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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWN!]R BTJII,DER DEI-CAIIA'TrcN
<br />I hcrhy affim1 u u p. rlry ,rf Fcrjury rhnr Ln crcnyr fn'm rhc C.DlEclor' Liccn\. trq tx rhc f',ll,,wi'rB rcrsn lS( 10.11 5
<br />Busnms and Pn,rc$hn Codc) Atry Cii, or Counry shi.h rcquircs ! I.rnrir x'.otr{,xd. {xc', nnpn)vc. dcmolth or EBrir,hy
<br />(ructurc. [ior ro ir\ hsurrcc. al$ rcqutc\ rh. +plic]nr itr \rch p.nnir ro lilc0 rigncd srdcnxnl rharlrorrh. n kcn\cd rumrnr
<br />b rhc lnivni.i( of rhc Cotrlr..rors Liccnscd ti* lChrprcr 9. Cornrmncins *irh s.crn,n ?fix) .r Divtri.tr I ol rhc Bu\iNss !n{t
<br />l'mfc$io.sCodc) orrnallE.!shc hcxenpr rhcrefronrand rhc ha\i\ r(trrh.rllcg.dcrcn{,rio. AtryviohlionofScrridnTi,.ll Shyiny
<br />rmlicxnrro,rtrn,irs!hjer\rh.rprli.rnrb,rivill.nrlry.rnornk,crhnntivclNndrcddollarlS5(xr)
<br />-1.iso*ncrollhcnmpcny.(trnry.'nnbyccswirhwaacs!\rhcnk,b.onDcr\rrion.silldoIhcworkmdrhesrd.rm(ftninrcndcd orofi.rcd for sl.(Sd 704-1. Bu\irc$.nd Pn,lcssi.trsCod. l hc Codrscrois I jc.ne l-a* dd\ mr ,prly r. !n osmr ol
<br />rhc lrDpcny who$uildsor i'qnrs thcd[ nnd *ho ddsskhwort hnn\clfor hcrsclforrhmulhhi\orhn owncilPloyccs.
<br />fn,vidcd rhdr su.h inpmvcnr s.Ennri cBlcd oro,larcd nn st Ii. hoscvcr, rlt bu i ing or infl.rcm h sold tirhin on. y.tr
<br />olcon{,brion. rtEO*ncrBlikic. willh,rt rh. hidcDorphvirsrh h. or sh. drl ret buiil or in{.orc lhe pDFny for rh. puqrM.l
<br />l, i! owmr ol rh. pnlldy. a r rr.lusnclr.dnr ir8$irIhc.n\dlconrracktrsrocon<rucrrhcpn)Jc.r(Sc.7(l!.BunNs
<br />i hni\sionaoc:rhcCorrncloasl.i.cnscl-!qdo€snorrprlybdowicr.rpr)p.nyshobuildsoiiarprorc\rhcrcon.
<br />trd who mnrDcrs fitr such p' ru..t wirh d CuDtr!.ror(r) li..n$d Nrsur n,lhcC.nrft.lu s l-i.ctrsc lrs)
<br />I n r.rcnrfl u dcr Sc.itrn
<br />Dorc orner:
<br />W(IlrKERS CTNIPENSATION
<br />DDgrII}AIlg!
<br />I hcrchy rIftn undcr p.Mhy or pcrjffy oR nlrhc nnl,,EirB dc.lnmrions
<br />Ihrvc willnhinrai'rrCcnill.rrcofconscdrJSclllr{cbr$or[.riconrcnnii,r.aspn,!id.dn hyS.\ri 37(x)olrhc
<br />l-alxr Cotlc- f{rrhc pcdirnLiccofrh. work ntr which rltlcrn t N{rcJ.
