|
Btl I,-DING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framinq i/b/A >\\ffi
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Ceftif .
<br />FINAL
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc.
<br />OWNl:R OT]ILDER DI]I,CARATI{)N
<br />I hcrcl,y !(nm undcr p.lalry ()r Frjrry rhrr I an, ercdpr rmm rhc co kd.in\' LtT.t L.r' n{ thc lnll,cin8 rcrw'n '$' Torr s
<br />Ltusircs\ ! Proli$ion Codc)r Any Ciry or Coumy w[i.l] rcluncs r pcrnril ro con{ru.1. all.r. i'npu,vc. Jc blhh or rcErn My
<br />s .rurc. l]ri,rh ir\ i$!ancc. rl$ rcquitusrhclnllicrnrli)r{'ehp.'niit,lil.r \igtrcJ ftrci* rh.rhcordEislic.rscd ,'us{rnr
<br />lo rhc nolishns of lhc Conrnctn s l-iccnscd lnu (Chrpr.r 9. CommcmiDg *irh S.cri()n 70(Xr of Dirision I of rh\ Btr\irr.s {trd
<br />Pn,fcisi(,n\ CoJc) or rhar hcorih. n.x.'npr rhcrcfr.dnnd rhc hr\is f(trrhc,llcgcd crcnl|rio. Any!nnarion.lSccli{nr70.ll5hyan!
<br />rpplicrtrrntr,lrnnirsubjccFthcaprliconllorcivil!.nrlryormrnxrclh lnc hundrcd dolla^(St(xr)
<br />-l.aso$ncrollheprepcny.ormycmtk,rccsuirhqrscr
<br />lhcir $1. con!,isrr i.n, sill do rhc wtrk mn thc (trrE i\ tor
<br />n crldd or oficrcd ntr sb ( Sd 7t!4, Busim$ .nd Prcrc\sn)nr C.dc: Thc C('ntrror's l-i.cns Llw ioes nor lpIly h m oond of
<br />ihc pnp.ny *tD huilds or i'.proKs rhcmn. ud $no d{r\ \Eh sor* himselior h.nclfor rhmuEh hn orh oqn cn0loycc\.
<br />provid.d r hrr su.h iDpmvcruB rm mr i' .frLd .r .rTcrcd rar \rlc It lrmtlr. rhc hu 'k!rE or i'nJmvcm.t is $!l $irhin onr rtr
<br />oi.omplclion.lhcowncrrluil.lcr*illh!rcIhcbu cn ol novirg rhar h. or \hc dil nor huiH or irnmrr thc pn,Fiy fu rh. !uqx)*- of
<br />-l-
<br />arosncroirhc ptr,l}.ny. !mcxclu\ivclyconr.dins sirh lircnscd conrr.kns h .on{ ctrhcpn'}i.r1se 7(}1,t.l}u\itu$
<br />rnd Pnna\sr)nCodc:rh.Coniirnr\Li.etrscLrwduc\trorrprlyb!n.trtrcroipioF_nyshohuildsornnprolcsrhcr.oi.
<br />aid wh. coika.k tu' such rruc.* sirh r C.ikr.tr(9 li.enscd pur{rir t)rhcCo raciofs l.icctrsc ltrw)
<br />I rni ckn,B undrr S(i
<br />DIiEIAa^II!)!
<br />I hcrrh,rfinntr cr pcnalryorpcrJury on. ofrh. followi'rE dcrlrrrrnnrl
<br />I havc dd will tunnrir r Ccnrltdc ol Con\cnl k, srlf- IrNUtu r(n s.r kd \' .ompcnr.r ion. rs fmviicd li)r hy sd nn :17{n of rhc
<br />t-ahrr C{il.- nr r[. pcrforn nccofrhc$ont ntr which rhc ,rnnii ni$ucd
<br />I havc rtrd willrmirtniD NorkcrJ .onrlctrs,rior nNmr.c. rs rcqutudbyScclionlTlx)ofuhcljhorCodc.nnrhcNrionnm.col
<br />rhc work lor which rhisNrnrn is ssucd. My workcr' coml]ctrsrhon iNurrncccrdcr indrmlicynumhcrrd:
<br />-lccnilylh0l
<br />irthcpcrrbnrulccollhc work lbr which l[t pcnir i\ i\\ucd.I sfiallior c !n.t flyPcr\ rhinynr rncr
<br />$ .s ro h.i.'ft suhjc.r rorhc{ork.rl.omp.ns,nn hws.fCrlifoiri...nd |l3Erhll iilslmul(l }r.oft sul,rc.r ror}t
<br />sortd\.ompcnsaridDnrvnb.solSdion:lT0OofrhcL-rluCoJc.l\h!ll-l'onh*irhc.nlPlywirhrhorltuvkn (
<br />IVARNINC: Flilurc ro scurc sorlcn compensrrion mvcrlsc i\ unlrwrul, trd \hdlsubjc.r .rr cnrploys to cririDlIt alrisfln,l
<br />.vi ftn\trt'r'otr.hu rnl rl,oulxDn Jollr\ lll(x).(xr)r. n, r ri(inniI rMfcs rr prridcd tur lhc
<br />Srrion:1016 of rh. Llt r Gdq imftd and drbmy
<br />D.rq _ _ _ Appllor
<br />DECI,ASAIION
<br />I hcEby arltrm undcr p.mlry of p.rjury rhal I !m licnsd undn lovision oI Chlptcr 9 (omntici'rs wirh sc.iirn 7000) ofDivision:l
<br />of rh. Burimis tud Pmfcssirnr C.dc. tuld m, li..ns is i. hrll for.r.nd cflirt
<br />CO!SIf,!.(] r!IDNDINC.d!jEN(}
<br />I hcrch, afllrm undc! pc.lhroapciury rhar rh.rc n a con{d.rion lc.ding ig.tr.y for thc l).rfonn.rcc ollhc work r.r which lni\ F ri n
<br />tsucd (Scc.3g)?. Civ. C )
<br />ATSLIIANLIIDCLAS{IXXi
<br />ItMhy rmronddr Fmhy orpcrjur! onc ofrh. iollowire dc.lir.rions
<br />I)cmolilion Pcrmiis AslEslo\ Norificarion lrcdcral Rcsulalions ('rirb4r), Pad6)
<br />-Requncd
<br />L.rrc. ot Noiifi qrion
<br />I ccdifyrhrrrhc rcd.tulr.SuLrn \ r8rdins *bc{.senlrqlnrc nur {ipliciblc Io lhttntccr
<br />-lccniiyrhur
<br />ltuvcrcldrhtdpplicrrioi{rdnorcrharrn.$ovcinftrn rn i..rc(r lrgr&tod)
<br />n'Jrldrrc\ nllGrc Liw\ rcl,ntrr k' huiUi"Acnnrru/ tr.n. rnJ hlrhl odrh /, ',F,\'nr, trc.or rhr
<br />:[:::l]::r""{:w* bu,o^Pemil.c nrnr (prinO:
<br />trll)lrwirhrll Cilyrni Coutrry
<br />Ciry and Counryt, cnrcr troo rhe
<br />,",o|lauab
<br />UFER Ground
<br />g/r /tT M}en
<br />CJr:.r
<br />l-ic. tr se C hss
<br />-Licensc
<br />Nunlbc.
<br />-
<br />Drl. Conrn.r.r
<br />I
|