|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DI;LCARATION
<br />I hllcb, xffirm lndc pcnalry oi r.rju.r rhur I d excmpr tinm rtc Conk&i(ra Li(n* uw lnr rhc rollosing o.on (Scc 7031.5
<br />Busilrcss a Proacrsi.n codc): Any City or Coumy which rcqutc! d Frmil to consfl.'. oh6, inrJ,rovc- dcmli\h or rFn rn,
<br />ituctrtrc, prior lo ils hsuancc.,ko rcqrirc\ rhcapplica rbr slchncnnir t, fihasisncd (,icnEnr Ihdi h.orsh. h liccnscd lunuanr
<br />ro rhc provhions ofrhc Conlllclols l-iccn$d t * lchq'lcr 9, Commcncins wth Scclion 7U)O ot Divnion.l orrhc Btrsincs d
<br />Pn,fd$n,nr Codc) o, thar ts o! she il excnpr rhercriodlnd rhe baiis lbr rh. il.sdd.rcnprion. AnyviolarionolscclionT0ll5l,yany
<br />ryplicad lofu Frmr subj(h thc applicrnr lo r civil pcn.lry o r nor $rc lhao livc hundrcd dollm (5500)
<br />I. a. .w'rr of rhc pn,Ir.ry. o ny .mploy..s wiih wagc{ o\ rhrt v,lc conf.n\d bn. will dd rh. work and ilE ntrtu i nor
<br />i cnkl or ollcrd lor eh ( Se.7O!1, Busincs ard Pn,fcssi N C{xl. Thc Gr hcktr s t-iccnsc Liw doc\ nor q,Ily h o owncr of
<br />rhc pmFny who boilds o. inrpmr€s rhcmn. a,xl who d@s such *.* hn.scllor hc.sllor rhmugh hi\ or hcr owtr.mpl.yccs.
<br />pmvidcd lhar su.h nlll)mwnrnts m nor inlcftled or ollcFi ror qt It bxcvcr. rlr huillina or iry)nvcnD r is sll rirhrom )ur
<br />of.o Vktirn, rh. Owncr Build.y will htrn rhc hordcn .f tn)ling rtur h. or sh. drl ft, huikl or inuovc llrc IhrIEny lor rtr puliE ol
<br />I. rsosncroarh.plopcny. ad€xchsnrlycotrtrcring $irh licrD\.d contxct,\ ro connfl( rhc tx!..i lScc 7(111, Ausi',us
<br />n AoLssion Codcr ThcContacr.fs Liccnsc L.w J({s nor rl)plytu rtroMcroi[)trf,lywho build\ or i'nIr)vc\ rhcrcotr.
<br />rtrd who conrrc(for surh pnucc* wirha Contacr)(t liccnscJ,rdr\ur r t)rh.Contrir'\ Lrctrs. La*)
<br />-l
<br />aocrcmpt undcr Sccrion-. B. & PC lorihi@w,n
<br />lr.(e: Or{.r
<br />MAAI:&iI;AUPIiNSA.I]I,IN
<br />DtsCLA.B^IIO
<br />I hcdh,aflnhu dcr r.nrhtofFrjury odc ofrhc r(,lk,ai'ra de.hfuln'ns
<br />-l
<br />hnlc .lld will ,Mnrlain a Ctnific colconsnlIoScl nsur. tbr workcF s,nrr.nsalii,n, us pmvidddr.rhysccrionl7s)oirM
<br />trbor Codc. for rhe p$fo@ftc of thc work for whi.h rhe ,.rnfi ii ksucd
<br />WfrrlfrI hr!. itrd will nrri rin workcrc'c
<br />1"*\,.,tat
<br />I .r'rify rhrr in rhc Ptrion,um. ofrlrc so,k tur which rhis Firnir i\ nsrcd, I rhrll ior cnll]k)y iny Nrv,n in rny m!trNr
<br />$ s lo hcmNc {rb].cl ro lhc qolkcr'con$ctrslrion hssolcalibrnir.onl !sr.c lhrr il lrhould t co ,c\uhj..r hrhc
<br />$.rlcr\ comrcnsrlion pnivisions ofScction 37(x)oflhc Lllnr C.de.l sh{ll. nflh*irh coa]Pl, wirh rll,r l)n,vi\ions.
<br />W:\RNIN(: l:rr u'. 1. \dru,a \nrk.^jl#i*"'tg l. and ihlll subjc.t cq)lorg lo siminrl pcmlrit\ and
<br />ro oN hLfJr.(l rhousrnd
<br />\o*",ucxruiD_roNr3ll.l-t1]tr
<br />I)IrCl Atd{- ()N
<br />I hcrchy amflnundcr l).naltyoinerju.y rhlr I a'n liened under Fovision ofChltrcr 9 (..'nmming wirh Scclhn ?oiJO) oIDilnion l
<br />01 rh. Btrrin.s iid Pr.r.s\i.tr\aod. rnd n,y li.c.s h in tulllbrcc mn cfiNr
<br />b 37*-
<br />\"
<br />coNErx.uqrctrt[dDlNclcrNg
<br />I hcrhy aiirm undcr F.alr, or p.rjurr rhar rh&c i! a co.iocri,n lc.dins r!.fty for rhc psfornrmc ollhc *ork f{tr shi.h rhis Frnir i1
<br />issucd lSa :1097. Civ. C )
<br />AIIIICANIIECIABAIION
<br />I tmhy aiinn undcr pcnalryofDc,juryonc oirhc aollo*in8 dalffiliotrs:
<br />DcnDlition PcnnirrAsbcstos Nolificotion ljcdcrul Rceuhiion( (Tirlc 4l). PlnO
<br />-Requircd
<br />Idrcr ol Norifi calion
<br />I.cniryrh r rhc lcdcfulr+uhrn ! rcSdding r\l{rot rr rivrlnrc rrrrt)t,li. hh n) rhirtron.r
<br />-r
<br />cdlili rhrr I hrvc rc rhh.!pl nM (rrc rlrrrhcrh,v. irturn r con.cr IrErcci,on,tlywirhrllCiryrtrdCounty
<br />o inflrccsrtrd Srarc tiws NldinE
<br />I 11/
<br />rh.vc nrnrnnrd |m,|f,nt f0
<br />(:".":ily':"
<br />1 iifl^-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loori VenV ln s u lat ion
<br />Rool Sheathing
<br />Shear Wall
<br />Framing l-'l\,w.\,\6*{u
<br />lnsu lation/E ne rqy "\_.
<br />Drywall 7/t ,, /t,o ,.)S tol
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lVasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceftif .
<br />FINAL 9-9-rA-lde{at
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />I
<br />[)
<br />Pool Fence
<br />fytz)
<br />(5
<br />Lcndci. Addrc$
<br />-
<br />I
<br />I
|