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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER At]II,DFJR DtrI,CAIIATIoN
<br />I turchy rffifln undcr pcn.lry ofJ'.rjury ihal I .!n cxcrfl fro,n rhc C.ihrcron Lic.tre Ltrw ntrrhc r.lbwing rca1otr (Sc.70:11.1
<br />ausincs ud PR,Ics\i{'n Code) Any Ciry or Counry \hth rquncs n ncflnt ro cotr\rnrr. alrcr. nnprovc. dcnmli\h.r rcBlt rn,
<br />slE.lrtrc. prinr. ns issuM.c. rh. rcquncs rhc{pli.anr lar srh pcrmir io filca ri3n.J iarcnrnr rhd hco. \h. is li..n\cd tuBur r
<br />'o
<br />Ihc F)vNbns or rhc Conrrr.t, \ l-iccnscd ljs (Chiprcr 9. Connncrcir8 sirh Secri,rn 7uD .l'Divnion I ol rh. Br\i'rc$ lnd
<br />Prntsion( Codc)or rhar hc.r(hc i\ crcnr rhcrcliomrnd rhc haris f{trrhdrlfua.ddr rlri{nr Aitvi(,hriinrolSc.rionT0ll5byrny
<br />rtplicur ft, r pcn,il suhjeclsrl.{ opi'lic!nllo rcivilpcnihyofnor.nnrlrn rivc hundrcd dollfls($5(xr)
<br />l. ar own.r ur rh. proFny, or my empbracs $irh wa8c\ rs lhcn soh co"rl)cnnf i.n- will do ihc work 3d thc sltrrlE h 'linrctrdcd or of.rcd lor $lc ( S( 7044. Businc* &d Pmf.sion\ Code 'I h. Conkrttr \ Liccnrc t-r* do.s nor lPrly ro ai orRr of
<br />thc rmncny who h,ilds.r i'nrr\r\ rhcFn. rMl who drcs {rh x)r* hinsclfor hcrclfor rhmugh his or hcr.wtr cn[lo)ccs-
<br />providcd rhrr such inpnvcn*nr. ie mr i,ncndrdor.nrd li, {'lc ll h.s.EL rhc huiHins or inproEnrd n ht xirhinore )!{
<br />olcomplcriotr, rlf,Ownd Build$ qillhilt rh. burdcn ofpro\ioa rhd hc or shc dA nor tlikl or improf ric pmtEny lo. ir puqne of
<br />_1. ls owncr of thc lr)p.ny. no cx.lulivclt .onrrcr in3 *irh liccn{d contrrrn\ h cotr{dcr rh. lnrJl{r ( Scc 7(11-.1. Bunno$
<br />tuxr Pnrssi Conc-r'hcC(,nrr,crtrsLic.n\cLrwdocrDorl|ptyr.rtrotrod.ltropc yvho huitdsor imtrovcs rhcrcon.
<br />rnd wh. co.rracrslor suchpnjNr\snhi(lr h.kr({) licctrscd prr\urDrr)rh.Conrrrkn \ l-icc'sc lrw)
<br />I 'nc\cmtru cr Scdi,r,-.ll & P C. ktr rhi\ .crn,n
<br />Dute ()sftr
<br />naatrE&sl:ouf[Ns rIoN
<br />DlrtAxAIlQN
<br />I hcrch! rffir'n un,l.r IxBlryolpcrury.Dc ol lhc nrkxvinA dcchturnnr!
