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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER Bt'ILt'ER DEI,CARATI(}N
<br />t hcrrhyrfir und.r NMlty of r.rjry lhlr I am demnr lrcn rhc co.lr tn Ltcn\c Law ltr rh. folbwin-! realr rstrTnll!
<br />ar(in.rs ird Profcssior Codc): Ao, Ciry or Counry sh'ch (q nc{ . Fnnil ro conitu.r. dlr.r. Nprolc. demlnh or Eprtr ,ny
<br />nfl.rurc. Driorlo ns issu$.c. rl{, rcqui.\ rhc lf,nli..nr lirsuch ncmil h fiL tr siPtrcd (arcNnr thit hcor \hc is lncn\cd putsurtrt
<br />lo rhc !r'!isi(,n\ or $c Cotrlraclols Liccnscd Li* (Chrprcr 9 Co nncn.ins Eirh Scclion 7(x{) ol Divisbn 3 oflhc Busin.$ dnd
<br />Pn'fc$n,nsCodc)or rhd hc orshc is.xcnDr rhcElrt,nahd rhchisi,orrhcllle8cdcxcnlPri,n AnyvnnarionolSaii,nT(,.ll5hytrtry
<br />!p!licrnriorrpcrnilsulrjucrsrhc,tplicdnrroacivilFcnrnyoi..rmorerhrifi(chuMrcddollus(S500)
<br />l, ns owno of rh. J)f,,lEny. or nry cflphysr siri wrgc$s rh.ir slc conDttrsorion. qill d. rhc wok ad rtc slrE-l@ i\ mr
<br />inlctuLn or oftrcd for slc (Ss 704,r. Busi.c$ and Profc$ions Codcr Th. Gnnra.lols Liccns ti* does nor lmly ro atr osmr of
<br />rhc pn,Iiery whD builds or numrcs rhcpn. un! who d.c! sch m'lk hnnscllor hcrcllor rhrongh hi\.r hcr owr cmt|yccs.
<br />pr.ridcdrhar such in,lmknrnrs dB.ot inrcnded o.ollird for et ll ho{twi rh. buiuin8 ot in{ro\r'rcnr i\ v,kl qirhinonc rls
<br />ofcormhlion, lh. Owncr Blitlo will hrvc rh. b{d.n ai ENi.8 rld hc or \h. did mr buikl or inrpmw lnc lrmFny ror rrr I'uqr$ of
<br />-1.
<br />as o$m,olrh! rroFny,.'ncx.hsnclyc. ndn,! *irh lic.n\dl .otrtlcrnn ro condB.l rirE In,lc.i (scc. ?Ol4- Bo\itrs
<br />rd &Dl6sbn Codc:'rhc Conra.i.as Li.c.s. hw docs.or orplyto !oo*ns orproFny who nuits or imPr.vcs rhcron.
<br />and who dnnrach r{tr sxch tr+.k wirh r Conlacr.(s) licc.\cil pursurnt tr) lhc C.nlrlcrois Li.c.s lje)
<br />-l
<br />!m $cn,pi undd sc.!
<br />t,t",1.064D4
<br />u!Ltl\r!1^
<br />Ilrrchtilltr uidcr |ctrilryolluljuy.nc olrh. t l
<br />-lhove
<br />afll will uinr,in aCcnirhnlc olconrcnl to Self-lnuF au nnkc^ conpcnsalion. a\ pi.lidcd for hy Sccrion]?00 otrhc
<br />Ltrhor Codc. for lh. ptrforrome oa rhc *ork tu which rh. IErmil is isslcd
<br />-l
<br />halc a'&l w iU nainrrin workcn conpcnsothn insurucc. a\ t{trir.d by Scclion l?00 of rhc ljbor Codc. lb! rh. PfLl11mc or
<br />rh. work ror which rhis p.mil is isud M y sorL.B .omP.srion inslErcc cari, uxl Flky numhcr m
<br />f {n'.J_ Nun$r' :-Expnr\
<br />lccnilyrI t ir llE |Erlbrroncc ol I lr work f.r whi.h rIis pclrnir i\ is!uc,l,I shrllror cn]Ploy rnyFr$n i lnynritrDcr
<br />\) s ro bcsrm \ubjcd ro rhc workfis .ompcnsrr mn h*\ o{ Calironria. rdnsrccrh3r iiI\hould h.om ub]c.rtorhc
<br />w,rtcr\ con,F-n\arn,ntn,vi\ionsolScdion:171)Oolihcl:'hnOnlo,lstnll lonhsirhcomllywirhrh.s,'r)vi\ions
<br />\IARNING: fiihnc b scuE sorkc Lsil|tN ion..vcriEc ls unhslul. rid :hnll sultcr arr cnrft,y$ k, mtniNl llcDal(is md
<br />.ivil lilrs up ro onc hud.cd rhorsbnd doll.s (SllXJ.(in lli(ion tr, nr.o{ ol.orrtEtrvrntr,. dr r!c\ rs lr,inu t,r r[.
<br />Sc.rn{:1076olrhc Lrhtr(-{xlc, i' cr.{ dd{rrc
<br />t",.. -.nfr.)4.1|
<br />I hctuhr" nJln n utucr t^-.nrlry.i f crjury rhd I rf , li.ctrwl r .r pr.vistin ofChaPt.r 9 (.nNrMcirrs +irh strri,n 7000) oiDirili.n l
<br />l()NlIIUCUOUTENI)NIi-&GENCI
<br />I hcrby atlnnr undcr lEnrlly ol prrpry rhar rh.r is a .onsdcrion tndins agcmy ror thc l)crlbrmrcc ol rh. srt for whth thi\ Frmir i\
<br />k\ucdlSs 1097. Civ. C.)
<br />tr.rJc:. \rr,r _
<br />l.cnifythot lhe tcdcrll t9larioo\ rcSrnirg asb.sos rcmovll drc nor {'nli.$lc lo Ihh plojccr
<br />-l
<br />ccnily rur ! hsvc ftnd rhis 0prltlrion lnd shrc ltnr rhc alt !. inr.hndion i\ .otre! Lgrd to coqtlv wilh aU Cnv and Counrv
<br />odrancF$'lsr c L{s (hrhs ro}urldrnE conrrdch.n, urd hcrcby tulhorirc eprcrcnrulv$ ofrhh Citv lnd Cdunrvto cnlcr ll'on lhc
<br />.vc mn,r,nc'l n,oD.ny rir,n,rcs6" n,'n *.;;;.;;;;;;,;"r' " ,h,e,. o!),otl
<br />p.mi,trM*,pri ,: l-S r \v ra. l2Laaa R4*t.-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulalion
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnl. Lath
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />t-.\
<br />FINAL 1-e*tK x-t()u,
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc.
<br />O,JC
<br />SITE.WORK
<br />Flood Zone Certif .
<br />.:''i,1-
<br />ol lhc B!sirc$ lnd Itolassior$ Codc, nd nryliccn\c i\ i',lull fur.cdrdcilccr
<br />ABSLICANLDqIA&UION
<br />I h.nty,Irnn lndcr pctrllry ofpcrjlryonc orrhc rollowin8 dsllrltions:
<br />Dcnhlirn)n Pcrnrirs Ashcsos Notificution rcdclllRcgulriions(Titlc 40- Pin6)
<br />_Rcquird tr .r of Norificalion
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