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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.OT!NER IIUILDER t}'LCANATrcN
<br />I hcrchy ifinr utrdcr lr.alry of n.riury lhll I !m cxcnrpr lmm rhc Conrrxct,n l-i.crs. Lnv tat rhc n hwin8 lcnbn lsc(.70.115
<br />Businc\s 0nd Pdcssion Codc) Ai, Cir, or Counr, which rdqutc\ ! Nnnir ro .o.srtucr. nllcr, iorl'nrvc. dcnnlnh nr rcNn rn)
<br />srtudurc. priort, irx isurncc. dls. rcquircs rhc ,I)plicdr r.r suchFirnirk, ilc. siSncd slrcmnl lhalhcor\h. is lic. \rd txNanr
<br />to lhc ,nvhions ol lhc Contra.lo Liccnaal llw (Chrprcr 9. Comtrncins sirh sc.rtun 7uI) ol Divkio. 3 of rh. B sints rnd
<br />Proi.si{'ns Codc) or rhar hc or sh. i\ crcn/ thcEno andrhchNsforrhcnllcacd.rcmli,r Atryriolrrtn,ofS..ridrT0ll5hyrtry
<br />amlrrtrr lornpcnnf subjaB rhc applEntrrto a.ivillrcnrlryofnol nFrc rh.n livc hutrdicJ dolld\(15(x]r
<br />L as owrcr .r rlr ptuFny. or tr1y cmplorrcs wnh s,Bcs as
<br />'hct
<br />slc com,rcnsal ion- *i!l do rhc work md rh. sMrurc is nol
<br />i cndcn o!oftr.dforslc(Se704.1-lrusincssandEotisionsCodcThccofkd.ror'FLi.cn{,rwdo.snoraPplyn)anowocroi
<br />rh. pNt dy wlx' boildr or nnonlvcs rhcmn. el who .ler such tu* himsdlf or hcrtlf or rhmu8h hn or hcr own cmrloyc.s.
<br />plovid.d rhri such imlrikftnh arc nor inrcnddl or olT.rsl lor eL.ll ho*cvcr Ihc ttriLling or iruDtftnr h $ld wthinon. ytar
<br />of.on{rLrion. rtr ()wnn Euikls sill hrrc rh. hurdcn ol prcving IhJr hc o! shc dil nor build or impn& rhc pmFly tu
<br />'lE
<br />purIre oi
<br />_l- aso*mrolrhc ropcny. merclrsivcly.unkr.rin!sithli.cnscd.ontrr(rtr\rocotrdru.rrhcpn,r.!(S...?()14.Suscss
<br />kl f'tufs\i Cod. Th.Cotrtrcrols l-iccnsc Lrwdocs nor rpnl!ln rn.rnsol o!.dywho buildsor imtrovcs rhcreon.
<br />rtrtl *ho conr.ds rbr such proJLrts wirn! Conrrnd.rl9 liccnscd Drrsk n,rhc Cirnt&k,\ Lic.nsc tis).
<br />I mcxcn!, u cr Scclion_
<br />D $=21:4{
<br />DICLAtsIIION
<br />I hcr.hyrllirr ndcr |Emhyof periuyonc ofrhc lollo$ilrg dcclarrri{nA
<br />I hrvc rl sillntrirlJin tr Ccrlilicrtc olConscnr k, Sclllnsurc Io, workcrJ.onrFnsdrion. as Pmvidcd for by Sn-rion 17fi, of rh.
<br />Ltrti, culc. ror rh, r.lforroRe ofthc solk lor Bhich thc pcrnril is isnEd
<br />rhc worl t(trshichrhis pcnnir is i$u.d MysorkcN .o lxnsrri(r in{{aD.c.]ri.' r{lF,li.yitr $cr trc
<br />I ccnl!rl[r ir rhc rcrlonMncc ol Ihc wort ior whi.hlhis pcrnir is is\!rd.l sltrll nur cnr oyrnyJrr{ ir 3ny nutrrf,r
<br />$ 3\rn hcm f, \ubJ.rrk, rhc sorkc^ .on!* \dtun hw{ofc.liLrnm. rtrd rgrcc r[d ifI slx,ultl hccom suha.r rorhc
<br />sorlc^ co'nn!n\arion pxrvisn,n\olSccri{n:l70Oofrhc llhr Ctxlc.l \hill.lonhqirh conDly wirh ilx)\d pn,!nidN
<br />W^RNIN(; Frilurr t) n.trrc $orkoJ (onrN \irn nn
<br />.'rl ftr\ uD k, ofc htr rcd rh!!,{xlJ.llxrs l:llln).lix
<br />Sc.rtr{:l{)76 irh.lrtxtr C.dc. n crc{ xnd rron*y\ lic\
<br />ll sublc.l atr cfi,'lorcr x, .ri'ni'[l perulri.s J d
<br />ul conlic.\!rion. danu'9.\ rs r(,lidtd lnr rh
<br />*.€.22/-4L
<br />I hcrcby lriirmudcr peflalryolrcrjurr rh,t I an li(0sd xndci pmvisio. oiCharlo 9(commncins wirh sdri,n TuD) olDivhion l
<br />ol rhc Busircs !fld Ptufesiors Codc- d my liccnsc t in flll fore ad cfft.r
<br />Liccnsc Nun r:
<br />caNlirSlreIlllNrlNDlNc.Aclllr
<br />I hcrul,y trllin! u'rdcr Fiiiry.f tf,rruryrh rhcrchi.on{nrrionktrdirgra.ncybrrh.pcnanfliccofrhctrorklotBhichrhh!!mirir
<br />hsucd(Scc :109r. Civ. C )
<br />Llndcis Ni.rc
<br />l..dilirhr' rh.rcd$dlm8ulario.s rcStudirs mhcnorrcnFvrlff. nor lprlicrhlc t,rhi\ F)jc.r.
<br />l..rrl_v rh l hivc r. lrlris xflrliuri(rrnd {
<br />nnliritrc.\rDa Srrrrl rtr\E]jitrgi)hrildin!.u,1
<br />vc inratrtotrim is .orcr I lgre ro con,Ily wnh ru city arri Counr,
<br />)c\.n(di!c\ of rhiscirv dcouN
<br />ftovc nrtrriorcd pm$rl! ltr insp.dn,n
<br />:\pDlicanl or ,\E€nl SiEnntrR
<br />I ;A ZA<2,2,/
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Su bf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\,4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL ?-24-/B ' J )do-ffiy)
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Set Backs
<br />UFER Ground
<br />Flood Zone Certif .
<br />,1nicy Ndn$cr:-Erpncs
<br />-
<br />a.PrlllAltt!&qlAnAllaN
<br />I h.rcby ulIm undcr ncoal', ol Frjury oft 6r rh. rdlowing d*le0t ions
<br />Dcnslition Pcrmits-Asbcslos Norifiqrion F.d.ral Rceuhri,,ns (Tnb 40. P|ln6)
<br />-Rcqutcd
<br />lrrrcr ol Mnifi .arbn
<br />"*.fr4t14''
<br />tt
<br />I
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