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BUILDING- INSPECTOR RECORD
<br />SITE.WOBK DATE IDiSIG.COMMENTS OWNER BUILDI}R DEI-CARA ION
<br />I hcrchy rffirm undcr pcnrlty ol pcrjury rhal I m€xcmtl rnrn rhc Co rudr. ticnc L,s hrIh( li,lln*inc rcrsotr (Scc7l,:ll5
<br />Br*iic$ snd Profc*ion Cdrc): An, Ciry o! Counry whi(h rc'tutrc\ J rrnnlr . .-",..f,,;. trnfnrc. Jc rlrh or rpni ,ny
<br />nru.iurc. t,i.rro irs h.u,n... rko rcquircs rh.,rrdkM! lir \u.h frrrni' h ft.a si8trcd {lrcmnr rh0l h.or shc h liccnsn lurslnt
<br />io rhc ,mltions or lh. CDnrtuctd \ Li.cr*d tiw (Chaprcr 9. Conmcrin! sirh S..rn,n l0OO of Divhion I of lhc Br$nrcsr dnd
<br />ttoicssnns Codc) or rhrt hc or shc is cxcmpr rh.Eiron a*l rhc bari lor rhc lllc3cd cxcnuri{r. Any viohtionolSr.^r6n70.115 hyxny
<br />rppliuir lnfu Frntir \ubF.B rh. aptli.inr b a ciril I,c.slr, of nor frrc rhrn ,lh hu ndrcd dolla^ I S5fi,
<br />-r.
<br />rs owncr ol rhc ,orny. or my cnll)lorccs with $.gca rs rhcn $t ouF.salion. will do rlE {o* ond rtE (rrr is el
<br />inrcndcn or ofTcrcd aor stc (Sa 7ol,r- Busincss and h)Iclsions Codc: -l}c C'o.rrrr, r Ltcnsc tjs docs mr ,r/y ro M osmt ol
<br />rhc F{f,dy 8h) builds or iDpmv6 0rNn- and sh. dcs su.h so* hinN.llor h.Gclfor thouBh hh or hcr o*ncmployccs.
<br />,bvidcd rhrr iu.h impmcc rna m mr i cfthd or or.ftd tu \rk Il lh*cvcr, rh. buillirS or inl,mw.Etrl h sld wirtm om )rs
<br />of.onubrion. rhc Oqrcr BuiHe will harc the burdcn ol frcving rh.r tE or stc di1 nn ioild or i,r{'ot rhc tn,p.ny f.r th. ,,urFls ol
<br />-1.
<br />!\o$ncroirnc nmpcny. !flcxclusilclyconhcrins sirh licc0scd(otrtr&i)Froc.n{'xcrrhc Iln,fcr(sft 7(}1-{, Busncs\
<br />id Pi'fs\intCodc: Thc ContKttr \ Li.cisc Lr*doc\ nor rpplyk) r own$olftupinyElr,huildsoii provcsrhcrcon,
<br />rn(l s1n).onrndsntrsurhlo]c.h$irh!C.nrrcr{fls)licctrscrlNnur r, ihc Cotrkr.(tr s l-icci* ks )
<br />-l
<br />r crrn,nr trn,fur Sc.rio tl & l'( li,r r[n rr !nr.
<br />Dale Owner:
<br />woRxFRs, couPttNs,ii!oN
<br />DIICIABAIIA!
<br />I hcrcl,y.linnundcr pcmlryolncrjryoncolrhclollo*irBdc.lnraridr\l
<br />-l
<br />h{v. i,nt will nDinl0h a Ccnificot of Consc.t h Sclal.surc lor sortsr snnpetr\arnnr. xs ptuvidcd tur by sNr ion r7lx) or rrt
<br />Lrixtr Codc. ntr rhc t r.rornDncc of fic wo.k lbr which thc pcmir is rs$cd
<br />l.cnifr rhr in rh. lxrfonMrc. ol rhc sork for whch rht p. nir is i$u.d.l sh0llnol cnlPloy in, p.ron inanymmncr
<br />so !sh hccom ruhjccr ro rh. wo cn compctrslrinn hws olColilhiri0. and n8N rhar itl slmuld hcconr \rbjkr brhc
<br />worker co.pcnsation [ovnions otSeclion ]1700 oflnc Lrtry Codc.l\h!ll. fonhwilh comrly qilhrho* lioviriuns
<br />WARNINC: Failurd b kun w.rkc* .ofrpcn\dnrn c.lrrgd i\ rnlawlul. rnd sh.ll iuhl..r of, cn{,loFr to rin nal Ianaltts lnd
<br />ro onc hui nd rltr'u\rtul dollar\ 1$|(x).(XX)). in diri,)n r, ihc ro{ ofro rl.nsrn r. dnEScs as providcd tur lhc
<br />sc.ri{'n.1076 or rhc Lhtrcctc. inirrd{ and arbmcy s rcc!4A^-.t-3-(t 7,
<br />I hcabr rllirm undfi pcndryolpcrjur! rhal I rn lrcnscd undfi pn)visnr ol Chr s 9(omnrtrcins wilh Scclior T(r0O) olf)
<br />ol rh.llu\i'i.$ nrllt,'lc*ntrn Ci r. M ry li(rnso s i'r ltrlllnrr. rlcll(r
<br />c(o -75bt8 q
<br />u*"'?'3-1?"",,*'-E 9"rn Rr^,
<br />coNualcutlNrENollti-atiENrl
<br />I hceby uf,irn und$ ,cndly ol pcrlury rhal thcrc is ! connrucrbn hndin8 qcncy fn rhc FrfonMncc of lhc aorl f.r *hkh thn Fmrir ir
<br />issucd lS.. .1097.Civ. C ).
<br />AIILICANLDECITIAAII}N
<br />I lrdry dmmr und.r pc.dhy of pcrtury om ofrhc follo*ing dcclirrtnrs
<br />Dc'mlirion Pclnits Asbcsrns Norificalion Fedcral RcB!hrt,ns ('l irlc.l). Prn6)
<br />-Rcquted
<br />Lcllcr of Norifi cdion
<br />I.cniryrhd r h. rcdcr0l rcgul,r io.s rcB&di.8Nb.{.src x'vdlric..r.|Dlicnblck,rhislrjNl
<br />I rcnil rh ( I hrk rcrdrhi\ afplicnnnrrid (dc rh]r rhcrtx,vc inf(ntrdior n.odc.r I rlrcct).onrnlywiihrllCily d()unry
<br />riv. nrcrri,nrcd ,ropcny lor impcclion 7,4AApDlicanl or Aa€nt sianrlrre
<br />Pcn rc. nnn'€(prnrr): }(.eSSie r Ho..h-1
<br />t-, -(9
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt, Lath
<br />Brown Coat
<br />[,4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL ltlulc 't\4{t
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />J
<br />-l
<br />h{vcind will Drirlain wor[crr c.mpcnsalion ]nsumncc. as rcquircnbySrcrtnr:l7lnoiihclf,horG .. ror Ihc pcrlbirMkc of
<br />,hctrorlr.rtrhic\r\nnc n['\s.dcdVytrndcq'smlcn{rh,nrn.u,,'ftc.]ni.'inrlF,lr.)numh'rr
<br />,",,", . Z....cic[ .t*t.l.erl'ct.-:.
<br />,.r-
<br />Landcir Ad&cs
<br />Forms/Steel/Holdowns
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