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BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE IDiSIG.()WNUR llUll-Dl:R DILCA R(IION
<br />I hcrcby alnm undcrynrliy of Frjury th l !n crcnu iror lh. ContrrcroF l-iccn\c If,w lnr rh. rolbwinA rcoqn (Scc.70ll.5
<br />Busincs rnd Profcssion Cdc): Any Cir, or Colnly $hich rcquirc\ r rnnir ro .o.sfl.r. alrcr. i.rlrorc, dcmnnh or mFt my
<br />dtucruE. pritrk' ik i\\uai.., rk. r.qunusrhd trlplicnir for su.h Fnnir ro filc 0 si8rcd st.tenEnt lhlr hcorshc is li.ciscd pxnumr
<br />ro rhc Inovision\ ol Ihc Conrracrols l-iccnsed trw (Chrlrer 9, Gn.n,cncids sirh sc.rbn 7000 or Divisnln .l ol lhc Ausincs rnd
<br />Pmfcs\tun!Code)orrhrrhcorsh.hcxcrprrhetuannnmdrhcbasi\f.rrhcrlhBcdercDpli.n.Anyvi.hlionoiSc.rbi70.115hyry
<br />apr'licinl inr r |xflnir \uhj.cts lhc 0Iplicrnr n) !.ivilpcn!llrol nor nFrcrhrn fivc hundBd,lollr (55(D).
<br />L as owncr ofrrE fm!.ny. or m, cmlloFcs wfh qr8cs as rhcn $t conDcnslrioi. trill do rho worr lnd rlr srtrturc t nvr
<br />ificndcn orol]tNl to! Mlc (Se.7044. Busircss ond I'hfes\ions Codc: Th. ornrr.tr's I-iccn\c hw doc{ nor npply r, an oqtur or
<br />rhc ptun rly wtF builds or imp(,(s thta)n. dxl qho tloN:mh *(d( hinNcllo. hlrcllor rhnrugh hi\ or hcr.*n c rdoyccs.
<br />prolid.d rlrr {'.h impmyomnkm rn inbfrl.d oroll.rud li,r$k lli k)*c\ri dr hoikli'rc or hrltmvcrrcnl is $ld within"m yrr
<br />of complcriotr rhc OvE BuiHcr *ill hrk rhc burdcn of rri,!in! rhd h. u \hc did fr build.r iiunovc thc pFl[ny for lhc purF)*ol
<br />l.asowncrorrhcpmpcdy. ncrclNivclycorncrinssnhli.ctrsdconrrr.trt,con{d.rlrf,l}oi{r(S.c?044.Buvnc$
<br />rRl lhifcr\irnCodc:'lhc Conlrrlors Liccn\c Lnw doc\ nolq)nlyh rnoqndr orIrc y sho huildsor im[ovcs rhcrcon.
<br />and sho codlach ror \ucn pojd.B wnh a Contrckn(, licctr{d Nr\uanrhrhcConrracrois l-iccn\c ll*)
<br />I rn ex.mpt und.r Se.r iM , B. & P.C. lor rhis rcason
<br />Dtl. oanerl
<br />uaaKD&\:.canlt[Nr I]QN
<br />IE(IANAIION
<br />I hrtohy rfin'n undcr prMlryorNrtury.nc olllrc li,lk,\'ir3 d.clrdti(fl\
<br />-l
<br />hrvcand{ill.ri airrCcnialrlcoi(-otrsnlhScllltrsurctur*1 crs' $nrtcnsarion, .s |m)lidcd l.r hy Scdion:l?(I)oirhc
<br />tjhtrCdlc, ror rhc p.rfoinun.r oi rhc *ork rd which rhc pcnnil h issucd
<br />t hrvc atul Nillmainrri'r w.rk.ra c. rt*trsdiotr insufu .c. as rcqurcd hyS..ri.nlT0OofrhcLrhorCodc. forrhc!. otnunccol
<br />thc sork n, whi.h rhislcr.nI is issucd. Myw.rkcn .onp.nnfion insLr!.cc ctrricr u F'li.! iutr$.r r.
<br />Policy Nunrb.r-Erpne\
<br />-lccnily
<br />thrr in rhc pcrioroun.c olrhc $ork lir which rhh p.nnir k i\sucd. I shtll nol cnrdoy ony Jr6on in any nutrtur
<br />v' a\ k, hdom subjc.t k, rhc wuik.s ..n!. s,rdr liw\ ol Cdlrlnari.. md dsr.c rhnl ir'l sh,uld h.coft subj..r ro rh.
<br />s.rkcricotpcn\dhnnmvsionsofsati:l7uJ.lrhcljtDrConc.Ishl.lhnhwirhco'.plyqilhrhosnmvtions.
<br />WA|INING: Faihrc to $curc *orkcn'cotrrcnsrrion.orcnsc i\ Dtrltrslnl. xiJ $rll suhjctr 0n cmploycr lo siNiDrlpctuhic\ rnd
<br />civil rincs u| 1,, otrc hundrcd thousand dollffi (SIUJ.0({)). ir addiri{n, b rhc .on or.o D.nsdion. danuscs 's F)lided n)t rh.
<br />sc(rk,n r,r6.n rlrc Lf,tnr C.nc. irrc,cn r,.d ir.r'x')'. ric.
<br />ApDliont:
<br />LICENIiED-CANI&}CII)B
<br />DIICIJEAIIAN
<br />I hcobyafllr u Mcr l.Mhy oi Fcrlury rhar l.D llcctrBtu cr nrovision of Chrprcr 9 ( comftnc ine *irh S.{t i[ 7u)O)olDivnion:l
<br />ot lhc Bu\incsxnd P!,fcsionsCodc, ajld ny li.tisc i{ i'r tull nr.c klcliccr
<br />CONIIBI(:IIONIENDINC.A(j.!:NI:I
<br />Ihcrcbyalti! uidcr F*nilryoif.rjurfrhar lhcrc is!cotrnruclion lcnding lcncyforrhcrcrfonnM.cofih.woiltuqhichrhi\lcrnrira
<br />isdcd (Src .l(D7, Civ C I
<br />A.TTLICANLDECIAIAIII]N
<br />lhsrhydnnnrndcr p.trrlry orp.qury onc ofrhc f(,lbwin8 dNlnratioos:
<br />Dcndition Pcmils AstEsros Noriicriion Fcd.ral R.gohrtn\ 1T I.40. Pln6)
<br />-Rcqutcd
<br />Gtrcr or'NirifEorbn
<br />l.odilyrh rhc radcrnlrcluhnotrs rc-r&lrnp i\bc{os rcrFvr xr mr rnfli(rhlc t) i}n\ I,R)lr.r
<br />l cdily rhrr l tuv. rcrd rhilatfli.rrmndxliarcrlx rh( rhnc iDlo.maii{nr i\comd lrBrdckr.o rrlyqirhrllCiryr.dcl'utrry
<br />ordinancr\ rnd SIrrc Ijwrrul in8b buitlii8 ..nslDcltun. Md hcrchyrurktrirc rcpr.s.nrarivc{.lrhisCnyirrJG)unryrocnrcrulxlnrhc
<br />ahrrc nf,trri,nnl pmpcny ntr i'rstc.rnnt ,urri,scs.
<br />,\pplich.l.r A!rnl Silnntur.
<br />lkn'ilm mnrc lpritrl):
<br />D.r.:
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lns u lation/En ero y
<br />D rywall
<br />Ext./1nl. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL ,/-?-/a.--,U.l?rJo (vi)
<br />Certilica te ol Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
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