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BUILDING. INSPECTOH RECORD
<br />SITE.WORK DATE ID/SIG,COMMENTS OWNEII BUILDIiR DELCARA'I'IIJN
<br />I hcrehy alrtn undcr p.nahy otFrjury rhal I am cxcnl linrn ihc Conrrrr()F l,icc.sc lrw tor rhc rt,llowin! rcakD (s!.70115
<br />Busnus ann Pmfcs\ior Cldc): Aiy Ciry or Counry whkh rcquts r fxmir k, .on{ru.r. ,lrLa. nn|)mvc, dcrnri\h or rcIrllir rny
<br />sindurc. ,ritrto ir{ issuamc. aho rcqtrircs rhcaDFlic r ,or suchrcnnil io ljlc r !3ncd srorcnrcnt rhlrheorshc i1]icciscd prr{,nr
<br />t, rhc pmvtn,ns .f rhc Co.trdoa\ I i&ns.d liw (Chrprcr 9. (i,nnfti.irs *irh Sc.rion 7lxx) of Dnkion -1 oi lhe Bu\incss and
<br />Prna$ io$ Codc) or ihrr lE or shc is crcryl rhcrcliom rkl rhc hrsi\ nvrhc !llc8cdcrcmplion Anyriolalionol Sccrioi 70.115 hyany
<br />arplicor lor !pennir suhjals rhc applicanr ro rcivilpcmlryolnol norc rhu lllc hundrcddollxrs(S50o).
<br />l.r\ uwkrorrh.J,n,pcn!.ortrryctr o)rc\eirhw.!.s,sihcirn,lc.orrcsaridr.silldoth.v( nnd rhc {trhru i\ Nn
<br />i d .n or olicr.d l0 elc ( SN 70r,1, Businc$ rnd Eolt$ion( Cdc Thc O,nrlcnn\ Liccn{ ljn &rcs nor rpply n, xn oancr of
<br />rh.lolxny who huildr or i'ffl,ws rh.n!n. md wh, doc\ skh Ml,l hnns.lfor hchclror rhmuSh hir.r hcr oBtr cnuloyccs.
<br />poviAcd rhot rlch iq)FvcnE.ts cnr inrcftlcrl iiroltarcd f.r sh Ii tr)*cv.r rl.. ttriHiry or i.npnNm.r is blll sirh]nonc ]ar
<br />ofcondchon. rlE owtrcr Buikt raillhrE thcbudctrofpn'vnrSrhar hcorsh.d tror htrild or iDl,rovc rhc lnrpdy ltr rhc puqxxc of
<br />_1.$n$crolrhcpnptny.rm.ichsivclyconrru.rins*irhli.ctrsc.otrtr.trshdnr{fl.rrral)ftrJ(tl(S.c7(!,1.lru{ncs
<br />a' Blrc\si,r Co,l. Thc Cohtactrtr s Licc.sc I-,s docs nor rmly t, nn ovNr ol pr)Fny who hu ilds or irprcr\ iher.nn,
<br />ani $ho conrricrs l'or such pmFls {irh ! Conn&t,(s I ltcnscd rursurnr brhe ContJcttr \ Li.cnsc Lrs)
<br />-l
<br />omcremrr undcr Sccrnrn-. B. & P C t,rhi\ rcNn'.
<br />Dole: Owrcr:
<br />llOit(ERS COMPf, NSA IION
<br />DECLAIAIION
<br />I h.rcbydtlinn!nd!rD.nruyof pcriuryonc.frhcn bvnxde16!rions:
<br />-l
<br />h!!c!'rl*illnuirhin!Ccni,l. colCoNcnlroScliln rclorrorkcrscontxnun,n,a\pruvid.dlirtbysc.riotrlT0ooirhc
<br />L$n Codc.lnrIhc!. onn0Neollhc rork Lr*hich rhc l]cnnn n hsucd
<br />rh. qorkli'rshi.hrhi\n nnir is i\\Lcrl Mytrorkc^ co |tnrrlim nrtrrrtuc .xricr riJ tx)ltr" itr $rrrc
<br />l.cnifyrhd nr rhc!$ro,nrn..olihc work lDr uhichrh( fiflnn is is{rcd.I shrll.or cn,tloy!n,I}cnon in Dny r Nr
<br />so rl(' hcont suhid k) lhc srrkcr'comp.nsdiotr lo$s oiCrlii.nia. nmt r['$ rhrr ifl \h,uld h(( t $bjd rortE
<br />*orkcrs conDcrsrltun pmlnnrDs or Sccr i(,o 17(ro ol thc Lrli'r ( Glc. l sh ll. inh$irh (,nDly s irh rhN Pn,vNn r
<br />WARNIN(;: Fiilur b wuic *i .r(.o'nl.n!dn ovcftgc i\ unhwful. ind shdl subicl nn cDlnlo)rr lo crimiml p.ulri( and
<br />.i!il fiics up ro otu hundrcd rhousand d.lls* ($1ff).U)o). n rditirnn 1. rlr.osl .l.ompcns.lidr. duntrScs $ pr)rtlcd itr rhc
<br />Sc.rion 1076 ofrh.Ijhtr Culc. nn.rci itrd Nunf,y s fe(.
<br />l)3lrr Applionll
<br />I rcr.NsFD(I)NTR CT()R
<br />DECI"AXAIAX
<br />I hcrhydllfl ! dcr pcialryufFrjuryrhd I rn licdn*dxfrlcr pmvnionolChrll$9(.o.mrncin3 wilhS.cri'n 7l)U))ofDivision.l
<br />ot rhc Businc$ und Pn,fesionsCodc- d myliccnse n in lulllorcconcffEcr
<br />Li.cnscclas: Li.cn\. Nr $.r:
<br />D.ler Conldctor:
<br />AIIUCANfDICLAX{IIAN
<br />I hcE'6yalinnundcr !.n!lry oINrju.y onc ol'hc followine del( io.s
<br />Dcmohion Pcnnih,^sb.sros Noliicrlio. IJcdci0l Rc3ul(riotrr frnt.10. l!!n6)
<br />Rcquncd Lllcr or Notifi cilion
<br />lronil,v!hrrrh.liJ.ralr.guhri,)n\'.!xftli'iAx\h.io\'.nn\rlIc,,rt)pl.rhl.kirln\f(,!:.r
<br />I.d'fyrhd I harcruilrh'\ 4!li.drn{rd {dicrhrr rh.rh,!c itrlinrlon i\.on..r Ir8rar'conrly$ilhrllCirfxnd(irtrrr_
<br />rhorc mcnrioncd po!.dy lnr ir\psrion purpo\c\
<br />,\policnnl or,\Icnl Sign.tUrc
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclron Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Il4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL *'zb-tZ J-\s.C t=@
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />CANIIIIII:UQNIENDIT(;.AIiI]N.CI
<br />I hcrchy rl ltn u.n( Fnnlly ol pcrjur rhor lhcrc iso.ondn'cri,n Ic in!rlcnc,f(rrh.r^-rf.htr,k.orrhcworltotwhichrhtlEflniris
<br />i\{rcd (Scc.:l097.Civ C )
<br />Ir Jr'.Nr h'
<br />SLAB Floor
<br />Flood Zone Certil.
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