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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATTON
<br />I h.r.by rftnn trndcr Fn,hy oi pcrjury rhar I .m ci.mfl lrum rh. Conta.bF' Lic.n€ Lav tur lh. n,lk,*u3 icaa,n (S& 70.11 5
<br />Bunncss ,,rl Pmlcsson Oic) Any Cir, or Connry *hrn rcqur.\ , Ifrnii b connd.r. alrcr, imPorc, Lkmlnh or npdn ey
<br />nN.tur., pnn t' iri !\oatu., alrd r.quircs rhc aptlf,{r r.r such Fm lo ilc a stned darcftnr rhar k or shc s liccns.d Fru.nt .
<br />to rh. F)vnn,ns of rhe Ornrrarktr'i l-iccnrl Lrw (Chaprcr 9. CDmmn.D3 wilh S.(rbn TOOO ol Divii'on I oflh. Busms .nd -'
<br />P&lc\ri,)ns Codc) di rhlr h. or shc r c\cmp hcrclioN!tu]rh. h.sis n}r rh. alleecd cxcnprb. Anyvn .rionoIScdi,nT0ll5 hrany
<br />,rploanr ktr I ncmx $hlers rhc applrrnr b ! qvrl pculry ol i.r mtr rh$ llv. hundrcd Jollex ($500 r.
<br />L a\ ow .r dl rhc pn)tEny ormy.mployccs wilh v!3cs rs rhcu (,1. uhr-*nsd('n. wJl d. rk w('rt !.il rhe dB-rh is rt
<br />inlc,xjd u .It rcd lbr elc (S(.70,i4. Busin.s anJ Pnn.$rns cGlc: Thc C.nt.ul,tr s l-k nse ljw 'lo.s nor rfply ro an owmr ol
<br />rh. pn,t dy wln) hnild\ nr rNrn)rs rlEB).. *l *h) nes ssh $ufi h'msc ll or hcr{lf or rhnuSh hr or hcr own c mPl,,y.cs,
<br />pn,v cJ rhar $rh inpnN.mdrmior cfilcJoroftrc{t tu ril!'.11. hEvc!, rh.tui[haor iqxrtdnr r s)ll'dhmoe Fd
<br />dl.omphrinr, rtEOwncr Bu Lr w lharc rhc nu cnol pn,vmS rhrr hr or \h. Jrl nor hudJ or hlForc lhc pn)Fny nr rh. puqr,r ol
<br />L a\ owmr ol lhc l1l,I.ny. am cxrlusntly roft rin8wihhr.n\cdL.nr.cttrsb..ndn .h. pn,rcc( (Sde 7014 Buene$
<br />rtu Pnnix\.n Codc: l hc C.nrtu.ttr s l-Ecnrc l-r* J.cs nor,pply b uo*nd oIFoP.ny wh,) hnrlds ot impn,!e! rhdrcon.
<br />,n'l who ('nhrr\ tur \uh pn)r..r s wirh r Conk!c()( () lrcnscd pusu t b rh. Orntactr'r l-ic.nt L.*)
<br />_l rn,.rcm/ u rrScrt
<br />!!.Q.8X,E8S1!O!!TENSIIQ!l2rcta8drlg!
<br />I h.rrhy rlnnn trhrl.r p.nrlryol p.rltrry.N.l rlE lnl[]wnr8 J\-.LD|('n\:
<br />lhnv..rxlwill nEhr.m !CcnilrlicolCon\. n) Sclunsure lnr sorkc^ .r,ml].nslr Nn. as FrvilcdntrhyS&ton1700olth.
<br />lrtbr C,xl., tur rhc p.rformnc. of lhc work n, whah rhc Jlcmn t is{ucd
<br />I hrv. rnd *rll nDrraitr *or[.rr .onlr(nsarion in\ur3h-.c, a\ rcqurcd hySc.rRr ]Tlt,.l rhc l,ahorCoJc, ntrthc P..lormlncc.l
<br />thc sork ntr whchr[F p{mi is k\ucJ Mywo*c^ (nnpcn$ton r\urec crrer I Ir li.ynumh.t ur:
<br />Policy Numh.r-Eldrcs
<br />I(n'lyrh inrh. ncnnrnrkc I rhc *ork ld *hE_h rht pcrm t s\u.J.I ihnll n.r cmp[)yrnypcron inanyhMncr
<br />$ as t) h<.m ut'jr b ih. work.6' .omn nsdr dr hws ol Cllldrni!. afti ryEr rtur il I \houLl h.cont qrbr.ci lo rlE
<br />work.F .on,pcnqton ttuv$ons of S(tr n l7m .f rhc tihtr Co,lc. I \hill. tunhwirh om y wlh rhts !)ovsions
<br />WARNINC: I'dlurc b ccurc sorten ..mt nsrrin $v.nsc ,r trnlawtul. lnd shall suhF.r rn chtloyd to cllru.l PctrlhEs m'l
<br />civrl linc\ u! t, onc huftlrcd rht,u\$d dollr{ ($loO.UXl), in rdd[lin n] rhc rod of.onFns&dn. drnrS.s !s pn)vklcd Inr rnc
<br />seuro! 1076olrhc lihtrGxl.. inr.tilndarorrcy \ l.c(
<br />LTCENSED LTONTRACTOR
<br />DECIdAAIIA!
<br />Ih.rhyrltumund.rFnlllyolp.rjuryIharIcnlrcenEJu.rl,ovirionolChlpr.rI(ommncinguirhSe.iil)n7GJ0)olDlvNion!
<br />of rh. BusN$ md Pruf.ss$n\ Codc, an! nry li..nE n n tull li)(r url c,f&r
<br />I-rcnr CL$
<br />-l-r.nr.
<br />Ntrmh.t
<br />lhl€.- Conlmclor-
<br />CONSTRUCTION LFITD!NG AGf, NCY
<br />I hcFt'y {firn un,lc. Fnrhyol p.4ury rhi rh.ru $ I con(E.t$n lcnlin3 ryercy for rh. Jttfolrm...rrhc work lirr *hi.i rht lmir L\
<br />6$rcd lscc..tor)r, Civ. C )
<br />^lEltCANLlEll
<br />AAuA!
<br />Ih(hydlnnu'dcrpctrrhyDll^..rjuyonc llhcnnhwnrgn(hDr[n\:
<br />D.mnion Pcnni+Ash.(o\ Noiili(dlon lr.dcr.lR.Eulrri.ns ( I lc4{}. Prn6)
<br />Rcqutr.,l l..rr.rol N(nllndrr,
<br />-l
<br />ccd'lyrhd rhcLdcr.lr.3ulalions rcSar'ling fhcdo\ rcnx,vrl Jr. norMltahlc r,, rhnlrn)jccr
<br />I..nrlirhlt I vc rcrJthN rlpl'(ton xnd {dc rh rlt dr)vc rnlanninon i\.orc(r Irgrccr,(" lnl!_*(hallC yan,lCouniy
<br />,fttinan.c\ u'i srrrc t,rw\ rchrrS r' hu'ld'ns cotr{nr.rt,n. md hcrbyitrlhru. rq}rc\.nu'vt\ orrtl cry !td counry().nhr uF,hrkr
<br />ak,rc mnfu)ncd tr.pcdy h! nrp..rtr,
<br />Appli.inl o. As€nt Si!nnl
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />'0.-1-1 .x.v.{r'tq
<br />Certilicate of Occupancy fl
<br />Notes, Remarks, Etc
<br />Drl.:
<br />knJ.r'\ AJ,l,c-
<br />Pool Fence
<br />Flood Zone Certit.
<br />FINAL
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