|
BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DET,CARATrcN
<br />I hcrchy trffinn ulldq Fnnxy or Frjury rhd I dh cx.hpr ftnn rh. Co.rdois Liccnsc ljr lor lhc lolhwins rerw,n (sc.7o:ll5
<br />au\ir.ls ,ki Piofcsio. Codc): Any Cily or Counly shi.h mqut$ r Frmil ro con(rucl- ,lrq, inprv.. dc $lnh ot rcptr My
<br />nrucrure. priorro irs issuo"e- aho rcquncs rhc aopltlrr l'or su.i p.mur ro filca sisrcd {arcmnr rhtrt hcor shc n li.ensd punulnl
<br />lo nr tlovnions ol lhc Conlractols Liccnscd tiw (Cllll cr 9. Connne.cin[ *irh Sccrion 7fix) or Division ] oflh. Busincs rnd
<br />Pnnasions Crxlc)or lhlt llcorshc iseicmpl lhcrciromlnd lhchs\i\ lor rhcrlLgcdcxc,ryrn Anyvn'lationofSalhnT0:ll.5hrlny
<br />lppliunl fq a Il.rmir slbjccrs rh. upnli.an o ucivilp..,lryofn.r nx,c th.n fivc hundrcd dol1a6 1S500).
<br />l. $ owtrcr ofthc lioJ)tny. or m, cnrtloyecs wirh *:lsc( rs rh.n sb.nmprn\!rn,n. sill do rhc *ork dd rhc atu]m tr 'rninrcdcd or oficrcd lor {h (Ss 7l}{]. arsirc\s and Prcfc$iiin\ C.xlc: Thc c(nta.ktr s Ltcnsc kw &cs nol amlt n' an .wncr ol
<br />thc pn)p.dy wh) buikls.r i'npmrcs lhc8nr. nnd sho dm\ \u.h *(l* hnnrcllor hc^cllor rhDlAh hh r lki owncnrhyNs.
<br />I' oli cd rhar {'ch i'npmvcm s m ior i c.dcd or oali:rcd li)r sslc ll h.w$rr. rlr huildirs or impmvcmn, i sold sirhin onc )tar
<br />ol conulctior. lhc Osrcr lruikcr wiu hN ltE hurdcn olpDvins rhJr hc or \hc dil frn hnilil or ir9tue rh. pmpsly lir lhc purlr{ ol
<br />-l.
<br />usowncrolrhcprorcny. imcxclusilclyconrrodirs wirI liccnsd coorEck,n n, .onqtud rhcpdccl(Scc 7014. Bu\inc\\
<br />snd &.ftssiDGd.: ThcConkdcro. rLi.cnsc Lrwdodr R npplyb rnowncr oltn'p.aywho huild\ or impn,vc\ rltcrcon.
<br />, d who .onhcB tu such rojccr\ *ith r O, mckn(r liccnsd puruad n' rhc Conka.ttr\ Li.cn* tjw).
<br />-lrDcx.nrt
<br />urdcrSali0
<br />lll)&Ni8[t:auu,Nlarl()NDI.]II,AR 'I'I0N
<br />I tercby.ffinn utrdcr peMlly of pcrju,y oft ofrhc followins d..lsarions:
<br />bhrE J q' ll mmhn o Ccnrrralc ol Cnnsnt to Scll- lnsurc for workcu conrcnsarion.N,ovidcdlorbySslion3?00oflhc
<br />lIJ[o, .,d., Ior rhc p.rlomkc.rrhc wo \ rry *hrhrhcr{irn is h\ucd
<br />r-, haw and will nuinl.in porkcr' .otr{Easario inslmmc, as rcqotcd by sc.rhn 1700 of lh. L.bor Codc. for lhc rrfotue oa
<br />rlt tro.k lor uhi.h rhn pcflnir t Mylukc^ .on,J,cn\rri.n i'rurrmc .nris xtrd F,li(y dtrD 'cr c
<br />1 d44
<br />l..nify rhar in rhc p.rronMncc olrhc wolk lir. *hi.h rhn Firnir is n\ucd. I \hrll nor empk,r,ny p.r*,n in 0ny n'onncr
<br />$ N lo bccom subj.cl lo lhc workcn' .omran\d ion laws ofcolifolnir. und astr rhm irI sk,ulil hcco'm suhicr k, rlE
<br />sorkos collr|*trstriion pnvnions ofScction 3?(x) of thc litxtr Corlc.l shrll, ronhsirh conrdy srih lhosc Povhions
<br />WARNING: FlnilnE ro sw sorkcn conDctrsorio. covcrrSc is unhwlirl. and \hrll srbjccr an.nrplo,tr to ciminal Pcuhis 3nd
<br />civil uncs up l. one hufrncd rhousand dollm (SlOO.ux)). in lddirion ro rhc .o{ or.. lPcnsntion. donuacs a\ Polid.d r{tr rh.
<br />Sccriotr 3076 olthc Lltnr Codc. inrercsr !.d
<br />DArc: 4 nltr A -,'*,,K h/1- I
<br />t.t(EiNtl, (or t&\( toR
<br />DtrCI.AIAUAN
<br />I hcrcby o,lim under Fc,alry ot pcrjury ihd I ''n lie.e{ tndcr pn,visim .i Chaplcr 9 (connrf,ncina wili SNrion ?(xxr) orDrision l
<br />oi rhc susinc$ d P$fcssions Codc. atrd nylicctrsc i\ h tull lore a8l cffc.r
<br />(av la;9tt t
<br />ti/{
<br />CAISIaI](;IIANIENDINC.A{iEN(:T
<br />Incrcbyatfimuderpcnalryortriuryrhdrrh.rcisa.unerudionlcndinsaScmylorlhcpcoflrBmcolrhcworkr whichrhis,Ernrit is
<br />issucd rscc 109?. Civ C.).
<br />tttucaNfDlirl./t&l.llo!
<br />I Ltrby afinnr undcr pcnrtry oiFrjury orc ol rhr rbrk,*in8 d(lnarion\
<br />Dc x,liri.n Pcnnih-Ashcios Notincltion rcdcr.l Rcsuhrion\(lnt{). P!n6l
<br />Rcqutcd Ir cr of Norifi carion
<br />_lccnifyrhi( rhc lcturalrcsrhri, s rcgrdtr,gr\h(no\ rcnn,vrLxr. or xt),rh.rhlc r, rhi\ nr(]lc.r
<br />_l.enifyrh{ I hnv. r.rd rhhapplkdnJ.rrdsr{rcrha[h.rt v. rnlonMrion hcorcr.I a8lsr.coqrywnbrUcnya.d(-ounry
<br />ordinlnccs and Srarc lj*r rchring l. buildinS connru.rk)n.,rxl h.Bby {ulhornc rc[csntalivcsoflhn Cirylod Counryro.nl$ uB)n rtr
<br />$ovc nrnriotrcd |n),Erly lirr insDcclnnr ,,iW
<br /> Dplicanl or A8cnl Si*nalu "AWL {/ulL
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />Itrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />Ir
<br />FINAL tL tg /JtL6/h
<br />I vCertif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />l rl ".A'lJ'.$
<br />Ext./lnt. Lath
|