|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK IDiSIG.COMMENTS OWNIiR BTI!LDER DEI,C RATION
<br />I hcrchy rfim undcl,Erllry of pcriury rh l m cicmrr irom rhc Conta.bE Li.c.\. trw for rhc nnl,win8 r.awn (sc.70.rl 5
<br />Brsinc$ nd Pdi$ion Cdlc)r Any cily or Counly whi.h rcqurrcs { t. rnit lo consrlucr. ,rlrs, inrr(,!r. dc'frnish or rc t ntry
<br />{ru.rurc. p.i,r b ns n$rcc.0lio rcquncs rhc ,l)Plicrnr fu such pcm rh filc a \istud d rmnl rhdl h.or shc is liccnsd punuanl
<br />ro rh. proviionr olrh. CoorEdn\ l,i.ciseJ Ltrw (Chatrrr 9. Gnnftn.nrg snh Scclion 7lxx) ol Divnio!.] or rhc atr\in*\ ind
<br />Pmrcsions Codc ) or rhlr hcorsh. h.rdm,)l rhcicrn,n,nd rhc hNh nr rhc .llc8cd crmpi ion Any liohrion orsc.rbn 70ll 5 hy !.y
<br />aptli.,nr ror a pcnnir \ublcck rhc amlicnnr ro..i!illcnrhyofnor mrclhln 6v. hunrcd dolldr(3500)
<br />-1.
<br />!\ o{ncrolrhcpn,Fdy.ornycntplortcs wirh srScs is th.ir nnc conDcnsation. silld. rhcwo trtul rhc {nEturc is mr
<br />inr.ndd or.ficr.d lor slc (Sd.7()14. Businc$ and Profc$ions Codc:'rhc Co ructr's t.i..nr tiw d.cs flor npflylo an owns of
<br />rlE pmlEny wlx' huild\ or imrmvcs Ih.N . rxl wh! dds {(h m* hn$.lf ot hcrtll.r lhmuah hir or hcr .*n cnDlDyccs.
<br />,mvidcd t h.t such i amvcmnls !rc rmr hrcnded q oficEi for eh If. hoscvcr, rh. buitlin8 .t inlmirm.r i\ rld wirhin om Fxr
<br />oi conDhtion. rh. O*ncr auitd will hrv. f, 6o.dctr ol pmvin8 thd lrcorshcdid nor l,uild or i'qrort rhc pmFny fot llt purrnf, ol
<br />I.r\oenfiorrh.rn,p.ny,,mcxclurivelyco racli'rs with li.enscd co.l,!cnr\ h d,n{fl.r rh. pnr,c.! (Scc. ?O14. Busoc$
<br />trd lh)lksir Codc lhcG,ntactn r Licch{ Ldw do.\ nor imlyro inornc!olDralrcnywho htildsor nnF,vcsrhcrcotr.
<br />itrd who contr{cls lirr such proFcls wirn r ConrEcklnn lic.nscd ltrrsunr i, rhc Conrkt(tr's Liccrs Llw)
<br />I i'ncrcnrnr undcr Seciion
<br />ua86[8i.lr}}lt[NraroN
<br />DLCLASAIION
<br />I h.r$yrflnnrnd.r pcnrlr) or|tirjryotrc ollnc toll(isin8 cchrorions
<br />,harr xlwill rilloinrCcnlfic.tofco.scnrroSel,ltrurclbrso Nr'cotopcnsln . as f,vidcd intbySltrion l7(x)ufrhc
<br />lrhtr Codc- f(n rhc Friornu.corrlr rork forrhich rhc pcnnit t tsucd
<br />I hav.lnd will rinrain work$a conrcnsri ion inqmk-.c. 0\ rcquircd hy Scr i6n l7m of rhr bbor Codc. ln lic Pcrformurc nf
<br />rhc work for*hichrhh p.rmi!,s ksuc{. Myrorkcrs onnpctrsalion inurtrtdcMid txllloli.ynumbcr irc:
<br />i, rlqq0')-
<br />-l
<br />ccnily rhrr i'r rhr FrlorsaDc..frhc sork f(tr {hrh rha ptrrnir is l$ucd. I thxll nor ctrPk)y riy lc^.n in iny Nntr.r
<br />$asr,b..o'ftluhic(trothcLvorlcrJ.ompctrsrliorb*solCrlifon,ir.r 4tucrhd ifl should bc.onE hr.d t, rlij
<br />vorkcr.onrlfnnrti,nr|Iovisionsolsccri, :]7(nofrhc l;'htr Clodc.lnr l.li)dhNirhconrply*ithrho{pfl,vi\i(rs
<br />W RNIN(; Frilu'c r) \crurc s rkc^ .onll).tr{rt{
<br />.nil linc\ un ro or hrinr.d rh.tr\rlld (l.llrn rtllx
<br />l( unhslul. ind \hxll \uhjc.r rn rmpl.lct lo cri'ninnl p.trrhic\ nd
<br />ddirion ro rhc.oi of(nr
<br />:.i'4fi lt'
<br />II&CI,ABAIIQN
<br />I hrhy aflirm uMcr lrn.hrofpcriury rhat I am liensd undc. Fovhion orchnpict 9 (.onnrcncin8 wilh
<br />or rhc Bnsincsmd Porcseons C.rlc. aM nrylic.nsc is ir lull forcc lndJlf-l
<br />7__t' -) o\LJ\q
<br />"^",8)az /tk- ."",
<br />I hcrchy rlfinnnndcr Nn.lryollcrjryrhrr lherc h a $n(rucri()n tciilins,Bttr.y ror thc lcrliirrnancc ol lhc sor*
<br />isucd (Scc.:1097. Civ C.)
<br />APPI I(I,\NTDF(:! AR{TI0N
<br />I lmby nmnn undc. lcnalty olrcrjury om ofrhc nnkrwi"s dclrain.s
<br />tx"hion Pcrnir\ Asbcsr.q Norific.rion Fcd.ml Rceuldhns (Tnb40. P!n6)
<br />Rcquircd kii.r of Norifrnhn
<br />I .crriiyrhd rhc lid.r0lrccuhri,,n\ rcstuJing ash.{.\ rcnxi!alrrc tror nftlli(.blc h rhil fntcr
<br />-l
<br />ccnily rhlr I hrvc rcdrhi\ {plkrri)nnM st.r.rhd rhc llthrc inhirn bnisconccr laEcci(,&mplyBirhrllCilya Couniy
<br />,trtl iN.\ )fJ Srxl.lrtr\\ r. xri'rg kl .on{fl.rinr. ndh$cbyrtrrh.riz.rclrcscrr rirc\of rhi\Ciyrtrd
<br />t,v..rtrrnn[d pro|xay i{ ins
<br />At)Dli.inl or AA.nl siantrk'r.
<br />Uc,<
<br />';hrIr
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathino Y72vr.L 7?.b,/'a-,/f2
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Heport
<br />Flood Zone Certif .
<br />/1
<br />FINAL I h,t/lfi ffibdt 4r'> ,,--
<br />Certilicate of Occupancy ' t"u
<br />Notes, Remarks, Etc.n
<br />6'r)
<br />DATE
<br />Subf loor/VenUl nsu lation
<br />--------T------
<br />--------T------
<br />tt
|