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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNER BI'II-DEN DELCARATION
<br />I lrrehy am n undcr p.mlry orlc jury rhNr I mr rx.mpr rr.h rhc Contrron Licc.sc tiw for rhc folk,win8 rc!$n (Scc.70315
<br />Dusircss rnn Prorision Codc): Any Ciry or Counry which r.qutcs r ,rcrn ro conslruc|. !hs. improvc. dcfr,lhh ,tr rcFn Jny
<br />todm. prior ro ils hsuancc. dho Equt6 rhc or'plicanr for ruch pcrnir b lile a siatud sricftnr thrt tror shc is licctrscd puruanl
<br />ro rhc provisio.s oI thl ConlEtols Liccnsd L.w (Chiprer 9, Commcncnr8 sith Sccrion TO(xr of Oilhion 3 or rh. ausinc$ and
<br />Pn,fc\sbns Codc)orrhar icorshc tcicmpr rhcrciroDlnd rh.ttr1sh lor rh. sllcScd cxcmpri.i. ant vnnrrionorScclion?011.5 byony
<br />appli.rm r(n a I).rnrir \ubl..rs rh. trptli.anrroacivilncnaliyofnor rrc rn,tr fivc huMrcd dollffi (S5&).
<br />-1.
<br />us owncr o! rhc 0mtcny. or my cml,loyees wirh wagcs 6 lhcn qrc comlEn{rn,n, will do rh. {ort dd rhc snr]luE is not
<br />imcnddd or orci.d for ek (S(.7O44. Burikss and Ptul*sidns C{)dc: Thc ft)nracxn r l-iccnsc lrs docs nor $Ply ro atr.wrcrof
<br />rhcpmFny sh) lrild\ or inD()Bs rh.Enr e, wh. des shh so* hinNcllor hcrclfor rhDUEh hh or hcr own cmployccs.
<br />pmvided rhnr such impn,rmnk m r, intnlsl or ofi.rul fr slc Il h,wuEr. rhc hoiklinS or inrpmrmnl h g,ld wirhin onc )cu
<br />olconprcrion. rhc ovncr Buildcr willtqvc tlE burdcn ol pruving rhd lror shc di.l x'r huitl or inrtmr rhc Iarpca, f.r rh. r rrDE.r
<br />-1.0sowncrofrhc
<br />Dmlcny. r cx.lu\ncly conlrd ir8 wirh liccnsl cotrrrlcro^ b conntud rhc ptui.r (sN 7tx-r, 8u$trc$
<br />Md h,rcsioi Codd Thc Contd.ttr\ Li..nsc l-aw dd\ nor apply ro M owncr ol propcny who l,uilds or inrprolcs rhcr.oD.
<br />lnd who onrmds lor such proJccts wir[ a Conretons) Iiccnscd l,usuanr to rh. ConrEcrols t.iccns tie)
<br />-l
<br />ancxcnPr lnder Sccti.n-, B. & P.C. ror'hb ro$n
<br />D.r€: ()m.rl
<br />uoa(!&tlrrJutrNsarM!
<br />PDCI,IAAIION
<br />I h.rchy !ltirnrundc. p.nilry ot Frjur) onc olrhc tnlbtrin8 dmhrrrions:
<br />Ihr\r]xleillroinrrinrCcnificrrcolCon\cnrroS.lfl'rsrrcfi,sorkc'ron!rtrrrrnnr.rrlnovidcdlirbySccri{n,:17(x)oIihc
<br />l]h, Cnle. rnr rhc l{iinBncc of rhc $orl n, which rhc pcnnil n n\ucd
<br />lhrvd aid willnunnain *orlcra.o'nprnsarn,n i.sxr.n.c, as BlxiNl h, Sccr ion :Um of rhc L$or Code- at rhc pcrfonron col
<br />lhc wdrk for whi.hthic p.mril is GsNd MyworkcN .onlcnerion in{umncc caricr ui polic} num6.r dc
<br />S{nfc f "" rl
<br />Y,.',,,,,,*, ?O!q.l(c'''.,;tc't( X,,.,',"'
<br />-l
<br />ccnily rh0r ir rhc trrloirrurcc olthc work Io! $hi.h thi\ p.rmit is issucJ. I \h(llnor rn,Iloy rny tc^oi in rfy nt.oncr
<br />e, r{, hcco'nc sub}d ki rhc workcn co it n\ari,,n hws ofcllituinir, and.!toc rharlfl should tEc.rm suhjccr ro th.
<br />sorkc^ $nipcnsrrionptuvhhnsorS..ti.r 37mofrhc UhtrCod..I dull. lonhqirhco ply with rhos pmvi\ion\
<br />WARNINC: Frilurc lo s(urc workc6'con{,cnsali{in covcmsc is unh*rul. rnd shall \rbjd an cnpk,ttr tr aiminal 0!nriis !trd
<br />civil ,incs up to onc hundrcd ri.usrnd d.llrs iSl0o-UIr. in rddirn,n h rh. coq uf.otrr|ols iotr. danuSrs rs povidc lar rFi'
<br />Sc.rnn,.llr76ol rh.lr xtrCodr.nrcrc{an,larkrtur'\CbJ'Y,". tf relr f \ILl(liluit2llNtltitlalt
<br />l2!rLr1-8Ai.&N
<br />I hcrcb, afitD undcr pc.all, ol Frjury thlt I am li..Bn undcr tn,vhion oiChaplc! 9 (con,ftncirrg wirh Sdrirn ?fiD) ofDivhion l
<br />.i rhc SosiEr\ r.d Pi(,fd$ions Co.r.. aM myli.cns i ir rull for.c r d cfti.t
<br />X".""","..gfaroq
<br />\* z/it/rt >€..,T.6 L)e'ttlstl^ it-'c
<br />CIINEISI]SIQN.LDNDIN(]1(iI!!.I
<br />I h.rbt atlirm undcr lunalrrortcrjury rhal lh..c is a.onstrudn)n hndir8 stscmy {in lhc pcrlormncc orrh. work for Rhichrhh [rnnit h
<br />irsued (Sa :1097, Civ C )
<br />AIIUCANLIECI.A8AI]AN
<br />I trnhr.frhntr cr lxmhyolpcrjuryonc oirhc iollo$i.g dshhriotr{:
<br />D.n,liri{'n Permi( Ash.nosNorifi.arnrn Fcdcrnl R.guhri{,ns(Tirlc40, I'd6)
<br />RcqriBl Lrrrcrol Norificdi,)n
<br />-lccrrilyth.t
<br />thc ltdc6| rcgu l.r ions rcBarding lsheslos rcnnv.l are nor"ppli.ahlc u rhi1pr.F.r.
<br />I.cnityrhar I lllvc rcad ihii rtplic.tiondd (dcrhdr thc rtnvc inl. mrn i corcrl lo8talommply
<br />;,1#h-;ltlJ*l"ii,:*l#sH :l'-""' f Yfhvbn
<br />h'arr"r$dd"rc'o htrc,
<br />80,,",,,..n*-,.,*",,.*L /Tlfalzbt r&" -
<br />\f.mxmn.m.,pdn,,, DnL,!/ i 64Sl o ru
<br />wirh lll Cny and Coumy
<br />aad Cou.ly k, cnrd ut,n rtr
<br />?y'4/n-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su btloor/Vent/lnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonr Y
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif
<br />FINAL tolr? /t9 677?07+/o
<br />Certilicate of Occupancy
<br />Notes, Remarks , Etc.
<br />DATE
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