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BUILDING- INSPECTOR RECORD
<br />SITE-WORK tD/stG.COMMENTS OWNER BUII,DER DELCAR TION
<br />I hcrchy rmr undcr ,.6,hy 0i p.aury thlt I m .x.nu rirn ihc Coffaclor' Liccne L!r' for rhc t,lL*inr rcryD (scc.7oll 5
<br />lrusinc$ 0 Prolcsion Codc): Any City or Counly which rcquncs r lEmit b con{to.r. alrcr impruvc. dcnnish or eBi any
<br />srrucrurc. pior ro irs hsuarc.. !h..cqlnes rhe apDlicanr lor suchpennirro lilc r sig..d ndc,mnr rh{ hcorshe ir liccnsc.l pd6urnr.
<br />h rhc pr.visn N orrh. Co.kr.rols Liccrs{ Low (Chiflcr 9. coDnncrcirs wilh Sccrn,n 7(xx) or Divnion :l ol rhc Busincs rtrd
<br />Pott$i.ns Codc)o.lhrr hcorsh. iscxcnrr lhcrcfromand lhc hlsis ror rt{ dk!.d.kmtrion A.yvio[rionolSccrionT0.]l5hrmt
<br />rnrlicsnr ru a prm rsuhjccr\rhd rnpli.anr b rcivilp.trrhyolno' nm6rhnn nrc hundrcd dollns(3500)
<br />I. {s owncrofthc J)ro|Eny. or [ycnrplo]es wirh w.Sc{ $ rhci, slc $n,Fnsarion. willdo rlh s(trk ldrhcstrlurci\nor
<br />inicndcd or oftcrcd nn srlc (S& 704-l. Busin.s n d Pr,L\\idN Cixlc Th. C.trtrrcrr's l-i.urc l.trs rl.c\ tror lprly ro m o* ncr of
<br />rhc pmFdy who huilll\ or i'npn)vcr th.Nr rnl sti, &{J Nch \olt hnnsc lf or hcr*ll or rhn,ugh hn or hcr own cn,Pl,,yccs,
<br />povidcd rh such imtlrotuEnrs sd inre' cnnoflcrci lorsnlc ll hoqcv(rlr huddine or nq'otnMr n wU uirhin nL itr
<br />ofconfkrion. rh. Owtur Buikld sill hrvc rh burd.n orprclii! rhrr Ir oi shc did nol huild or in{,ro\e thc pmFny turlf, turtiR of
<br />L as o*rri oI rhc lntpdy. aD cxclusivc ly .onlmcrirs sirh li.cn\cd .ontrckx r, .on{flcr rrr l)tur.t ( Scc 7(}44. Bu\im*
<br />und holcssionCodc'l'h.Conrra.t,st-i.cnsct-awdoc\iorrlplyhinowncrofprolcny$h.l,uilds..improv.rrhcr.on,
<br />Nd who.omi.islnrsuchnmFtswirn0Conrdonllhctr*dpu^uinrt.rheConrracroisl,iccn\clls).
<br />I rtr,rk.n,t undcr Sccrii)
<br />tla.Bxr&5_tauutlsjillJx
<br />uEcL .tsJll.li
<br />I h.rchyrlnnnutrddr|cnrlrlof ltrj!.!o (olrtulnlkNirrsJc.krrii(rrs
<br />lh,vcmt{illroinrdnrCcnili.dr.ofCoDs.trrt)Scliltr\urclitrworkcrs.onrFnsrri,,n.rqr('!idcdlnrhySc.tiotr.lTll)ofuh.
<br />Llhn Codc.lbr rhc pcrlornuncc ntrhc work forehichrh. Frn,ir i\ i\socd
<br />I hrlc rtrd willnrinhin workcr( conpcnsdbn insuhmc..s r
<br />rhc u4k litr shrh r!i{\n'ir i\ nsu.rd n1) * rko...nn n{. i^
<br />t',"o, ' Z*-Z-''^-l-t
<br />cluncd by S(tin :l?O(l ot rhc ln$xr (i'dc. lor rh. pcn'ormrcc ol
<br />. imuroncc.:dcr md E,lict nrmb.rr.
