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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNI'R BUILDER DEI-CARATION
<br />I hcrcby .fl1fln uMcr ncnllty ol lcrjry rhlt I lar.ic'np' lro,n rh. O'nkscror' l-i.cns. tjw lnr rhc fdlowin8 rcr$n (scc 70.11 5
<br />IJusiDes\ aM Pron$ion Coil.): A y Ciry or Counrt sh'.h rcqtrncs . lcnnil to con(ruc|. llrcr. imrhve. d.ftnth nr mFtr My
<br />id.turc, priirro irs hsumcc. iho rcquncs thc Erticd for srct pclnrir lo filc tr sirmd dxrcnr Ih,r l'. or shc n li.cnql pur\uanl
<br />ro lhe porisions ol rhe Conlracr{, r l-iccn*d Law (Chaprcr 9, co,nm.n.inE wilh Sccrn}n 7fir ol Oiri\n,n I Dr rhc Bxlincs rnd
<br />Pmfcssb ns Codc) or rhar hcorrhc iscxcmpr rh.rlnnnand lhc brsis lor lhc.llc8ci cxcmpli{n, Any viohrionofS.crhtr 7Oll5 byan,
<br />,ppli.ant Lr r r.nnn subic.lsthc qrtli.ant lo rcivilpcnrltyol mr nnmrhtrn litc hundrddollrs (S5U).
<br />Lrsown$.lrhctn,!.ny.ormrcmtk,rccswirh*ll3csesrhcnsh.o'npcns n)n,*illdorh.wotkatrdrhcslrucl!ruisRI
<br />inhnncd o,oilcrcd ior {lc (SN 7{M4, Bu\incs!and PnrtssioisCod. Thc contudor'r l,i.cnsc lrqJocs ortrPplyroano*ncrol
<br />rhc rr,fchy wk, huilds or impl ov6 ricBnr ud who dms slch *r hnnlclf.rh.rcliorihtoughhi\orh.ro*ncn9loyccs.
<br />piovidql rhar such iDpmvc,ftn( m mr id. Ld orollcrcd for $h ll lmscrcr. rhc tuiklins or in9n,vdftm is $ld wilhin onc }tn
<br />of.omtrcriotr. rhc oqrc. Buildcr willharc Ihc hurdcn ol lovinE lhaliEorshc did mn i ild or irymh lnl pmt ny ntrltE purri)t.r
<br />l- a\osncrorrhr pn,Fir. a'ncr.tu\ilcly. fu,.rins *irh li.cnscd coftr.r,n t) .onntucr rlr PoFd (Scc 7orl. But'rc$
<br />rtrd P$rc\s nCodc: l'hc Conlracl{r'\ l-iccn\c l-!*doc\ nor npplyk, rios cr.l fropcnywh. build!or inlnrvc\ rhricotr,
<br />ard qho conlmcrs ior sucn pn,Jc.rs siih r c(,nrncr.ri, licci{d Nruor lo rhc conrr0crois l,iccnsc l,rs)
<br />-l.nr
<br />cxcnrfl uoncr Sccri{nr
<br />Dnle Osner
<br />WORKERT.CiINiPENSA TION
<br />OEILABAIION
<br />I hcrchy rfllim utrdcr Fnrllyolrcrjuryo.c oflhc folk'aiD8 dcrhr:tnnr\
<br />I hrrc Md will.rn rinrCcar6.dcolC trrtrltoScllln\ur.lhrrvorkcrr.omFd\!rion,r( frovidcdloriySccri,,n.lT(nofrhc
<br />liho'Gdq fr rhc ncrfo uD...frh.wo* for whi.h rhc Frnrir iJ irsucd
<br />rhc sork ld which lhh pcanil is h\ulat I{y*ork. .on,0cn\rri(r in\lrJ .c.lnicr 0 |xni.!_ nnDG+r rr.
<br />_lccnilyrhrrinihd pcrlb un...rrh. sork ror whrh rhis p.flnn t t{Ed.I \hr!lnoi cndor rnt Frs.f iI rtry nurncr
<br />s N ro b.com subjel ro lh. workc!( c.nrpcnsalion la*s nf Cllifomis. md 4rcc rh irl shoulJ hcconr sul,jsi r.rhc
<br />workcB compcns(lion povni.ns ofSNrion.lTfir ofrhc tjhr Gxlc. t shall. f.nh$nh.onDly wilh lhoE pnli\nns
<br />W/\RNINC: Ftrilurc b {cu* work d.onD.6qrtr.ovcrrsc i\ utrhq'tu|. d \hrll {rl,Jccr !n c rllo)u b ninrinrl Pcnrlrics d
<br />rivil fiic\ rp b ofu hrndrcd rhouqnd dolldrs (SI00.U,\,. i0 trddnn'n ro lhc con ol.on
<br />ffi..,**"-
<br />na *irh Sedion 70()0) o{Oivhion 3
<br />Snr,'in Irl.h, 'h.I nh(CoJr. in'.re{ r1J nnry'.lrc\.
<br />![I;I,AB4IIAN
<br />I hcrcbyafllrnundd p.nnlly o I Frjury th0l I an lien{n undcr novhn,n orChsflor 9 (mrnrcnci
<br />of rhc UosiNs r d Pn,fc$bns Codc. Md my licctrsc is li]ll forc und.lINl
<br />Lians.Class-
<br />D.te:Potr+Pta3
<br />CoNSTRUCTI(}N I,ENNING IGTN(]Y
<br />I hcftby afllin und.r ltnaltyorp.rjurylhll thcrc G o con(ructi,n lcndins rgcRy ror th. Pcrformoncc nrrhc wotk ror whi.hrhi\ pcnnf s
<br />isruc (Sdc :1097. Ci! C ).
<br />a.PfucaNfDEgL &!-lla!
<br />I hcEhy lllm u nd.r Fnaht olpcrjry otrc uflh. lolbw rg dc.hrnrnnr
<br />l)cnnlti,in Pcnnils Ashcdnr Norilicarnnr Fcdcrrl Rcgrhrn,nr (Tirl..l0. Prn6)
<br />-Rcquncd
<br />l!I.r of Noiificlri0n
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL f'r2//(ryilery"/6-L---
<br />Certificate ol Occupancy 7 vt/
<br />Notes., Rgmarks, Etc t, -.<1L&r tiIz?7:
<br />ID/SIG.
<br />Ext./lnt. Lath
<br />krdcr'\ Addrc*
<br />l.cniryrhrr rhc rcd.rdrc8ulalhns rcsmdin8 osbcslos rcn&lal arc nor iplli.$lcro rhh Pmicl
<br />I ccnifylhal I tNc rcad rhir aDplicrrion ad sratc rhar lhcatx,vc inlorddn is.onNr. I a3rc ro (,mply Nirh .ll City.nd ('outrrl
<br />*r*:ffi#:xrldi@;-;-'ffi.
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