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BUILDING. INSPECTOB RECORD
<br />SITE-WORK DATE ID/SIG.COTl4MENTS OWNER BU!t,D8R DEI-CARATION
<br />I hcrchy iilirm uMcr pctrrlry ol Fru.y lhd I m.r.frpr ln,n rhc Conkrcros Li.cnsc tjw lor lhc followins rcrsn rsec703l.5
<br />Busines r Prolt$ion Co,lc): Any Ciry or Coutrry *hi.h rcquicu ltirnir ro consrruct. rllc.. imp.orc. dcnxnnh or Rnrn Jny
<br />sracrurc. priork, irs hslmce. n1\. rcquncs rhc olplicmr thr s'ch pennir ro fiL! si8ncd {rrcnEnr rhd hcoi sh. il li.cn\cd pursurtrt
<br />to lhc lNvisions ol lhc Contrrcrors Licc.*d tiw (ch!pr.r 9. connncftin8 *ilh Scction ,our ot Divhiotr :l ol rh. Busn'csr 8id
<br />Prufcs\n,nsCodc) orrhar lEo.\hc hcicmpr rhclctonrlnd rhchlsn iq rhc rllcscd crcmtrion anyvn,[rn ofsccri.nT0:]r 5brrny
<br />rtpli.r ritr r,r'nrii subjcc( rhc aprricsnr ro tr.lvilpcnalryolior r.rc dm. fiv. hufldul dolla6 ($5{D)
<br />-l-
<br />!s owrer oalh. pmpcny, or mycmplores wilh *aacs 6lhcn sb comFnsalion- iilldo lhe sorl aid dE sturxh t nur
<br />imcndcd o' ofcrcd fr slc ( Sk.?O14. Busincs aid Pmlcssn,ns CGlc Thc Contr.ror's Liccnsc hw d@r not oPply ro an owncr ol
<br />rhc pri,pcd, *ho t uilds o! in{'mEr lhcmn. sd $ho d€s such wor* [insclf or hcrsclr or rhmush his or hcr.wi c rployt.s,
<br />providc'l rh.l snch inl, rcmnN m mr intcndcd n ofreEd for slc. ll howcvcr. rhc huiBmg or imprerenEnr is bld *irhin om Ftr
<br />ofcon{,lcrk,n, OE Ownn Buil]6 wil hitr rlE bordc. of pmvnE rh{ h. .r sh. di] fr, buiE .. irrymrc lh. IoFny tb. rhc purF,* ol
<br />-1.
<br />aso*ncrolthc trcp.ny, rmcx.lusiklyconti.rin8 wirh li.cnscd $nricbm k,con(rucr lhc pm,cd 1scc. ?0+4. Bu\inc$
<br />lod h{n6sbn Conc lhcConlracrofsLiccnscLlwdocsnor{pplyi{'3no}ncrorproFdywhobuildsorinrpiovcsihcrcon.
<br />trtrd who.ontm.ktbrsuchpr.ielswirlraC.ntra.ro(nli.cnscdInBumrtorhcGntr0dolsLiccnseLaw).
<br />-l
<br />an.xcmpr utr&r Scdioo-, B. & P.C. for thn reason
<br />O*D€r:
<br />TOBtrE&::'COUIIINSAI]AT
<br />IECLAB{IIAN
<br />I hcrcby ar'it undcr NmltyolNrjuryonc ofthc iollowirs dcclmli{nN
<br />-l
<br />havc ad wiu roinrain a Ccnificlrc ol C.nEnr ro Scr. nsurc fo! sorkcc o,npc,s,rion, N ltrovid.d fd bt s.crio, rTol) ol rh.
<br />Libor Codc. lor thc rrforrurcc oi thc woft for which thc Frnril is issucd
<br />I hrvrrnd *illrrinrain trorkcrr cotr1p.tr\rrnn, nnurrn.c. n\ rcilutcd htSc.ri(r:1700 ofrhr tjhor Codc.liir rlrc pcrlonMrccol
<br />ihr\ p.i,nir n\nsu.\l nly trorkcrr co ion insur .c catrcr ard Jx,li.y trumbs dcl
<br />-l
<br />enify th.l in lhc pcrfornrncc.lthe qork loi shich thh l)cnnit h issucd- I shrll nol .npi,y any pcrv,n in rny manrcr
<br />s !\h t{com rutjccr lo rhc {orkc6' .onq --our t' n laws otcalifixni,- 3nd agrc rhnr irI stf,,uld hc.om subjcd
<br />'o
<br />rhc
<br />lortc6 clnpcns ion Dmvhions of Sdiotr l7(xrotrhc LIhtrCodc.Ishlll, rodhwirh.omplywilhrhosc Dmvtions
<br />WARNING: Farlurc to $.urc qorkcrr' co nDc nsal nrn orcmAc rs utrliwaul. and shrll subFcr !o cmpk,yci ro rilnind Jf* rhs ond
<br />civil linc( up t,' oflc hrdrcd lhousand dollan ($I(x)-dn). in addiri,). ro rhe con .r coD!.nsarion, d,mBcs is lroridcd for rh.,_,,,,1'yT\Y.'* .:il:,t petSoLctf
<br />I hcebyrtlirmuMcr pcn.lryofpcrjury rhrl I im li.ctr*l undd lrolnn,n ofCnrplcr I (commncirB sirh Secri(ni 7000) ofDivirion l
<br />ot rhc aonn \srid Pmtusnrn Codc. rlld rnyli.ci€ i\ fullfrtr.d dclfc.rqb
<br />CONSIBJCIIQXIINDINGIIiI;XI.I
<br />I he.cby llfirm undcr ricnalryolpcrJulyrhar rhcrc n r.onsrd.rio! bodios lscncy rd rh.,rtrorm,n.. orrhc aork fo! which this pcmir h
<br />issucd 1S(. 3097. Civ Cl.
<br />AI?LICANIDEq.AA{U9IY
<br />I hcrcby rinm u ndcr !.rally oipciur, onc ofrhc dlowin8 dcclarariors:
<br />Dcmlition Pcrnrirl^shcaos Noliicdior Fcdcnl Rcgll0lions Ont 40. Pon6)
<br />Rcquncd ktt.r of Noinc,lion
<br />-l.enifythlt
<br />lhe lcdcrul rc8ulalions E8ardin-q asti.$os rcmvil!E nor oplltuhk ro lhis rtuF.r
<br />IccnilyrhrrIhrvcrcadrhi\ipplicrri(,n dsrrcrl ihrrhivc idfinnrri(u (.onr.r.I rlrcchconrdy$(hlllCiryrnd(outrry
<br />f'di',rn(.\ r d Srrrr lrLs\ rclarog t) buildi
<br />JIx,vc nrnriurdl]tr)Icny
<br />rk,izc rcprc$ alivcs ol lhisCily
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing +j 1i8.fi '41.r*z 4'") l#*A^^J-
<br />lnsulationi Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL 1.tl't b ''4tn.^.{3,
<br />Certilicate ol Occupancy
<br />Notes R emarks, Etc.
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />,\-\q
<br />I
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