCiryd 'lCoutrryonlimtu.\ r Srrrc l-r$\(Lri',!n.scnr.rivcs oirhis Cily and Counry ro c l$ utotr rhc
<br />ih^c.Etrlidrd rrpcdy rbr
<br />.\pt,lir nr or,\s. l SiEnilu
<br />q.eg4
<br />Set Backs
<br />Erection Pads
<br />[JFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq o/ttltt 6m>a-/ s>---
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL bh<//P &usra /o
<br />COMMENTS
<br />Formsi Steel/Holdowns
<br />Pool Fence
<br />Flood Zone Certil.
<br />Certiticate ot Occupancv
<br />Notes, Remarks, Etc.oI rhc Ilu\i',c$ rid Pn'fcrsnnrs C.d., rRlDy liccnr i\ in tulllbRr{ntlclra.r
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<br />t trdcr. AdJrcs:
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