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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulalion
<br />Rool Sheathing 4lhlt9,.c,c/t4f ,t
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Depuly Final Report
<br />Engineer Final Beport
<br />Flood Zone Cenif
<br />FINAL ((;/'7 /,-tr tb 6cry.
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />_l.!s owncr of rhe lrnrrrny, or ycnDkJt.swirh*,ac\a\rhc \,1c conr!.nsll i,'n, sill do lnc wort &d rhc {trrm i! rxr
<br />i' .idcd or or.rcd lor slc lse 7044. Businc$ 6nd Pmlcsionr Codc 'l h ConrBcttr s Li.cn$ Lrw de. rct drlly k, sD o$q of
<br />rhc pR,tfny qtx, hilds or imDn)rsrhcN)n. md qho des {trh wort him\clfor hcr{lfor rhmu8h hh or ho own cn{loyces.
<br />Iovidcd rhrr such impovcrnn m to, inr.toLd or olacnn for slc. la kNc!r!. th. huilling or inrlrn,tmnr i\ etl wirhh orc ltd
<br />oi co DLri'n. rlf, owNr Buildcr sill harc thc hrdcn .f fmviLq lhd lE or \hc diil mr bnill .r inlmvt thc pBlxny nn ltE puqn$ of
<br />l.asowtrcr.lrhctllxny-ifltcxclusivclycontrrcrinswilnliccn\cdconta.tr\t,.nnnru.lllEpmicllscc?O$.aL\inr\{
<br />lnd thfcsioo Codc: Thc Cotrtrcroas Li..nsc Law d..s not apfly l() !oowncr nipnlrny *ho builds or anPiott\ thcrcon.
<br />.nn who conra.hfoisu.hrrorccrsBirhaC.nr,scr,,rtliccnrd pui\r,N
<br />'orh.Conractois
<br />l-iccn* h*)
<br />lrncic,,rDrLn,l$ Sc.lt ' .B &PC ln'rhi.r3..tr
<br />Irlre Oen.r
<br />]llratrESsioMrEN$Iq!
<br />DECLABAIION
<br />I hcreh, 5fitn urder penrhyorFrjuryoic.rrh. rolk,win8 dNlrrlnnN
<br />-lhove!dwillnui
<br />lin u CcnirEarc ofCon*nt k, S.lalnru6 for rorker' compcnel ion. !s polilcdLrbys(lrn37(xJollh€
<br />L{b.r codc. lor rhe lErfonMncc of thc wo,k loNhkh lnc pcrmir h i\aucd.
<br />t(l hove and *illDaincii s.ikc^ .onrFnsdion iNnrnncc.0s rcquncdhySdn,n:lT00olrhcDborCodc.lorlhcp.rionn.nce.r
<br />rh. work forwhichrhn pernir ia ksu.d. Myworkds .om!.ns,ti.n insurlncc.iricr und Flicy nnmb.r m:
<br />tri-+ C ,....o U- fr*/=
<br />/ c b ?Ob<)
<br />-*nt*
<br />l+'Ol -i{
<br />l .ctrify rhd ir rlr lcrhnnrmc ot rh. *ork i{ uhich rhn ll..n r is i\sucd. I (h{ll D.r cmpl,'y ,y p.rs,. fi any Mrcr
<br />$ N n' h..onE sh]ccl ro rh. qorhcn $ lEn\arionhs\ofcalinrili,rnirgrccll rilI \&,rlil h.con*suhlcdr !)lhc
<br />workcri compcnsrlionprcvi\n,i{orSedn :1700 ol rh. lrtbr C.d.. l \h!ll. fifih*irh.unPly wirhrhosc Pmvisidr\
<br />IVARNINC l:ailurc ro scrrc *orr.^ onlpcnsaitn.ou.'rs. 's unhqlul. rnn shrll suhjccr nn. 'Plolti io LYiNnnl Fnrlrf,s rd
<br />(i!il fincs un ro ,,m hun'lrcLl rhud\rn'l d'nlr\ l!10(1.(Xx)
<br />s(i'on 107^,'rrhc bhr c, c. *t*q "',i rrn*J' r"-
<br />;,",, );-;-i? ;*# - 4k .on ol comPcnsdion. drmBcs !s
<br />I hcnby rrfiflnrnd$ p.nn,ty of Frjury th0r I om liansd !trdcr provisidr or chnoc, 9 ( comrm,cins wilh S(li,! ?m0) orDivisio l
<br />ol rhc Bo\in.s\ rtrd Phrcssbns Codc. and yliccnsc h ir aull i c 0tolcficcr
<br />7'tts'bV
<br />t2lilllB.rM.^
<br />C
<br />- {'1.t91 -o-1.*
<br />AIII.ICAILDICI.AAAIIjN
<br />Ilr'rby Imr uid.r l).nah y or p.rju.y om of rhc follosin8 dahr ions
<br />lxn,lirt,n Pcrmn! Ashes.s Nori6c.rion Fcdcnl R+urrrions (1nt 4r.l'rn6)
<br />_Rcqrn.d Lcrrd of N.rii.dbn
<br />l.cdirrrharrh.rcd.mlrcEublionsrcBulineashcno!ren{,valxrc.r,trli.dhl o'hispmic.r
<br />!r(liL' r..\ r rlsrnrr 1r*\ kl]r n[o hulldir8 .onstrudio[ aM hc.cb!.ulhorizc Eprc\cnl]rnts orrhG Ciry Md abutrtyro cnrcr qx'n rhc
<br />rhrlc trEnrinrcd nrop.ny i(tr
<br />plionl or Ictrl SiAnrlurc
<br />JIF
<br />-o,!*u^,:-tra-iF
<br />OIVNTR IITIILDI]R DIILCARATlI)N
<br />I lrrdhy dtlirn undcr pcniryol pcrjury rh$ I8ncxcn!, lrurnrhc Cotrlncro6 l,i.ai\c uw lor rhc rollowin8 rcum. (Src 70315
<br />Busirc{ ,nn Pknesion Cdlc): Any Cily or Coutrry whi.h rcquirc\ 3 rtmir k, .on{tucr. .lrcr. l Prot. dca'li\h ,tr q|!n Jny
<br />dr.rurc. pri, n, ir\ n\ultr... rh. rqtrnc\ rhc +tl.nd li)r s!.hr.irnirro ilc a siencd srrrcmnr rhd hcorrh.i' li.cn\td l[ruanr
<br />lo rnc fiovtio.s ot rhc Conlracrors l-iccDrd bw lchrprcr 9. Comrckhs qirh s.crion ?00(, of l)ivni.n:] .fuir Bu\i'ras ond
<br />Pmf.\sbn\ Codc)orrhar h.orshc iscxcnu rhcrcftomrnd rhcbrsis Lrlhclllcgc *c Uion AnyriohrbtroiScclionTl)Jl.5hy!n,
<br />ntDlicrtrrlnr0F-anirsunj.chth.!prlicanrx,acivilpcn!lryolior xtr rhmrivchr dr.ddolhrs(J5OO)
<br />h"
<br />I h-rcby afir uMcrp.n0lryofp.rjurylhallhcrchacondrucrionkndinSdgcn.yrorrhcNrfomonccofrhc{orlror*hichrhnlEnniti(
<br />hsucd (Scc 1097. Civ C.)
<br />Lcndcis AddEs.
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