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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS OWNTJR B('ILOAR DTJLCARAfl ON
<br />I hcrchy rffnn u.dq tc.,lry of pcrjury rhd I m' .xc rpi rm'n rhc a, rrtm Licensc I-8w In ltc followins r.a$i (sN ?0.]l 5
<br />BusiN$ nlrd l\ofcsion Codcl An, Cily or Gutrry !hi.h rcquirc\ ! ncrnrir h consrtucl. rlrcr, inrptuv.. d.frrhh L{ rcntrir .ny
<br />itucrur. prior ro ns issutricc, aho rcquto: rhc lrpli.trfl t{ rrch pcrnrir b nlcrsign d sr.rcnrnt lhol h.or shc h licctrrd pursurnl
<br />lo rhc povtions ollhc Contru.lols l-icenrd L.w (Chaplcr 9- Commcncins $ilh Secrin 7O0O oa Divist,n I orrhc BNilrcss,rd
<br />Pn,lcssbn3Codc)orrh{ h.orrh. iscx.mpr rh.Efrofrntul rh.hrs( Lr rh. rllctcd cxcnyri( AnyviolatiotrofSdi,n?0ll5byany
<br />aptlic.trr aoru pcn t sublcctslnc ryplicant lo rcivilncnlltyol.ol trDrclhan fivc hundrcd d.ll.6 (SnD)
<br />Lr\.!mrolrhrpn,p.nt.ormycnrrloyccswirhs4csasrh.nwltrotrfcn\dn,wil]do r*.rl and rhe sMurc n n.r
<br />i cfrlc{ or oflcrcd hr srlc (Sa.7044. ausincss oDd Prclassors Codc: l hc (bNacrois Li.cnr b* doc\ nor aml, tr ar osmrol
<br />rhc pmrdy *ho huilds or impmv.s rhcG)n. dd who dods such ao* hin*clfor hc.sulfor (h$u8h his o. hcr owncnlPloy&s,
<br />rr ovtlcd rhlr $ch impnrcmnrs @ nor inrc'xkl or olrd cd ntr salc ll ho\.wr, rhc bu ildins or infrov.!tunr is $ld w hin onc ]qr
<br />of.onDhrnnr.rh.OwndrAuild$willhrvcth.burdc.fF,vir!lhdhorshcdi,lnorhuildori tmvc lhc pml'cny f.r rhc purpr ol
<br />I. Nowi$ orrh. !op.ny, !mcr.lusivclyconk..rinE shh liens.d . o n ra.ron to construcr rhc lrmjcd (S(. 71X4. Bt.incs
<br />ad PhEashn Codc: l hc Coirr!.ro* l-ic.n\c l-!w des nor apply lo un ovnc, or pop€n, Bho builds or impmvc\ rhcrcon.
<br />a.d who.o m.h ror su.h tojc.ts *iln a Conhcnri!) li..nscd lusua lothcCo ractois Liccn{ Iio)
<br />lxtrrcrrn,tn u $ SL{ri(
<br />ORner:
<br />!t!x6E&t_coutrNsAlr()!
<br />DIiCLABA.UAX
<br />I h.rchy rffian undcr p.trrlryoltrUtrry otrc oirhc iinloqnE 'l..lr.rions:
<br />-l
<br />hrvctudwillrnntratur(tn fc{rcolConscnths.lilnsurctu wortc (nnFr\arnn,. !r Dmvidcd fubysccri lTrx)ollhc
<br />Libor codc,lor lhc pcrloiiMtrcc orlhc sori lnr ehich rhc ncnnil is Gsucd.
<br />-t
<br />hlvc.nd*ill nuinlain workcG coDrcnsalin nru6ncc. rs rcquiEd b, s(rion.l7l)O orrh. Ltrhor Qrd., ror rhc pcrfonuncc of
<br />rnc work lor shich rfihFrmil is hslcd. Myso.kcs compcnurion inrurxftc.atrtr dl F,lky nu.rb.r dc:
<br />1..'rllyrhri i'r rh. |xni)rnir'f,c {)t r1r *ort nn shi.h rl,i\ pcnnir i i\{'.d. 1 \hrll n.r c rf oylry |rrnnr ir ary rtrr'cr
<br />$ n\ h l*.oN \uhicr h rr soikc .o\xtr\rrn hssorcdlibnnn.ddrlrccrhd iil dmul,l h..o'm \ut'jc.r hrh.
<br />woacN onlE.q.onlnr vieons ofSccrion lT(x)olrhc tih.r Codc.l srlrll. ri,nhsirhcu 'nnl) \ irh r,x,{ nnni\n,n\
<br />NARNIN(:: Fxih'c r, srurc so*.^ .o r|rn\rri(i\ utrlr{tuI, ind shrll subF_r rn cnDlo}rr lo omi.rl ,cBlrt\ and
<br />.r,l ri r\ trt) ro .n. hLnrir!rL rhru\x rl ),{XX)r. in addirnrn tu rhc.o.l ol conrcns iotr. daflrgcs as p,olidcd for rhc
<br />"Yr^,""€- tz- t{*a
<br />I hcrcby lnnmunder pcrulry of p.rjLry rhar I am licenan lnd€r rmlision orChnnrci 9t.onmn.in8 *irh ss'ion 7m0) ol l)ivi\ion:l
<br />ol tlE Busircs and Pmicssn'ns C.dc- d my liccn{ i\ in Inll lore onl cilccr
<br />u-34 C ]2b6p,
<br />o,," g'- t3 .- t(&u4p -{r,4-
<br />I hcEhy rifinn undcr rEnrhyotpcrj'try
<br />hsucd (Sc..1097.Crv. C ).
<br />rucrion kndinsrgcncy ror rhclcrronun& ofihc work lbrsni.h lhis pcrnril k
<br />AIIUIANLI]EII.AMIIO!
<br />Ihcntyr nounnc!pcolllyol pcrjuryoncolrhclollowt'rdcchr i{n$:
<br />Dc'nollrnr Pcnnirr sbc{os Norillcarion lcdcrrlltcsulnrions (1irlc 40. Pr116)
<br />n,!ly sirh rll Cny.nd ( (,!trr!
<br />( irr_rndCoLtrrvrornrcr ut{{ rlr
<br />e- t3 -t6
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathinq
<br />v hz//l fr?ilrn-tC-1/-
<br />Framinq I
<br />lnsu Iation/Energy
<br />Drywall
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />ll
<br />FINAL vlll ll( ,
<br />I fuuturat 1."b)
<br />Certif icate ol Occupancy lt rul
<br />Notes Remarks , EIC
<br />Erection Pads
<br />Shear Wall
<br />Ext./lnt. Lath
<br />cehr
<br />a.
<br />trndci. Addrc$. -
<br />f --r-----
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