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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS OWNER BIJIt,DER DELCATA'T!ON
<br />I hdtoby aflnn uMcr pcnahy ol !.rlury rhd I n cxcnrl amrn rhc Cotrlrtrcron l.i.Tn$ lrw ntrrhc lnuoeing rcibn (Scc 7031I
<br />ausincss aM Proltsion Codc): Any Cily or Counly $hich rcquircs r Fnnil k, .lnNrud, rx6, nn[ovc. dcmlish ,tr tFn nny
<br />srucrurc. p orlo ils issu0rcc. aho r.rruner rhc rrtlicaor ti,r skhFrmir b filcd \i8trcd nllcnEnl lh hcor shc i\ li.cn\cd ,'xr\unr
<br />tu rlt proviioN or rh. conlfl.kn s Li.cnrd Law (Cnrplcr 9- Corrnrcnci'rg wirh s..ri.tr 70(D ol Division 3 ot lhc Busints ud
<br />Proic$ionsCodc)orlhlthcorrhchcxc'npirhcrrn,hridrlrh"si\r(trrh.rllcgcdcrcn{lion.Anyviol,rit,notsc.ridrT0:ll5bynny
<br />rpplicrnr ldr a p.rnrn subr..t rhc dfflicnnl ro 0ci!ill)c.rlryofnor mrcrhM livc hundrcddolldsl$50O
<br />-1.
<br />rs .wncrolrh. poFdy. or mycmfloy.cs wirh w,g.\ rs rhct snc conrNnsulioD. *illdo rh work sril rh. itrture i\ nnr
<br />i,rlc*lcd .r oflircd ror elc ISN 70.14- Burincss ond ltolc$n'ns Cdc: Th. c(,hrtntr s Ll.cnse tiw d€s nor opPly ro rn o*.cr or
<br />rhc pn,Fny who buikls or imlsrcs rhcmn. aM who des such *orl hinNclior hcrsclfor rhft,rgh his orhd own cn[l,,yccs,
<br />,,rovidcd rn$ ru.h inrpmwEnG N nor inr.nd.rl d off.ftn for sL. Ii hos$a. rtu bliklillc or inrprolcnrnr k sld wirhin orc )eu
<br />oi conplctir.. rhc Oarer Buildcr will Mrc thc ttrdcn oI pmvi"g rhnr hc or shc d*l nor huild o. imlmrc lhc F)pcny ror rtr purr$t or
<br />_1. nsounq oirhc popcny, r crclu\ivdly.onrr!.ring wirh li.cnxcncotrnadorlocon{rucr rlf, pn,Jccr (SN. 7(x,1. Bustrc$
<br />n*l A.fssi.n(i)d.:ThcC.nka.rol!Li.ctrscLawdmsnorlptlyk,oo$iu.rpn'Faywhobuildsorinnn,rclrhcr...
<br />..d who conrracrs for such lojccrs sirh a Co.rtudon t li..n\.d pusu,trl ro thc Conlrlcrors l,icdn* Ire)
<br />I arncrmnrundcr Ssrian .B &PC r.rrhnicJ\on
<br />lIa8.[EIlS.:C0rltENSAr0!
<br />DECIAXAIIQ!
