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BUILDING- INSPECTOR RECORD
<br />OWNER BUTLDER DIILCARTtI lON
<br />I hcrcby alinflr undcr pcnalry {,r p.rjury rhd I am crc'ntr riom rh, (bnrdos Li.cnsc lls f{rrhe rolk,fins masotr (Sc..7031.5
<br />Busincis trnd Profc$ir Codc) Any City or Counl) which rcqutc\ r Frn,ir h .on{fld. Jrd. inrootc. d.ndi\h nr r+rn any
<br />rrxcturc. I)'iorro irs hslmcc. !lv, lcqonc{thc atpli.nnr fff \u.h l.i,nir h filc 0 siancd nftnEnr rhrr h.or shr i\ li.ctrscd Putsotrr
<br />ro rh. pnivirn'ns of rhc Cotrtrocktr s Licctr\cd ljN (Chrtrcr S. c(nn ticing wnh Sc.rion l0O0 ol Dilhn'o.l of rhd Bu\incqs nd
<br />Itofcssidrs Codc ) or lnrl tr or she iscrc.fr rlticfro andrhch*isf.rrhcrllcg.ncxcmnlion AnyliohrionofS.crirT03l5byotry
<br />!mli.!nr r(,uFnnir srhj srhc dmli.a n) icivillcni[yolmr nmrclhrn rirc hundr.ddolld\ (s50or.
<br />L ns oqNr ol rhc propcny. or nry crylolccs *ilh ,arc\ a\ rhct w,l. ..'nff, rs,i ion. will do tlE $ork rnd lnc lrturm n 'riiotcnd or olltrcd for elc (Sr'. 7014. Busincs md hof.$n,n\ cdlc Thc C.nrrn.tor's t.i(nsc I f,q Jo.s nor rPpl! r. an o*n r ot
<br />rlr pr,p.dy whohuikh.r ir0rovcs its6n..d who d,s \uch w* hnn\cltorhcrtlfor rhmuSh his or hcr o*n rn$loycc\.
<br />,iovid.drl \uch i'nlovcnrtrhlrc Nr inrcndod oroltrci lirr {]c ll hr{r\ci rh( btildi'ts ur nnptuEnr t $ld wirhi', otrc }tr
<br />of.omDbri()n. rhc Osnq B!iH6 willhNr rhr hrilcn o, pi.vnrg trur lE or shc dil nol hikl nr i'npir*t dt tmFny n]r ltr Pu[nc ol
<br />_.1. nsowncr olrhc pniplny. rtr,cr.lusivcly.o rdi'r! wfh hcrNci cotrrrr.tr\ki.otrntod rif, n'o).d 1Sc.. ](!,1.llusnc$
<br />r'{l lhni:\\iri Codc: Thc C.ntru s l-i.cn\c l,i* dr.s rorrpnlr k) rn oqtur of t)n)lrny $ho htrillh o! im|(rc\ rhctuotr,
<br />rn(l sho .otrri'.trin\rch tn,)ccr\ wirh r (inrn.tn1\)I'c \cd lurs,ud hrh. (:otrtn ntr \ Lic.n\c L.q)
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<br />encicmpr underScrio
<br />Gvc.,rida \-o
<br />.uonKlrBs:lout[Nsall0N
<br />DE!;I]$AIIO!
<br />pe:7-
<br />I l,.rch!rtfnrutrdrr I)c ahtol
<br />-lhavc
<br />und Nill nuinuin d C.n ifi.nrc of Cotrsht ro Scllhrurc r'or workss. cohncn\d bn. ds pmvidcd fot hyScclion.lTlx) orrhc
<br />l]hrr Codc. hr rh€ I)(rl'oirMmc oi rie so'k ror which rh.r.nnn h i{cd
<br />_lhavctrftitrillmri'ndinsorkcn..micns0rionn$utunc.asrcquiEdliySccri{m:l7lDofrhcljb(trCudc.IhrlhcncrfornBnccof
<br />rh. work lar*hi.hthis pcmir is irsucd. Myworkas conrc$rlior insumncc crricr tt },li.ynu ncr !rc:
<br />hrftrc!
<br />I.cni,!r1[l in rhclErl.rmancc {)trhc *o tu*hichrhnr.fln,r is i\sucd.I (hrlln.r cmnkryrnypctu nr trynntrn.r
<br />$ s ro lEconE \lhjcd h rhc $orloJ .onNhsdri(r hs\ of Crlrroarir. rtrd isNc I hr il I srk,![l hccotrE subic' to rhc
<br />sorkcr'cotrrrcnsori{'npR,visbilolS..ii 3700 ofthc L txtr C.d..I \lnll. rbni*ir[.o'nply uirh rhoc DrovhioF
<br />WARNINC: I'ailurc lo scurc workc.i.omJf,nsdn r covcn$ i\ utrlil'ful. lnd \h!ll \rhrrcr r..'ntlotcr fu $iDnrd plnrlrEs rnd
<br />.ivil fincs up ro.E hun rcn rhousn d d.lldr (slU).UXr. in dddirion x, rtu co{ of.otrIfniaridl drnmS.r as F)ridcd for rhc
<br />Sccri( :1076.l rh.l,rlxnC.J.. i'[cr.n r d /.,kl rO.C-^e\a r--orez^
<br />ull:Ntlll!lrrlxrfal3
<br />l1IjlI!!BAr!1
<br />I hcrby rflntrr und$ $nnlryolFrjwy I!rll.cn{dn orfniri\i( o,(hrJ'lcr9lc.nnrcncingwirlrSe.ri( 70tr0) ol Di\ision l
<br />l-i.cn\c Nxnlbd:
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<br />CONITNIrcTIITN ! FNIIING A(;ENCY
<br />I hcEby lfftr'n undcr pcnall, or ptrjury rhar rh.rc is a consdclion lcfrlirE lsenc, for rh. Pfrornmc. of rhc *orld'or whkh rht ldmir i\
<br />ksucd (Scc 3097. Civ C.)
<br />ATIL&ANIJIESdSAIIA!
<br />I hcrcby3mmrundcrp.nolr,olpcrj ry onc orihc rolhwin! dcclu,rn,ns:
<br />Dcnsliliotr Pc nirlAsh.ios Notificalion Fcdcftl R.gulxri{,ns (Tirlc /{). Pin6)
<br />Rrquir.d t (ci otNorifi catior
<br />r.itr,vnlrc tror,'ptni.ih!c ni rhn |nir.r
<br />rh,vc infir drn i\corst. l!3re ro comply{irh rllCilyatrd aouniy
<br />$d hcrch, rur h. ri2c rc rnc {nr ivcs ol Iht Cily!n,l Coutrrrro ctrrd ulnn rhc
<br />L-cFe"L
<br />SITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL ilztltq -fvr,,rwrV,r{*
<br />Certificate of Occupancy t t ut
<br />Notes, Remarks, Etc
<br />\-op:-:1l L511l.
<br />COMMENTS
<br />Fo rm s/Stee l/ Ho ldown s
<br />Pool Fence
<br />ol rh. Bu\ih-sr,nd Pturc\siotrs 6dc.atolmy licctr( h in lull forc.onl crrccr
<br />I ctrd., \ r\ddr.{
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