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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNI]R BUILDER i}ELCA RATION
<br />I hcEby .iftrn undcr l.n0lry ('a p.rlury rhar I !m cicmtr arom rh. conti.rotr Liens ljw for rhc iolloqin8 r.a$n lsc..70ll.5
<br />gusinc$ ard Prcfession Codc) Atry Ciry or (tuxNy *hi.h icquncs 0 Ismir lo orntud. ahcr. inlrov., &mlth or EPair !n,
<br />slrucrurc. r,riorlo ns hsuaice. aho r.quncq rhc applicanr lor such lcnnil to lilc a signcd (aicB.r rharh.orsh.nlicenscd Prtolll
<br />h rh. [ovisionr.rttr Conkrrors Liccnscd tis (Chrflcr 9. C.mhcncing *irh s..rirn 7u)o ol Divkion ] olrhc Bu\inc* rnd
<br />Profcssions Codc)orthri hcorshc iscrcq)r rhercfromand rhc hnsi\ f.rih.aucBcdcrcmplion Any!i,,LrnrnofSccriotrT0:ll5hyan,
<br />lpplic! fuapcnnn subj&ls rh. rpplicrm lo r.ivilp.Drlryolnor nr.rcrhan fivc hxhdrcd dollnis($500)
<br />-1.
<br />$ owncr of rhc prcrEnt. (tr ny c'nplo)r.c wirh w0!.\ ds rhcn snc coinFnsar ion- Bill do rhc woA $kl Ih. sfldN is nol
<br />i'ncfrktl .r .fl.6d for slc ( Se 7(}4,4. Busitrc$ lnd Profc$ions Cdc 'Ihe Co rrcktr\ Liccn{ tjs docs nol 0pPly ro r. own.r of
<br />rhc nofany sho builds a. inprts rhcd.. ari who d(s such w.ti himsclfor hcr*llor ihn)ugh his or h.r oqn cmPloyccs.
<br />pR,vid.d rh.! such in|m)rnEnB nrc nor irlcnH or olTcrcd nn eb lt ho*cvcr, rlr bu ildii8 or irlll'n,rcrnl is sld sirhin ofr ttr
<br />.I conphrion. rhc Owner auiher *ill h,E rhr hoil.n or pbving rhxr h. or rhc dt mt buiH ., nq'ow rhc In,rrny ror thc ,,u4nt of
<br />I. .s owNr or rhc pmlcny. mr gcllsively conlracr ins wil h liccnscd conkacbr b ..n{ru.r rhc ,mj( (Sm 1044, Bu ,incs
<br />md Pt,acsi,nCode'th.Co.rrciofsLicenscLawd*snot.pllyloanowncroip(,pcnywhohuildsorimprovs\lhcrcon.
<br />{Dd sho co mcls ior such r(icch Birh a Conr,acron, liccosd puru tiorhcCo mciols l,iccnE Law)
<br />I. rcxcnrfl uDdcr Sc.r
<br />]YOf,SEXI.CAIIIDNIAIION
<br />DECI,ISAIP!
<br />I h.rcby ofirmundcr pcnally o, p.rrury orc otrhc rollosin8 d(lsarion\l
<br />-l
<br />hlvc and*ill minrain r Ccnificsrc 6f C6ne.r b sclf lnsuB for eorkcr' .on{rnsdion- a\ ptuvidcd ror byserion3?00oflhc
<br />t lxtr Codc. ior lhc pcrlolmrrcc of lhc work tor which rh. Fmir i\ i\ cd.
<br />I hrv. rnJ $illn,xi' ri'r rork.r! .o rt,etr\rrid, trNurrn.r. r!
<br />Nlr
<br />.Z
<br />i
<br />l..nifyrhrr inrhe Friofln{nce ol thc uo l'or *hich rhi\ pcrnir k i$xcd,I shrll nor cnrloyanrpcrson in rnytn.nmr
<br />b s lo bc!!m sut isl lo lhc *orkcr' cohl.nq 6n hw\ ol Calinnir. a o8rcc rhalirI {tx ld b.r.m subrccl ro thc
<br />worlcn compcnsarion porisioi\ ofs.di.n l70o.frh. hbr Cdlc.I shall.lonn*irh comply wirh rtFt Pn,vtions.
<br />W RNIN(;] Ftrilur. t) {.ur. trlxkcri conr.n\rrion covcm8c i\ unhwtul.ll \rbjd cn,fkDrr h dnnrrl Nnilrics rll4
<br />.Nil hrcs uf r. otrc hu drci ihou\and dollars (Sl(x).(lx)). ir diri,nr iinr. d, figcs a( pnvidcd lbr rhc
<br />PTI-Iz;':;-4I ,..r)(
<br />I ncrebyatlirmundcr FnahyorFrjury rh.r I am liccnsl uRlcr Fmvision olChartcr 9l.onnEncirg wnh Sccrion 70d)) orDivirnrn l
<br />of lhc Busi,rcss tr.d Pmfc$ion\ Codc. !d myliccn$ n inroll rdrcc 0nd cllccl.
<br />^,- ]|l4h1cm,ndml
<br />CONiIBIJSUONIDXDINC.ACENCI
<br />I hcrhy lfllrm und$ Fmllyorpciurylhal rhcrc is acon(rucri.,n lcodinE aSdn y toi rht p.rfornrncc.frhc work r.r wh,.h thi lEirnn n
<br />nrucd (s(.1097_cir. c )
<br />AIILICANLDIiIIABAIION
<br />I tmt, al-rnn undcr pcmhy ot pcrjurt om olrhc loln,wirg d.cl.ritrnnrs:
<br />ocnnirion Pcrmih Ashcstos Norifi.dri.n F.d.ral RCGUlnri.r( (Tirl. 10. Pan6)
<br />-Rcquned
<br />Lrrtcr oi Norifi .din'
<br />I ccnifyrhar lhc fcdcml ,cNhrnrns rcsardinE ash.skx rfr,val arc nor sptlicanb lo rhn pmJccr
<br />-l
<br />ccdiiyrhar I hrvc rcad rhi\spplic,tion,nlsar.rh,r rhc,hrvc inr'ormlion hcorar I rsre k,.onply qnh flll Cny and O,rnly
<br />ordinrnccsard Slllc Laws rchrnEb building horchy&thorizc rcprc{nurir.s of rhh cirynnd Counl
<br />nh)vc
<br />'mnr
<br />i{,ncd fl.ltrty lor iNI'c.lionIrUr
<br />,\pplimnl or ,\!.nl SixMln
<br />""-n""
<br />nu-" ,rnn,, {Fo/
<br />€
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFEB Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Rool Sheathing
<br />Shear Wall t
<br />Framing J/lt/r{.-**u'.
<br />lnsulation/Eneroy ('tt-,/
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence I
<br />T-Bar &/z"h{.r9\yl
<br />Handicap Req.
<br />Deputy Final Beport
<br />Engineer Final Report
<br />Flood Zone Certif
<br />lt
<br />FINAL q/r/?-/t1 r ."*1 7)
<br />Certilicate of Occupancy /L./
<br />Notes, Remarks, Etc
<br />Erection Pads
<br />Sccrid .r?rn ol rhc l-aborCodc. forlhc p.rfonnnm.or
<br />Lrndcrr Nam:-
<br />Lcndcir Addrs
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