<br />I hcrcby affinnundcr ncoshy o, perjury otu orrhc r{,lLwins d.rLmriotrsl
<br />-lhuvcmd'illminllinaCcniararcorc{,n*nrtusclrln{rcturk
<br />kcn- .. nrr.nor ion. a\ polidcdr{trbysc.li.nl7(I)ollhc
<br />bb.r codc. ror thc p.rfomtrce oi rhc uo for which rh. pcmir ir ir\ucil
<br />I havc and willhri.bin wo.kcra.onDctrsorion insurturc, as rcquircd 6y S$rnrn :1700 .f rhc lj$or Cod.. Ior lhc psfortun$ of
<br />rhc *Drk fui *hi.h rht pcnnn is issucd My uortcfi co rlicnsal iqr in\uBn( .arid .rd Fnicy nunh.r uc:
<br />1e-t,a e-*n oA? - *3t -oa /o 7a t€
<br />-l
<br />ccnifyrlur in lhc ltrfornume ofrhc {.lk f(t shi.h rhir Fnnir is is\ucn- I lhtrll Dor cnrPn,r riv lr^otr trt trtry m.trncr
<br />$ as t, b..om suhjccr ro rhc $ol{cr' co Fnslrion lawr.l Crliti'rnis, ind rsrc rhd ifr stru[l hcconE h]tcrrorhc
<br />woAcrs.om!.ns!rn,nfmrhionsofSccliool7(X,olrhcUhrrC,xlc.Ishrll,l.dhsirhcorPly$irhrhosPn,vi\i{,ns
<br />I{ARNINC: tjailurc t. $urc work.ri conr.nsarnnr $vcr,8c ir utrhqhn. ! shlll \uhjccr rh.nlplorr
<br />'o
<br />dNirrl rnnhi\ rnd
<br />civil lincs up lo ore [undrcd rhouv d d.lhrs ($l(D.0(nr, irr dddiriotr ro rhc.o{ ofc.nrFn\arnn. dr'tu!$ rs ,'n,viicd Inr rhc
<br />Codc. inr.'.{ dd rtoimt t fc\.
<br />1 /0
<br />llEcL EauQN
<br />I h.rcbyalfirmund$ pcn.lty oI !.rjury rhal I an liccnyn u.lcr Pn)visnin orch{rrct 9(.onnrrncirrs q'iri SNrin 7(xx), ol Dilisnr 1
<br />of (hc arsincssxtul Pruf.ssions C.dc. alll Dy liccnsc is ir lirll lorcc nl cficrr
<br />B 7 j?6
<br />7
<br />(:oNSTRiICTIoN LTiNUNC A(iT'N1:Y
<br />I hcrcby afllfln u crFcrhrorp.luryrhdrhcrch!con(rucllonlcndinsqctr.yrarthclcrli,nniflucol'lhc*orkfttrthichrhisF.nritis
<br />ksucd (Scc. 3097. Civ. C.)
<br />AITLISANIDEEIAITIIO!
<br />I lrcrct y !ftnn undcr p€nahy oltcrjury onc ollhc lblbwirS dcclannnnrs
<br />Dc.mlniotr PcrnrirlAst nos Norificrrion F.d$al Rcguldids (Tirlc40. PM6)
<br />kquicd kncr olNolilifl tion
<br />_l ccnifr rhd rh. t dcralrcgulariotrs rgrdinS lshc(os rcrmvll nrc .ol trmli. l. tu rr'is pn,jccr
<br />Y-l.r'n'l) rhJrlhr\c'cnd rhr. omlicarrnnrl {orcrhr rhr t.h, lJir(r,omrl)
<br />6rdrnrnc..rndSrolcIjw.rcl!riFErnhuihirg.,,nJ r'o1 rnl\c'chyJUrhnrucrc!_carrn'rv(\nrrhnCtr)
<br />ny lor iNrcclinrrual{l
<br />.\pdicrn! or ]\,snl Signrlure /) lPt 0, sDa
<br />^:''r")":'-.b/ // /t:t+
<br />Set Backs
<br />Forms/Steel/Holdowns (&D1 t0 - l( -ty
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loor/Venl/l nsulation
<br />Roof Shealhinq
<br />A
<br />Framing PX-nZ loJa'ly
<br />ln s u lation/E neroy w
<br />Drywall ll-y-t1 rl
<br />Ext./1nl. Lath
<br />Brown Coat
<br />l\,4asonry
<br />Pool Fence
<br />T-Bar AN,f lt-)r-t'1
<br />Handicap deq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL il -ls{1 nl
<br />Certif icate of Occupancy U IJ
<br />-6-,(,2-t hr
<br />N-/turn d t>-/-,
<br />,'fi eeH
<br />4.U_PKCE}
<br />t r
<br />4
<br />A
<br />Pr-Wli)
<br />Shear Wall
<br />Notes, Remarks, Etc.
<br />n.-t|. I ot Ofu,.r,t' - dtt *;L -t- C
<br />L.trJ.'-! \ 'nc _
<br />F,Wv-
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