|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BUILDTJT DI]LC RATION
<br />I hcrchy.mrn und.r !..rhy,rr pcrjury rhar Idercmrr from rhc Coniracron l-ic.nsc h* lor rhc folk,*i,rt r.,$n (sd 70:ll5
<br />llusiDcss and Pr.lc$ion Cdlc)r Any City or Coxnry whirh rcquirc\ r Frmir b .onnflcr, rlrd. impiUv.. dcnolish or rcpair ant
<br />druclurc, prior lo ns issuotrcc, ul$ rcquncs rhc.pplicatrr 6r su.httnnn ro ilc r siSmd ndcnf,.t rh,' tror shc i\ li.cn{d puruatrr
<br />ro rhc lrotisions orrlt C.nta.ior's Li..nscd kw (Chlprcr q. Omnrncin! wirh Sccrion 7(XX).f Divkn,n 3 nf rhc Ausnrrs rnd
<br />ProtcsionsCodc)orrhrlhcorrhctcxcnDrrhcrclmfl..drh.basilrurhcrlrc8L{cx.mprion.AnrviolrlionolSc.linn?0.115$y3ny
<br />0p!li.rr fft a ptmir suhJccrsrhc rppli.anr b acililpcnanrotnor morcrhan nlc hundrcddours (s5mr
<br />Lrsor cr oI rhc pqf,ny. or my cmflorcs wilh w4cr tr\ rhcr v)lc .oNlxtrs.riotr. will do rh. work ud rtu sln{rur! h mr
<br />rlrt popcny *fu) huilds or i'!prorcs rhcFnr !R $hod.cs{.h\b*hirnscllorhcrscliorrhouphhisorhcr.*r.'npbyccs.
<br />,tuvidcdlharsu.h inpn)vr'tunrs m nor i'ncndcd oroficred i,tr srL ll hoscrcr. rhc huilding or i'qnrcnrnr ils,ld*ithi'r'{rr rrrr
<br />or.o'nplclion. rhc Osrcr Buildcr *illtnrE Ihc hur dcn ol F)vinS rhd h. d rhc dil ret huikl or i'r{rcv. rh. pn)&ny n)r rhc rulF)E ol
<br />_l. rsowmr of rhd pnrlrdy. rcklu\ivcly.oikr.rilg wirh li..n\cdroftn.k,^nJ.oh{ru.[hc rn+.r (Sd.7(X-1. Bunrc$
<br />rl tllrcssion Codc:'l hc Conrrrrol\ Liccnse L$,der ml an!ly ro 0n nwncr olplop.ny wio tuilds or inprc\os rh$con.
<br />,nd sh. conrtock for sx.h !u.ct wirhaConrE rort\) liccn\cd pur\urnr t,rh.Conrdois Ijccn{ Lrq)
<br />I rmc\cnrl trndcr sNrirnr .lr & P( ntrr[n r.ivnr
<br />Dore: ()$ner:
<br />1rl)nx,[SurQuLnNralt0!DIQIA rOtr
<br />I hcrcbyift muhd.r|f rlryuf tr'jurtuic.frh.n,lk,*in!d..hrxrit,,\:
<br />I lr\r dd will tuinrri. r Ccdifi. corCon\cnrr,Sclfln\xrcnrworl.s cnmp.i\rrion. rs providcd turbySoc.utr lTtrorlrhi
<br />Lnhrr Code. lor rhc rrfonu.cc ol rhc *ort ,o! q,hich lhc I'crnrir n h\ucr .
<br />I hrvc rnn qillhrinlain sorlcri cofrpdn\arioi ih\nrrncc. !s rurlutcd bySccrionlT0O.frhc tjhlr Cild.. ftrrh. pcrfomEtrc of
<br />t[c Nork lor whi.h rh,s p.nnn is hse\d My vort.6 .on{r \.ri, nrsurrR..ani.r tFlic,nun$.rd.
<br />-l.cniryIharinlhc
<br />pcrltnnrn.c .l thc $ork Inr shichihis |frnrn h isa'cd.I shrll nor cnrtloyirypcrvnr in trtryn nncr
<br />sNk,h.tonrsrhjccrhrhdworkr*'.ortE\rri,)nlnw\of(rlilnrrir.riJrsrccrhxritlstn,ul.lh.( r{hicdtutlr
<br />qorkcr{.o rp.tr\rri(,rltr{nair, \ols.cioi.l7(x)ofrhcl-xhtr(inl. l\h ll. nflhtrirhco'npl
<br />WARNINC I'ailurc to h-.urc sorkcn'conrl).nsdion drvcnlc n cn oycr r) (rimlnrl ncmlric\ 3Dd
<br />civil fitrcs up Io onc hundrcd Ihousrnd d.lln6 (Slm,(xx)), i d nsation. d0nu8cs as providcd ntr rhc
<br />Sccrlon 3076 of rhc tjhor Qdc. rnrcrcsr md axormy-\ ltc\
<br />I hcrchy rlfi nn uft l.r nanrlry ol )^-rJUry rhrr I n, I q (.onn,rncn,g \!irh S(riifl 7(XX)).fD.'i\i(,r l
<br />y'n
<br />I hcrby nrn undc. Fnrlry of pcrjury lh.r rh.rc is a co.srocrion le.dinE rg.ncy t6, lhe rnr()lfucc .r rtr work for *htn thh F,mir ir
<br />issucd(SN 1097. Ci!. C.)
<br />AIILICANIDIIEI.II.BAIION
<br />I h.rchy ll]lm uklcr !.mlly ol tujury onc ol'thc lbllo* r8 dc.lmr nrN
<br />Dcndnion PcmnsAshcsros Noriicriio. Fidcmi RcAuliriotrs (l-'ilc 4{r. Prn6)
<br />k.qurcd 1rr.' ol Nor'll. iL n
<br />I(c if ihlr rlr litrd 'rgu rr(nr\ '.!tudtrrg rsbcno\ rrnuxlir. ri rpfl.rhL. t, rlh I[,i.d
<br />-l
<br />ccnify lhal I Mvcrcldthn nprlicoriooandnntc ! h corccr I +re ro .onr,'ly sirh all Cny rnd Coonr!
<br />orlinnnccs and Sr0rc h*r Ehritrs ro hulldlnE co rcprclctrtlrn$ ol thn Cilynnd G,!nry t,.nrcr uF,n rhc
<br />rt$vc nrdioncd Dnrpcny lnr Nreri(
<br />'\pt'li.rnr.r,\t.rl SiItrrl rr s-tt'K
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing 2,tzt.tz'ztl /r-2
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL Vz)*f-.4i9>-/0r)
<br />Certilicate of Occu pancy
<br />Notes Remarks, Etc.
<br />DATE
<br />CinEr
<br />ol rhc Busincslnd PolcssionsCodc. ud nryliccnsc h ir iulllorcc 0 ciccr
<br />kndn's AddE$.
<br />I
<br />I
|