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BUILDING. INSPECTOR RECORD
<br />SITE.WORK ID/SIG.COMMENTS OWNER BUtI,DER DI,:I-CARATION
<br />I lEr.hy rllirnr undcr Enahy ot pcriury rh l u crc.9r fmm rhc Conkcnns t-i..nq Las lor rh. f{,ltowin8 rclv)n (Sc' 70.11 5
<br />l,usincss and Pnncssi.n Codc): Any Cn, ur cou y whi.h rcquircs a Fnnir ro consrrucr' alr.r' imPove. dcnnlhh'tr (lri inv
<br />ntucrrrr, rrlor ro irs issulncc, rkD rcquncs rheaDtlkinr ntr skhFnnn h filcfl \isncd ddcrhN rhal hcff \h. is li.cNed lru6uanr
<br />ro rhc pmvtions of rh. Controcto s Liccn{d l-.s (ChaPt.r 9- Conmctint wirh Sccrirn 7(XXl of Division I orrh' B \in's 'trd
<br />Pdisst,nsCod.) orlhar tr orshc iscxcm lhcrciro a rh.hs for lhc ollcgcd cr. rnrion. Atrvvioldn ofsL{rim70:115hyrtry
<br />rpt'licrnr ri)r a ll.rnir suhjc.h thc nttlica loaciviltt rxyolnor m,!rhai fivc hundrqtd.llan ($s{x))
<br />l. r\ owncr ofrhc popcny..r ny cmDloltcs wilh wagcs a\ ihcir slc.omfn\dnnr' *rll do llE work lrlrh. {mhrc i\ nor
<br />tr cNlcd oroficrq] lor slc lSN.701,1.lt!\inc\\xid Pnnasn \ Codcr'fhc Coitx.roi\ I-iccn{ lrwdocs mr rPplvrr mo!rcrol
<br />rhclnliny who huilds or i,nnn,vc\ rllNn. lnd *h, dms {.h w(rk hnn\clfor hc^clf.Ir rhmugh hi\ or hcr owtr cnl,irvcc\'
<br />poridcJrlursu.h inD(*crmnh rc or cndcd ortlllr<ll'r)r ulc ll, k)wcvcr ihc huikliry or nnrovdnf,nr i\ skl qirhi.onc,ttr
<br />;iconrrLlhn. rlE osnrr sur{d eillh{rc rlE trrdci.rfnrvrS rtu( hc or \hc Jrd trtr tnrild o. nnPmv. rhc lsPsnv nlr rlf, Nrlr)coi
<br />l. ,s .wNr ol rhc lrotxny, tcx.lusivclycontrcri^g$irh lNnscd conlacktrs t, .on(rucl liE Ptr,rc.r (S( 7014. Br ncsr
<br />and h.B\ion Codr: Thc Conlracnr\ l-i.ctrsc lnw docs nor aPJrly t, rn ostrcr oin('P.ny who huil'ls or nnprovc{ rhcrcon'
<br />trnd sho connrdsntrsuch pmtccrs ,irh tr conk bds) licctrscd Plrsua r k,rhcCotrklcroas t-iccnsc I1*r
<br />l. cxcmpl und.rsernn-
<br />]IQtr(II8I.CONTDNSI.IIAN
<br />I,UiI.LABAIIO!
<br />I he'.hy rlTnnu dcr r.hlry olpcrjrryoic nfrhc ldk*vins dc.]rrrri{trt\:
<br />lih.r Codc. turrhc I).narrnrnccolrht qork 1,tr qhichrhc pcnnir i\ i$trctl
<br />I hrv.nmlwill nrirllir sorkcrs ..nr!.n\rrior inuranc.. \ rdqutr l hySccri, :17(X)oilhc lnt'orCodc. f.r rlt lcrnrnr$,rt1fqunhtnoq,n,.,^d.J.tttltrnr(c',\.n'n.tr.i.nn.tru,.1icrr'tr1r rlryn.trnhc, r'.'
<br />,.,"",*erQ- An/'",.',"Wqltlt(
<br />I ccdilyrhal in lhclcrtonnamcofrhc work ior whi.hrhi\ Pcflnil is i$d.d.l shall not cnrtlovrnll.rnnr ir rnvnmrr
<br />so as k, lEcom {rh,c.r k, rhc ro.tcr' L$,hp.neri,n liws oi Crlili,rnir. md 4rcc rhd if I \h.uld bccom sbj.. o rhc
<br />workc r.mpcnsdion [)rnions ofSc.ri(,n ]70Ooithc ti}ln Gxlc,I shall.lhnhsnh conll)ly wiih rhot nn)vi\ions
<br />WARNINGT i'oilurc l{, k.ur. wolkcr' conpcn{ri,nr c.vcasc is nrl0$r!|. rtr slrll subjccr ur c rllovcr ro dmiMl l).trrlrhs mn
<br />.ivrl fincs u! loonchun ed rhousrnd dollaB l$Ifi).(loo) addirion k' rh. cusl ofcomFn{rion. drnugcs r\ lln']vnhn l,('r rhc
<br />:::",::w/'f'''^"^:
<br />DECIdSAUAN
<br />I hcreb! sffirm undcr lcn lryoir.rlry rh l am liensn under Provi\i(,n.lCh.t'rct9klnn'ftn.itr8 silh SNriJn 7(xD) ol Divi\nnr l
<br />ol llrc BusiN$ und P(nasions Code- lnd nrrli..n{ is ir lill lucc andcfic(r.
<br />/1625
<br />CoNSTRIJC'TION LF'NDIN(; A(;FI\CY
<br />l hcrby nllirnr uNlcr pcnahyofr.rjurylh lhcleis!consrfl.riotrlcndinga8ctyntrthcp.rfomn...frh.wotkforwhi'hrhnPcnni h
<br />ksucd (Scc .1097, Civ. C.)
<br />AI'P! I(:AN'T DTCLAIIA I{ IN
<br />I h.Rbyrmnnu cr p(mlry ofnctjny onc ol rhc folbsing d..lffrrior\
<br />D.nx,lirion PcnnnrAsbcnos N.rificrrn I'cdcrrl Rcgu!rri(n,\ lTirl.4).1'{n6r
<br />R.!r r.J lcrr.r ol N,illi.rri(tr,
<br />Iccnil-vnrn rh. fc,icr lrc8ul otrs rcgrrlnr! r\hc{.s nnovrl !rc Nrrntli.xblc ro llli\ Pm[cr
<br />I ccni, rhar I havc rcrd rhk anrlicar ion ,kl {ar. thlt rh. ahN innnrrion i( corcr I rEr& nJ .omllv
<br />ordi'rnccs rnd SIrc l-r$ s r.[rirE ti hui rc|ncrnrrr(cs ol rht Ciry
<br />rh,vc ntrd i()nc(l nn)runt tur ris!..r
<br />/\t'dicrnr or \[rnl Sirnnh'r.
<br />z(/e6o.'t
<br />;fl);."-""
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />FINAL 4 lcltE tm 1)ul VCertif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />DATE
<br />q
<br />l-rl.- .
<br />^J'lir
<br />r
<br />UFER Ground
<br />Flood Zone Ceftif .
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