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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDER OELCAR TION
<br />I hcrcby nl6.n undn t nrlry ol Fdury thlt I un crcn{r riom rhc C.nrra.h^ l -i.cns. tjw ror rhc lbllowin8 rcN)n ( SN 70.1 1 5
<br />Busine$ !d Prorc$ion Conc): Any Cn, or C.nnry which rcquircs d lf nrit ro con(rucr. ollcr. iqrrovc. d.elilh or rcI,i ,ny
<br />nrudnd. tri)rb ir\ i\sudtr... aho rcqunN rhc rmlicatrr io! such pcirnil lo tilc 0 \i-sned datcftnr Ihdr tEor shc is li.cnril punuanl
<br />ro rhc fl)vnions ofrhc Conrru.roi\ Licrnscd l- * (Chryrcr 9, cohn min8 with Sednn 7000 {I Di!i\n,n 3 orrhc Bu\incss and
<br />Potusn,.s Code) or rh,t hr or ih. t crcmrr rh.r.fron xnd thc bnsis for thc rllcEen .r.nrpln,n Any viol,rionofSccrbnT0Sl5 by ony
<br />q'Ilic,nlrornp.rnlirsubjcckrhc.mlicanrroa.ivilrcnalrlolnormrcrhtrifiv.hundrddollri(S50o).
<br />-t.r\
<br />osncr of rhr pn,Fdr. .r iy cmpk,B\ eirh wrtc\ .s rh.ir snc corlnctrs.rion. $illdo itE *ork aJd rh. {r*ruc is ftn
<br />i'ncnd.d or.fi.rcd lor srlc (5(.704,1. Busincs ind holi$ions C.dcr Thc Contncttr \ Lic.nr tre docs norrpply r' 3n o*ncrof
<br />rhcpmFny sln, huilds or inrp(,v.s tlrr$n. url slk) dtus slch q,& hnnscll or h.(cllor rhior8h hi\ or htr own cnlloycc\.
<br />phvidcd rhd such imlDwEnr rc mr i.rcnildl or on'cEl nn sb li howc\tr. rh. buildir8 o! inltovemnr i\ $ld wirh .ic ycr
<br />ol conrLri,)n. rhc Ownd au,klcr wrllhavc rhc hurdctr of prorinB rhat h. or shc did nol t{ild or inlrmvt rhc ptur.ny ror ih. PU4n$ of
<br />I. tuoqDcrol rhclropcrry.0mcx.lusivclycotrlrlciins with liccr\cd co rrk,sk)coi{nkrrhct,ott\t(scc 704.1.11r\r c!\
<br />n l ftDlcsi.nCodc lhcCanrracrois t-iccnsc l rw dor\ nor3mlyt' arosnd ofpl()t'. ywho huikhor i'nPii,vc\ rhcrcon
<br />r who conhcn lnr soch ptu](tN w[haCont&ro(\rh.cDscd lunurrr lo rlN C(,ntmktr's l-i.cn{ L.w).
<br />I rmrxcmpr rtrJcr Scrrnn
<br />t!oa.6!&t:tj)ulE!lallaN
<br />TIiCLAAAIJQN
<br />I h.r.byalllrnrrnd$Icnrlr,ofr.rjuryotrcofrhctulnr*ingdccl ari{nrs:
<br />IhawrMwillmii rin!CcnilicdcolConscnlroSelllnsurctrsorkcs d,np..{rnnr.0s lmvidcJforh}Sr-rt,.3?firorrh.
<br />bh.r Cod., ror rhc Frfonmnc. ulrh. wofi lb.whi.hthc pcrnril t h{cd.
<br />lh. *ork Inrlti.hrhis nlnnir i\ nsucd My$orl. rotr)B \.rii nr\trrtrc.clrltr rnd F,li.l nuf$rr r.
<br />t.cniryrlDr in rhc ,).rrorntrmc of rItr work hr s'hichrnis pcimir ir hsu.,l.l sh3llNr.nllloy,ny ne6on inony,nlomr
<br />$ s lo b.conE $bjccl ro rhc sodc6 or.pcn$rion la*s oi Calinn.ia.
<br />"nd
<br />,Bnc thd if I should tEconrc sbj.rr ro rhc
<br />workcrl .omp.rnrrion rovhions olSccrion 1700ol rhc ljhi, C{)dc,I shll. nnhqilh con{'ly $irh lhos Poltn,ns
<br />WARNING: Failurc ro s.nto *nrk.^ contr*n{rion ..v.ngc is utrl.NtuI. ird shall subjccl ai c.lpL}tr ro diniorl pc rhts a
<br />.i!il lnrs trp rr.nc huntlrrd rlDu\rid doll.rr 11l(x
<br />S..riN 1076.l rh.lrhtr (ixlc nrcrc{ rid rn.'G..v \
<br />nl8rs ds I'rcvidcd tur lh(
<br />'.,
<br />I hcrcby ilrirmundcr pcmlryolp.rjurr rni I u lic.nscd r Pmlisbn of chrlrd I (omnr ! sirl, S..ri(u 7(rxr).fl)iv !otr l
<br />of rh. Bu\inc$ Jtrd Piofcssbns Codc,0nd my liccnsc is in llllttra! rllirr
<br />I hcrchr,lfirn und.r F'Ehrorp.rjuryrhd rlrrc i\ !.o.{d.tion lcndins oscncy fo, rhc Frrontui.. orrhc sork lor shi!:h rhi\ IE,rnil h
<br />nNcd lSc..3(},7,Civ. C.)
<br />A.STLICANTDEEIJIAIION
<br />I tEEb, litm undcr pcuhy orpcrjort o.c Drrh.li,llowirrg dc.l,r rn,N
<br />ocrmlIiotr Pcflnils Asbc(os Noriliclrion tqicral R.grlari.ns ('l'irl..lo, Pd6)
<br />Rc!r r.d Lcrrcr olNotilicriion
<br />I rM,fyrh.rrhd LdcnlrcSuhrions N8ul\]ing a\hc(os r.rovrl rrc noroppliuhlo b rhisfn)lccr
<br />-l
<br />eniiyrhar I holc rcld rhhsmlic{n rMnrrcrharrhcrt !c nrinrnmtiotr h conNr IogreloonPlywirhallciry{ndcounty
<br />ordinanccs ond Sllrc I!w\ DLTiDE b bxildins .on{dcli.n, dld h.rcby,urhorizc rcprcscnlali!$ olrnh Ciry,nd Counlyro enlc, !!on lhe
<br />^*:,-^:ffi":",X$V*&. /u nt/,n *,., t'2:1{
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/E nerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />-..-.rr^
<br />FINAL {;L{-/d ,/')st :Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />Lcndcis Adtncs:
<br />-
<br />Set Backs
<br />UFER Ground
<br />Flood Zone Certif .
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