|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNAR BUILDER DT,JLCARATION
<br />I hcrchy lriin! undcr prnllry ol prrjury rhai l8ncxcnrpt lmrn lhc Co Bclon Li(cnsc ljw for rh. ii,llowing rcak,' (sct 70.115
<br />Busnrss and P(na$ion Cod.)r try Ciry or Counry ahirh rcqunc\ r Fnnir ro .on$flcr. ,h.r. inrflovc, dcmolish or rcl[n {ny
<br />sl cturc. t,hrro irs h .ncc. rso rcquncs lhcuppli.lnr br su.hr.nnil h 6lca si8ncd st,tcnrnl lhal hcorshc is liccncd purulnl
<br />Io rhc pov$n,ns ot rh. Conra.fi \ Li.cn\cd Lj* (Chaprcr 9. Conxmnci'rg wjth S.cri6o 7t)(x) of Diririon I ol rhc Busir.ss nnd
<br />Pmfc$bns cl)dc) or rhlr ir or shc is crcnp hciclio'n drh.h\i\r.rrh.alLgcdcrcmflio. A.yviohrionorScdion 70.11.5 hyany
<br />aff,licanl lbr a pcnnil subjelsth. apflic.nl lo.civilpcna[yolM nmrcrlmtr 6!c hun&cd do,les (S5(D).
<br />I. as owncr of rhc pmfEny, or ny cf,tlo)$q *irh wdS.\ ,s rhct q,lc c.nD.nsdn,n. lill do rhc w6k dd dc sururc h mr
<br />inlcflrH or onar.n for slc (Se 7()44. Busincss md Pmrcsi{,N C.dc Tlr (iMadol s Liccns l,w does nol lpnly ro an owncr of
<br />rh. r,opcny sho hoilds or iqmEs dEE)n, arxl wtr de\ qch wl.l( htnsclfor ftrclforthmugh his or hcr o*n cmrloy.cs.
<br />providcdrhal slch n{,mw.Enls e ml inrcM.t oroficcrd turelc It lt)*c!rr. rhc tdiHin8or ir{,rorcBnr i\ $kl *irhin o'r rw
<br />ofcompkh( ltf Own.r auil}$ *ill hrv. rh burdo .f l,.linE rhd h. oi *h. dil mr hild m ir{fo{ thr pmldy ,or ltr puqn* of
<br />-l.0s
<br />ownc.of rhc lDpcny. ! cxclusilcly conrmdin8 wirh licctr{d.onrra.ro6ro on{rucr rhe ltroj.{r (scc 7u1.1, Bu\iRs
<br />iff] I\of6\bn CGlc: ThcG)ntacttr s Lic.is. Lnw docs trorrt,plyro rnosnfioffn,p. ! who buildsor inrrore\ rhcrcon-
<br />lnd who conn ich rd such pnjcd s with 0 (tntrrxn( r) licctr{d purulnr ro rhc Contrlci{,\ l-ic.tr* I f,w)
<br />-lr',ctcm0r
<br />undcr Scciiotr-. A &PC li)rrhisrctrvrn
<br />ltaaf,!f,srrou[l,Ntar.tllN
<br />DE(IAIATIAA
<br />I h.r.by l|l_rrn unncr lcnahyolFruryom.r lhc rhllo*irA n.chnrnnN
<br />-lh
<br />ca'twillnuirrdnoCcnificlrcofconscrrloScli:lnstrcl'orworkc .ompcn\arion,rs povnhd tur hysccri.tr 37u)of'hc
<br />trbor Codc. iorrhcpc a mncc ofrhcw.rk ror wlri.hlhcr.nnit is i\\ucd
<br />-l
<br />havc rtrd will.rtri sinworkcscornNn{li(nrirffrnc.r\rcquirdhySccrion:17(northcl-ttx,.CoJc,rorrhcpcrlornrmcor
<br />rhc {sk lor which rhis pcrnir is i\$cd Mywo*c^ conDcn\ation iNurrncc crricr andFnicynu'nhr c:
<br />Iccnifyrhrrinrhcpcrrbnrun.cofrhcrorkr(trwhichrhi\pcn ir i\ i\cudd.I shall Nr .mploy atr! Frson inany D Nr
<br />$ !s
<br />'o
<br />hccom suhjccl lo Iic wo*c6 culDensorion lo*s olc0lihrnia. Md lArcc rhar ifl srmuld h.{om snbFr t, rh-
<br />$.rk.r\ c.nrpcn\rlion pmvi\ion\oISccri{,n.lTlloolih.lrlxr (ndc.l\tu'll. hnhNiihconTly {
<br />WARNIN(;: Failurc ro sccurc workcr con|rnsliotr .ovcr{c is un plorcr t' di rind lEnrhict md
<br />ciril lincs uD ro onc hundlcd rhousud dollor (Sl{ .ll(lr). in add n. drmrg(\ r\ l,diJrd nn rhc
<br />S€crion 1076 ofrhc ljhn Conc. inrc,crl lnd anormy
<br />I hctubt rlln r u d.r I)c rkyofFrjuryl} l mr l'(i drrd 9 icommrcira silh Scclion TlXXlrofl)ivi\nn,l
<br />ot rhc Bu\i'rc\!rtrd I'}ro fcs \i, nN Codc- d n,y li.rtrso n i', hnlktrNlxlrtlr.r
<br />I heEhy ailinn L.der Fuliy or perjury rhDi rhdc k ! con(tocrion knding agcncy ror rhc p.rrormncc ofrhc work fo! which lhh pcrmit is
<br />i$ucd (Sec. 1097, Civ. C ).
<br />Laldcr'. \,rc
<br />-
<br />-l
<br />ccflilyrhrr rh.lcdcral rcsulltions rsudin8 rshcsrosrcnFvrlnE nol rprlicanlc ro rhn phrccr
<br />l.crril,vrhxr l hnr. rc rhis rlt,licrri{r rl n ct ncomcr I rgre tJ.o ply sirh ,ll Cny aftl C.utrrt
<br />rcrc{nrrri\cs ofrhn cirymd coudt ro cnrs ut &,onlinanccsandSrarcLi$srcl,rinArobuiliinscon(
<br />ahove mtrrio.cd t'olcny lor inspcd
<br />,\pplic.nl or Eenl SiEnnturc
<br />P€miie Dme lpritrl)l
<br />*,",J1/4
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathi ng {.t lr+Erhta-/17-
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/ason ry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL *h)P *nom-/tu-
<br />Certili cate ot Occupancy
<br />Notes, Remarks, Etc.
<br />T-Bar
<br />clft,
<br />tarCer', AdCr$
<br />-
<br />ATII.IQINLIIECI.AXAIIO!
<br />I h.'r.$t lnnntr cr!.mlrtof F.rjuryomof rhc lallii*n,! d(furrii{n :
<br />Delroliri,)n Pcrmjrs Ashcslos Norilic(i,)n Fcdc'!lRcsrlll6n\t lirlc to. Prn6)
<br />Rcqutcd tricr of Norifi crrin,
<br />I
<br />I
<br />=
|