<br />Expnc\
<br />-lccnililhar
<br />in rhc ncrl(,runcc of rlEwo f{r whi.h rhil Fonir ( ksucd.I shrll nolcmlloyany llcrqr inrnymnnncr
<br />k' as rJ b..om subjcr r. rhc sod{s( conDcns ion lnws ofc.lir'orrir. .n<l lEEc rhar irl shoxld tE.oft suhjet n,th.
<br />wortcB.o.rlr.s0rionpmvnionsofSetion:l?0OoflhcLiborConc.llholl.fonhsirh.omplywirhrhos.Povisiotrs
<br />WARNINC: hilurc ro scurc w(trkcs .onlpenrlrn,n cokrarc i\ unhqhrl. i.d sh,ll suhi(l an cntPlolcr h.n intlr.nrrri.\.nd
<br />cnil finc. nn ro nnc hlndrcd rhnu\aitl J',llr\ l!l(p.ffxr), in rddfn to lhc cotr oicompcns0lion. d!ruges,\ Povidcd for thc
<br />sccrinn:107^nl rl.. Lrh Cnd..i.n-.vrnJ funof.lrc. 11
<br />';7546 ^,lS gecroru Yroq"'4)'7
<br />/ LllIlstD-l,lJ!-tl^LB.a
<br />DEII.AIAIION
<br />I h.rb, dflirft lhdo F.aht .t lcrjury lhrl I .m liened u dc. rovision oi Chnrrcr 9 (.onrmn.ing enh Sdiotr 7000) ot Division .l
<br />of rhc Businc$ and Pmltsions Codc. and ny li.ci{ h in tuU f.r!'t, 0d .tfccr.
<br />Q #Tort-1fi
<br />l72.o4L ?r4"rtr]<2
<br />AITI.IgANTIIEII.AAA:TIQN
<br />I hcd'y {flinn ullccr pctr.lly or p.rju.y orc ol'lhc I'ollowins dcclrari{,n\l
<br />Dcnx,lirn,n Pcnni( Ash.ros Notificrlior FcdcrrlRcBul ions (1it,c t0- Pan6)
<br />R.quircd lrncr ol Norifi colion
<br />l.c'ril.vrhrr rh. nd.rrl r.rrl3rtrnr\ Rgrrdsr! r\lx{os rcnnvarm rcr mnliclhlc lo rhn nojc.r
<br />Lar lhc !bov. i.futurion is.otrc.t.I rSretocomnly
<br />ioo, ad h€rchy aurhrri,c r.tlmscnralivcs ofthis Cir}
<br />l.cnilyrh.r I hNc rcrd rhhnppltart,na irrcrh
<br />and Colmyto c o xlln' lhc
<br />zblsodimo.csn srdrc l:lx rcl$irsro
<br />atsv. 'mnii.md pioFny lar ir
<br />.\pplirntrl o.,\xcnlSixnnlu k-f /./t/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf Ioor/Vent/l nsulatron
<br />Roof Sheathing
<br />Shear Wall r^\
<br />Framinq 7-"4-lr A'{lLiO)
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/laso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceftif
<br />/'{
<br />FINAL K-2s-tK hJtLtt)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />DATE
<br />Erection Pads
<br />V.r>'.
<br />IAISIf,IJCII9NIENDINIi.AIiEACI
<br />I hcrchy riirnr undcr lEo0lrr.l!.rjury rhai rhcrc is a connodion kndiis aacn.y lor rft ndlhnnrnc orrhc Nork inr *hi.h rhs Frnrir is
<br />i\sucd (s{.:1097. civ. c.)
<br />l. a'\ NJtr c
<br />Lnd"r. ddm(.:-
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