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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION
<br />I hercl', atlid undcr p.nally oi pcrjury llEl I nn cx.'hpl fmrn lhc Conlractra Li.ctrsc Ltra ior lhc f.lk,win8 rctrFn (Scc.70ll.5
<br />Busincs\ and Pturcsion Codc): An, Ciry or Coutrr, whth rciuircs ! P.rnrn to .otrslru(|, ahcr. inDtuvc. dcmolth o. qrir rnv
<br />{ crurc. priorro ils Gsuancc. r\o rcquncs thc nftlicanr forsuch Frmil t' filc tr sistrcd sldcmnr th h.or shc n lil{n\.d pu.su0tr'
<br />ro lhc p rvi\ioN of tn. Conrracroas l,ic.nscd tjw (Ch+rcr 9. Connn. cnrB with Scclion lU)o of Oivhion I olrhe Borincss and
<br />Pr.fc*ions Codc) or rhrr h€ or shc h cxcnDt lhcrcirom lnd rh.ltrNis r.r lhc ollqcd cicmprhn. AnyviddlionofS.cin)nT0ll5nvonv
<br />{rliconr for a p€mir subjccN rhc lpplicanl ro !civilpctrdhyol ml nmrclhun liv. huitlr.ddollors iS500)
<br />-1.
<br />!r osn r ol rhc ptupcflx or my cmplort.r wnh w08cs os lhcn \ob ..mp.ns,l idr. $ill do lhc wolk !n thc ntrt!( i\ nn
<br />imc.ddl or ollcrcd for $lc ( Sr ?044. Busincs md Prcics\iotrs Codc Thc Cunt ofs Liccn{ I-rwdocs not ryllybnnosncr ol
<br />rhctmpcny *h huild\or inpmvcslfu@n. arxl *ho dd\ skh work himsellor hcr$lf.r rhnruah his or hcr osn cmplovcc\'
<br />Frovdcd rhlr snch iqn k.rds dc nor inrcndcd or on'cL'd li)r sh. lt howcvcr' rhc hrildi.! or nnprcvcnrnr is 3'l] *irh;n on' ]t tr
<br />of.orplciotr rlE O$ncr Buittr will haE rhc tDrdcn .l poving rhnr lt or shc dil mr hdiLl or inll)m\t lhc Impcny fn rh. ,,u.trt ol
<br />l,.sowncroirhcpmpcnr.xrcrclusirclyconrrlcring*irhli..n{dcotrlnct,nt,.on(ru.rrtEltojecr(S(7(x1 Bx\i"rs
<br />lnd tbfssbn Codc: Thc Conradoa s Liccn\. Lrw docs nol {,plv ro ri .wncr of prcpcnv $h{, l,uildr or imlnre\ nMco .
<br />and who conracrs lo such rojccb with a Conrr-t,(, li.{n*d l]uruanr b rhc Contrr.is Li.en\c ljw)
<br />-l
<br />anrer.npr undcr Sc.rio
<br />I h.rcby a,ltrm under p€nslry of FrFry onc of lhc rolh,inE dNkErionc:
<br />I hav. ad will minlain a Cenifkat ol consnl lo Sclalnsurc nv eo*cB comlEBalion. &r pmvi,cd fo, bv Se'ion lTsJ ol lhc
<br />l-rrr C.dc, ro. rh. pdfolmrc. ol llE wotk tor wnkn lhc ,smjl is n.u.d
<br />I havc ondNillroinuin workcij co,npcnsorion insrrrnc.. Js rcqutrcd bys.crn,n.1700ofrlrc Lrhor CGlc. r(r rhc ocnnrntNc of
<br />rM }ork tor whth rhi\ p.nnir ic issu.d M y wortcG .otrqrnturn,n irsurrncc tnd.r dkl Plicv nu mbcr rc:
<br />-Expircs:-I c.niry rhar in lhc pcrlorrorc or rhc worklor snicnlhi\ pcnnir i\ t\u.d.l snlll nor .rlk,y aov Pcson in anv
<br />'nnnncr$ s b bcco,m $btd ro rhc mrtss ompcnsarn,n hss ur c,lifoirri!. !' rsd rhd it l should k{o.t subitr lo lhc
<br />qorkcr'contFn\arionrmvhionsofSccrion:lT0ool .lat(tr Codc.l stslr. ronhwilh.o.Dly *irh rtnl* tfl)vision\
<br />WARNTNC: kilurc b surc *Drkc( or.Pcns ion .ovcfl8c is trola*tu|. and \hrll sub.iccr an cnDlo)cr ro mni.il nqrlris rDd
<br />.ivil 6ncs up r. onc huMrcd rhousotrd dollar lslm.fiD) in addibtr lo rhc.o$ ofc.nFnsarion. Janu8cs !s t',ovild for rhc
<br />I hctuby ,frtrn undcr pcnalty o, F.jury th,t I am liNned lDder rovkion of Chtrprq 9 (conmn ing wil[ Scd hn 7{xx) of Divisi'n :]
<br />of thc Busincss and Pmtcssions Codc, ard m, li...sc is in rull forcc ! cl1dr.
<br />CONSTRI'(:T(tN I FNlrIN(: A(:FN(:Y
<br />I h.mb,dfln undcrpcmllyoinerjtrryrhdrhdcisu.otr{ruclionlcningtcncyt)rrhcpcrfoflnrn.c.llhc$orkf(,whichrhtp.ani(is
<br />hrucJ (Str :1097. Ci!. C )
<br />I rrJ{'. AJ \r..
<br />A.TTL.ICANLIJIiIIIIN.trIIAN
<br />I holby,finnlndcr pcnrlryolpc.juryoid.f rhc tollotringdcchrrriois:
<br />Dcmolirion l'rmirr Ash.(os Norificorion FcdcrlR.!ulili( N (lirlc 40.I'rnO
<br />Rcquncd lr(.r.rNorincdi.tr
<br />-l.cnili
<br />rh,dhc fcdcnl reslhrn,is r.lidirgrttrslosrcnnrvrlrru ior rfflHhrc ro ihi\ P(rjd1.
<br />I.cnnjrhar I h3vc rcnJ rhisrftlicrrion!ndslrrcrhxrrhcrh'rc 'trttrtr ion i\cotud.I rrre l.c.mPl,sirhrllCirv!1
<br />ordirdrccrrndSx c La*\ fthritr8 to huildin8 .onslrudn,n, rd hctchy,ulhorizc rcPrc\ctrr nc\t)llhhCilt dCotrrrvro
<br />$.vc ncnrioncd popen, ror insFrtiotr purp,scs
<br />,\DDlitrnl or '\sml Sirn luru w WdfLs-U"4>/-tu-R
<br />Set Backs
<br />Forms/51eel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulalion
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Fleport
<br />Flood Zone Cenif
<br />.ktD/rtr/B<-ff4//,1 84,4 1t\- r44.;n-, l/4(/
<br />FINAL <hz/rk '-qrlelL lD-
<br />Certilicate of Occupancy "1
<br />Notes, Remarks, Etc
<br />Erection Pads
<br />Brown Coal
<br />u
<br />sccrion 3076 olrhc tf,tltr C'odc, inrcEsl md rnorfty \ ltc\
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