<br />I huv. dd silleinrniDs Ccdiliorc olConsrr h Scllltrsu.c ror sorkcr' comrcrs0rion. rs rnvidcd lnr bySccrion:l?molrnc
<br />Ijh., Gxlc. {or lhc ptrlhnMrcc ol'lhc work lbr *ii.h rhcr.nhn is i(lucd
<br />_lha\tundwillnuintrinworkcr'comlcnsali(,nnsuranc.r\rcqui(dhySarn,nlT0Oollhcbborcode.lbrrhcpcrfornnnccoi
<br />rhc wo.k for which thhpcrmit is nsu.t. Mywolkns omtl.nsdi.n iNurm..trrid ond FJli.y nunrb.r m:
<br />(
<br />Q ?Znqoc)'zl\allE
<br />-l
<br />ccniayrhar inthc pcrfo onccolrlEwork for shi.h rhi\ F.' rir tr (\ucrl.I shrlltroi cnr oyrtry |fron rn.nynrMncr
<br />v' asl. h.$ft {bjrd t,rhc wotle\ cohpctrsdn,n hssoiCrlilomir. mdr8recrh.r ii I shoukl l,cconE slhFcr r{, rh.
<br />volkdt.o'nFn\arn,npmdsionsors.ction]TOOotrhchtr('odc.lshall.ronhwirh.onlplywirhrhoEnnlnionr
<br />WARNINC: l,lilurc lo sc.urc q.ik s .orrFnsartnr co\rragc is nnlr*fxl, rd shrll \ubj.{r ,n .m,il,,rrr ro din nol lf,nnlric{ and
<br />civi! lincs !p r. onc hutrdrcd rhousrnd doltrs ($100.0(nl. in rddirnrn io rhc.osl of..nIrtrsrlnnr. ddu8cs as proridcd for rhc
<br />Sccri{nr 1076 ol'lhc Litry C.dc. intcrcsi lnd ltromyi l4s.
<br />o,,", . X/zll ix ^oon*,,,* -=z
<br />uc[lsurl;oNrMcrr.]B
<br />DEC'.4&UIAN
<br />Ihcmby,fllrnnnddFtr,lryorFrjuryd1dls'nlic.iydudc,pmvisi,rofChlprcr9lc.nrcicinssirtsc.rbn7(xD)orDivhnnr-l
<br />ol rhc Busincs\lnd PmresionsCodc. d myliccnsc h in lullnncc0dctlcd.
<br />.icrns. Nun$cr: ' ,lO-.* 555
<br />D,,' 2/15lir--_. c*t*a..7L.::d1
<br />qONSAICUAI{IENIIN!.AGDM;I
<br />lhcrct'yaififlnnndcrncmlryo{lcrjLtrylh.tlhcrcilr.oflsrfl.i nlcndir8rAcN!rorrhcpcrrofluftcorthc*orkior$nichlhnpcrnin
<br />n$cd (Scc 1097. Civ c.).
<br />AT'JCANI.IECLAEAITO!
<br />I hrcby afim undcr pctr0llyofpcrjuy onc ofthc rolnrRing d..lu,riotrs
<br />DcnFlirio. Pcrnril*Ash.slos Notifi.ilion Fcd$rl Rcguhrnnrs (Tirlc 40, Pd6)
<br />-Rcquncd
<br />Lcltcr ol Nolifi clriotr
<br />_l..niryrhxrrhcfcdcralrcsulorion\ reBrrdins asttnosrennvrlorc nor afplicahlcro rhh pmi.r
<br />otl.cdily rhd I hnv. rnd rhi\ arpltsri,,nad drrcrhlrrhe!tD!c rnr{,nurion
<br />'\cotrccr.
<br />r u8rc. b.\'nprl q trrl(i,ryrdd ti,u y
<br />oidin,D.csmd Sr r lxws rcldir8 k, buildins con{dcrion. lnd hcrchy rurho,iTc rcprcscnhrnrs (,frhh Cir, and Cdunryb.nid orn,h.
<br />rh !. nf,r''nmLl prn|cl) lor nsFcrion |ur|.sc, -_- -
<br />7
<br />,rppttconr o,rgenr srgnorur.T(- Z-a:
<br />""-u* *.",,n,,, X- njkic, Sha<-lror-r'
<br />o,," " Stzl/ln
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Bool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />lt/ason ry
<br />Pool Fence
<br />Handicap Req.
<br />Qeputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />FINAL xl%.lN-n rz))
<br />Certilicate ol Occu pan-y 7 I uI
<br />Notes Remarks Etc
<br />--
<br />DATE
<br />T-Bar
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