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BUILDING. INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OIVNER BI'I I,DER DELC R TX)N
<br />I hcd), uiirn undc' prnslry ('r pcrjurt rh,l I Mr cx.'nrr rmn lhe conlrndom Lice,sc L,w irrh. rolk,*il8 rcrsn (Scc70.11.5
<br />Busi,r.ss and Pr.f.$ion Codc): Atry Cit, or Counly shich icquircs ! plrn,ir io .onsn.r. ,hd. nrlnvc. dcmlhh nr mIJn rny
<br />strlclurc. p,ior to ils issuamc. also rcqlircs rhclpplica tu \uchr.nnil k,lil., slSmd st.tenEnt lhal hcorshc i\ li.ci*d pr u'inr
<br />nJ rhc ptuvi\nrns ofulE Cont0.ro* Lic.nscd kw (Chrptcr 9. Connnencins *ilh Scclion TlXx) of Division I of rhc Busirrcs ond
<br />Pmfcssmni codc) or rhar h.orsn iscrcnDr lh€rcfr.mund thc hffis tn rhc klcdcrcnprbn AnyviohrionofScclion70:ll.56yant
<br />arplicllrtorapcnnnsrhjsalh.trtpli.rnrbr.ivilp.mlry.Iiornbrcrhdnfiv.hunnrddollrr(35(D)
<br />*l-rsowmrolrhcprepcny.or'.,cmpbj{cswirhwa!.\ssrhcirn'lc.onlttrtditr.silldothcsork Irhcdtrrmnnn
<br />inrc cd or.ffcrcd td sl. (s.c 7044. Bu.incs nd ProltssidF Codc lhc(onrrlcr.ist-icc!{l-rwdocstrot{rlyl. ro*mrni
<br />rhcFlpcny rlm hnilds or itqrctls rtEB,n. and who Aes sEh No!{ hinxclfor ltr^.llor rhtuugh hN.r hcr o{n cn{l,,ycc!.
<br />pi,,vidcd rhnr \uch imprchmnrs rr nor i'ncidcd ur olitr.J nn sh Il h,scvcr Ih. huiUilrs o, inDnEtrEnl is sld sirhi'r on. ,tr
<br />olcomlhnotr.lhr Owrcr lluildcr willhxe rhc lDrdcn olpovirE rhd h. or shc dld tr.r htrild or iq)mvc rlrc fmI{ny lor rhc Purlns of
<br />-l,r\o{'rrolrhrpmlrnr..'n.r.lu\ntlr.oitrcrr!wiihli.c\cd.otrtrNtn\lo.nnsrruciihcnr+crlSc.
<br />l(}1-]. Bu\i,ru\\
<br />rtrd lh)lt$iniCodc:lhcCorrrrcrrtrsl,ic.n{l.rwdoc\norrpnlyn,mo*i.roff)!.nysh(,burldsotirnPrcvc\rhtr.oi.
<br />rnd sho d,nrm.h f(r srch ptul..r wirh d Co act)i\) li.cn\cd Dur$r torhcQn rrctn \ l-i..n\c L w)
<br />I arclr ,pr undrr Sc.riu
<br />!$.&tr8&tla[uErJA.ll()t
<br />DICLIAAII!)!
<br />I hcrchy a,lnnr undcr |anrlryol pcrjry onc oirhc tull)qirs tlccIrirn
<br />Co(l..ldllN n riornrnccolrtu {ork lar qhich rhr l[.nn '\ irnrcd
<br />anJ sill rinrain workcr ..nrtc.s.tion iNnmrcc. i\ r.qutcd hySarnrn-l7morrhc Lrbor Codc, ,or lhc P.rl.ne,mcot
<br />t I aory
<br />-l
<br />ccrlifylhar inrhc pcnnrnumc of rhc work nn *hich rhi\ Ilt trir is
<br />y, r\r,tr.Dnr subi.r !orh. sorkc6'.onrcnsnri( hwsol Calilnrnir-
<br />lsh!lltror.mpl,)yany pc^on inin, 'n ucr
<br />kl rgrt.rlrr i{l (iiuld hc.onrc nrh}cr brlr
<br />workcn e,npcnsdion pn,vtions ol S(lnr 3?0Oollhc hhtr C(l, tunhsih.o rdy Eith rlNrrrovilions
<br />rV,\LNl\(; t.r lu. 1o \crrc qor[.'\ .on,Nn\J(n (nL.'x!. tr u l. rnd shrll suhJcd rn c'nplo)€r k, dinlinrl Pcnrllts ind
<br />trcs ur io otrc humlrcd rhou\ud dollas (S100,({{)).+uii.t i"" Iil*ui\f ijtlrA
<br />\Anptlcr,rt, f
<br />r rdhr\sFr) (()NT[r( ToR
<br />DECIASAIION
<br />I hcrchy afiim und.r l*n0lryolpcrrury thrt l0m liensn undcr provhion orChlptur 9l.ommmnrB wilh Sdion ?mO).rDivision l
<br />oi lhe Busim$ and Prcfc$ions Code, dd ny liccns k in tull r.r.c,ndcfrccl
<br />V lr
<br />IANiIBIIIIANIEIDIIIiJIiINCI
<br />Ihcrcbyn,fiirnundcrpctrrlryolpcrjuryrhnrrhcrci\.oritucrionLidmgr8cn.yhrrncp.tlonu!.colihcsork,or$hichrhispcnir$
<br />LrnJci. Ad.tcs
<br />-
<br />AITIICAXLI,IECLAAAIION
<br />Il*Nl,y lnDrutrd.rlcnrltyolrciuryon.ollhclbllowi.s (lmrii,r\
<br />Dcnx,lirion Pc'nik Asbc\b\ NolificrlnD frdcral RcAUhlnnN(lillc,l(r.l'rn6)
<br />Rcqutrcd hrrcrof Norific i
<br />-ffiffi ffi ;;dil;ffi;',;#ffi ,,* ****,*",,,,*,"
<br />ibvc nEnriomd pr.p.n, fir ios
<br />Pcmi'e Mm€(pnnl): M 9r\rDX
<br />vl\ I tr
<br />Set Backs
<br />Forms/51eel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubllooriVenVl nsu lation
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/lason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL 9ltT ltg ,.(//dql t9,/
<br />Certif icate ol Occupancy
<br />Notes, Bemarks, Etc
<br />!\
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