<br />I hrrc..d Bill ri nin porkcrr conDcrsilioo in$nin.c. rs rcqtrtcd hyS.yri,,n l7(X)ofrht libor Codc. lor ric pcrfonnlncc of
<br />rhc $ork lnr which r[h !.rnril is hsucd. My workcr' .omplnrlrion in\urMcc cuicr drr a,li.y.r.rhcr m:
<br />_Expids
<br />-lccnily
<br />rhll h ihc p.rformkc olrhc sork n)r shth rhi\ p.irnir n i\sucd. I \h.ll nor cmploy lny pcron in rny nrtdncr
<br />wJ as t' hcco,r rubad n,
<br />'hc
<br />wo, kcn' .o nf.nsar ion laws ol cilifonri( rnd !3E rhJ' irl \holld tacom\ubirr t()rh.
<br />vorkcr\ conrpcnq..n [ovisions ofSsriotr:]TUJolrhc Ljtnr Codc.l\hrll- fonhsirh con,ply *irh rho* F,rhions
<br />WARNINC: liillrc lo scurc eorkcF s ptnsdi{nr colcrrsc is u lrstul. rtrd \hall }uhjcct rn c,nploytt t, ai'nirrl n nrlrics tnd
<br />civil nmi up ro onc hundrcd rhousand Jolhn (Sl(x).(Xn), in add i(r ro rt .os '/aniEn*i1dstu8c. ss ,rovid.n r.r
<br />'hc
<br />+$B)S..rtr llrT6ollhc Inhtr (n,t. i .r.( rnd rrMicy s lcc\'-r
<br />[-sJr!8,73-1f
<br />DICIJIAIION
<br />I hcEhy affirm undo F.alryofp.rrnry rh.r I dm li(nsrd uM.r nmvisim ofCnnplcr 9 (com'mncing wirh Serirn 7(XD) oiDivhion.l
<br />ot rhc Busin6safrl Prcfcq\n,isCodc. dd ny li..nsc h i'r tulllorcc rftl ciiar
<br />r,z<. \g c-r*l*{
<br />CoNSTRUCTTN LENDIN(i AGiJN(:Y
<br />I hcrcby rfnfln undcr pcnrllyolFrjury rh0r lhcrc n r drn(nn1i,r hndifs ascrEy n, rh. Fsr.nnnn.c oflhc wo* tor shich rhi\ Frhir k
<br />hsn.d rsr. 1097. Civ C.l
<br />APPLrcAN'I' DECI ARA'IION
<br />I lrrhy rfilfln undrr lci lrynl l,crltrry.trcofrhc Llk,winB dcclnrrtiorsl
<br />D.molirion Pcnnirs Asbcnor Nolin.ain,n Fcdcml R.tuhli(nN (Tirlc.l0, Pan6l
<br />-Rcquirq!
<br />tr(cr ot Norilicark,n
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino 'llltalB \fi.(
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1/5./,'.b 5\*(
<br />Certiticate of Occu pancy
<br />N tes Rem S Etc.I l9 r'-b Po r**ee,4.kl o-
<br />G*,< &,- 4 A s,-rsr?, ut tt t,,,a rcob ,<-,<tt W"ott'.
<br />ID/SIG.
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />-l
<br />ccniryth rhc fcdcrolrc8ululions rcEadin8 asbcslos rcnn,val arc ioi Eppli.ahL ro lhis pbjd.
<br />-l.enily
<br />lhal I hivc rcad rhn lpfllkarion afll rrarr rhd
<br />'h.
<br />sh,rc rnntrglJlqalEg.r. I rEte ('con0ly trirh tll Ciynnd ('ounry
<br />ordinanccs and Shtc Llws rckr ins ro hlildinE .on(rucrion, M'l hschytrurh.ift rcprc(c}divs of tht Cny md Cndnry tu cnt r upl'n th.
<br />0h.!. tunr,on,i pmp.dy r., {.srnnryp ,c,. --] 1 \
<br />'\
<br />;;,.;;,;.;;;,.;;";" k lG-\ \-\-s+ *" 8:36d8
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