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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNI]R BUIt-DEi DELCARATION
<br />I hcrchy aflirnr lndcr nenahy ,'t pcrjory rhd I d .xcmnr tom th. Conradon Licen\e Ii{ r.r rh. following rcrsn (Scc.?0.11.5
<br />lrusincss lrn Pro,c$ion CGlc): Any Cily or Coumy shi.h rcqutcs i Ennil lo con(d.r, rhcr. inDi(nt. d:nohh or rcnrt un,
<br />srruclurc.r orroih hsuan!,akorcquncsrhorypli.0trlforsuchpcmilhnEarig'td{alcnrnl ihal h.or shc h li.cn*d pu*uaii
<br />ro rhc pmvision\ of rtE Conl.acnn\ t,ien\c lrw (Chrfro 9. Q)nnncncinA wirh Sccrion 7fin Df Division 3 ofrhc lrusincrs lnd
<br />PlrtsionrCodc)orrhar h.orsh. ncrenVrr thcrclon lnd rhc h!si\ torrh.alk8crlcxcmplion Anyviollrion.fS..!ion?031.5$yany
<br />dttli.rnt aor 0 pcmit subjccrs ric applicnrr t, !civilpcn.kyorn.t Drorcll$tr lilc hundrcddotl.r (55tU)
<br />-1.
<br />oin{otrhc pn,frdy,(r rycmph}rcs wirh wa8.sasrhcir $lc ..nlpcisnri,r'. willdo th. *ok n Ocsrehn'or
<br />inb nd oroftcrcd tur $lc (Sa7Ou, Btrsiacs\rnd tSorisi,nr Cod. Ihc C.nrGror's l-i.cn\c L,s ,iocs nor .plly h rn osmr ol
<br />rhclmpcny who buikkor nnp.ovcs thcrstr. r whodocssuchw,rkhnnscllorhc cllorrhRrughhi\.ihcrowncNlloycc\.
<br />providcd r hri such inprowmnh nt n.r ificnd.d or oflarcrl frn s,c. ll howevci rh. hiUn+ .r ,nryovenrnr i\ bE sirhin orE ]t
<br />.r.o'roldrir rtr owmr auiklcr willhlE rtc budcn otnn,vins ihr h. or fi- did mr t{ik or iry,ovc rh. pmFty for rtt purtDt of
<br />-1,
<br />as o$rc! ol'rh. prc!.rry, .m .x.hrivcly cotrtr$rnrS wirh lic.oscrl conta.rB hr ..nnfld ttr pn'Fl (Sc. 7(I.l.4. Bus.css
<br />rNl hllt$ion Codc 1 hc Conrrucrof s l-icc.rc l-aw docs n.r rmly ro M orvrc. of Prol.d y sho h ilds or in|xorcs rhcrcon.
<br />and who conlmcB ror sdch piqc.8 wirhrContra.kss)li.c scd punurDi n,rhcC'onta.ttr s Li.cnsc t,aw)
<br />I rncr. ,F unddr Sc.rnn
<br />b,,," 1')'-LV
<br />l,IlllA&LuQN
<br />I hcrcbyiilirmu crpdtrrlry.rn 4uryoncof rhclDllowinAd(lrtrlrions
<br />lharcMdwillnDn trinoCcnilErrc.lConscnrhSclflnsuRft,workd(.onDcn$rion.r\ nn,vid.dfotbySccriotr.lT0l)o{thc
<br />tjtxr C{xrc. rrtr r hc ncrronM Dcc ofrhe work for qnichlhcpcn.i n issucd
<br />I hart rftlsrllnrirtain Norkcri c.mFn\ io in\urrncc. r! rcqundhyS$rion.lTlX).frhcl-.borCrdc.lorlhcptrlnntut.of
<br />rho qork f.r whichrhis Nnnil is hsuBl My$orkc^ .onrrcis trr Nurin.c crricr arxl I irynun$cr 0rc:
<br />Pol,cy Nun$cr
<br />-Ekrid\
<br />I ccniry rhd nr rhc pcrroirmtrce ollhc work nn whi.h rhk |f,nnir h issucd. I null nol empb, any pcr$n rn rny Danncr
<br />s !sb lBom n'bjcd kr
<br />'hc
<br />workc* .o lrnsarion lrssofcrlirbrnh. lnd Jsm rlu irI stsuld h.cotrE suhJcd n, rhc
<br />so*c6' qDpcnsarion ps,visi.tr* of sc.r ion 170'l ol lhc htu Codc- I shall nflhwirh .oinPly wirh tho$ Ptuvi\iohs
<br />WARNINC: Failur. ro sclrc Borkcs'co.Dcn\lliur covcEs. i\ onhvrul. and dull subjccr 3n dmpk,y.r ro dirinllPctriris rnd
<br />ciljl ftrs Dn k, .i. htrtrdrcd lhousand dolhtrs (il(n.Os)). in adJ n , n rhr cu{ ni cornncnsorrn. 'ldnHBt rs l1rolidcd lin rhe
<br />Shrn n 1010,{ rhr lih{ corlc. nrcrci Jnd r n'Ty'. Ir. A /
<br />Da.: a-?rty ^,,*kl*#(K!;&a144/r
<br />I hc6by rfiinnundcr pcnulry ol pc,ju,r rhnr I an licoiq{ xrklcr pmvknr olCharrcr 9(.onnNrnr8 vnh Salion ?fi)o) orDivisim l
<br />of rhc B!\irEssan Pnrrcs\ion, Codc. u.d my liccnsc h io flll f{d rtrd cller
<br />(QAEIXI]EIIONLIII)IIG]IAINII
<br />IhcEhy lllinrudcr Fnrlryorrcrjuryrh rhctc kaconnrudion bndinsalcn.y r(t rhc Frraanrncc olrhcsork lor \lrichrhis P! nir il
<br />tsucd lscc. .loe?. Civ C I
<br />APILICANLDICIAEAIIQN
<br />I hlNhy rffrm u Mcr t'cnrlry oipcrjury onc ofrh. folkrvir! dc.lnfuh.tr\:
<br />Dcnmlirn,n Pf rirs A\b.jos Noliicntion ltdcelllcguk i{n\ llirlc;10. Pr116)
<br />R.quncd btlcr olNolilicalion
<br />-l
<br />ccrrily rhur rhc lcd.ral rcgxlriions rcEadillg0
<br />l.c 1ry rhrr I hrtr rc{llhi\ rypl
<br />ordiIrtrc.\ aM Sritc trqsElaling lo
<br />$orr nEnrionl.d p!,pcd! ror i.lpccr
<br />Z
<br />:-
<br />Kt:ADplice or \letrrSlsnlluP -
<br />I'rmri'Q mmc Innn'r, 14
<br />3
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />I
<br />f /ar/t/ .
<br />Certificate of Occupancy I
<br />Notes, Remarks, Etc
<br />b v(L C^z t
<br />h Z.
<br />Forms/Steel/Holdowns
<br />FINAL
<br />CnEr
<br />-
<br />f-------T------
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