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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />SubllooriVent/l nsulation
<br />sRoof Sheathin
<br />Shear Wall
<br />Framing
<br />lnsulatio n/Energy
<br />allD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itilaso n ry
<br />Handi cap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL tillL"tr !b 4l\1<b
<br />Certiticate of Occu pancy
<br />Notes Remarks Etc.
<br />OWNER AUII,DEN DELCARATION
<br />I hc.c6, a0tnr undcr Fnrhy.a p.rjury rhtrl I dn.x.mpr ft.$ rbc C.n ra.ron l-i..ns. tlw itr rh. rolk,win! r.rsn lscc 70.115
<br />Busincs uftl Prolcsion Code): Any Cily or Coutrly which rcquncs r Frmil ro con(dct, ,lr.r, im,lovc. dcrmlhh or Ernir atry
<br />nrudurc. ptdb n! isuncc. also !.qon€s rh€ opplic.nl forsu.h pcr.ril lo nh i sigred sl.tcmnl rhol h..r snc is li.cnscd pur$.nl
<br />ro lhc provhions ofllE Conkr.ror's Liccn*d L.w (Chnptcr 9, Conmci.iig wirh Se.rio. XX)O of Dilisi.n I of rhc Busin.ss a d
<br />Pn,rc(n,ns Cod€) or rhal hc or sh. k cxcmpl th.rcfrom ud lhc ba\i aor rhc nu.ecd cxcnlLon Any vnnrtionolS..rion 70.11.5 bl.ny
<br />aptli., rd. r.irnir subjc.k rh. lpnli.rnr l{r scivilpcnulryoinor morerhatr tivc hu rcddoulB(35LU).
<br />L N owncr of rhc proFny. or my cnlnL]es with waBcs !s rhcir $L: .onp.trsriotr. will do lhc wo* dd fic slMurc i\ mr
<br />inrcnici or ofi.rcd rrr sh (sd.7u4 Burincs and Prore\sion\ Gic:-lht Conractois l,iccnsc Llw d@s ool {!plr ro sn o$ncroI
<br />rhc Imrcny $ho builds.r improv€s lhcNn. aJxl pho d{s su.h so* hnn\.lfor h.rs.lfoi rhtuuBh his or h.r own.nphtcci
<br />Fovidcd rhd nkh inlpn*rmnk m nor inr.ndcd or ollcr{ tor stc. I( h.*trrr. rhc hoiktir8 or ifpturcmnr is std widin om ,cd
<br />of cohpLrion. rhc O*nc, Builds wiU h.rc rhc hurdcn or pbvinS rhlr h. or shd dil frn bdld or inpmrt th. ImFny tu dr PlrlEt ol
<br />-1.
<br />!soqRrofrhc pn,lcny. dncr.lusiv.lyc.ntn.ri.g wirh liccnscdconrEci,nx,conntud rhc pmJecr (Sd 7Or4. Br{ncss
<br />aid Pn,rs\btrCodc:lhcConlrocrolsLiccnscLardocsndrrpplyuMowncrorpror.dyehr)blildsorimprovcsrn$con.
<br />and wh. .onrtu.rs r,tr luch rmrcd\ wir h a co rocb( s) ticc;s"a r,**-r r,, rt
<br />"
<br />innr*irn, ' ri*n* t"*r
<br />I nncrcmpr xrlcr SL{r
<br />MB.f,ti&rlauruNJAll1)N
<br />IIICLABAII!}!
<br />I hcr.by dlilirnrnd.. nc.alry of p.rjfiy o.c ofrhc loll,'*ine d.clarrlion\:
<br />-l
<br />hNc d rill'minrdin.Ccnlf.nr..fCon\ctrrt,Sclfln\urcli'r*orkcr'coarFns,ri{n,.s\F)ridcdforbySc.rnnr:ll(Xlofrhc
<br />hhor G)d.. rorrhc p.rfonnrn( or rhc *orl( tur *hich thcpcnnit i h$cd
<br />lhrlc Dnd willfrainloin wortcrl .on{Ensorn,n itrsurrtu.,.s rcquncd bySccrrn 170(rolrhc LlbDrCodc. br th. pcrloflrutrc. .l
<br />rh. work rirr shi.h rhis pcnnlr is tsucd My*qkcr\e.ion insumNc clricr lRl riolicy Nnrhcr.rcl
<br />,,.'.,, A €Eletr l,^,9 .
<br />o o ooo I Zr/
<br />-l
<br />ccdify rhrr ii rhr p.rfotrtuic. ofrl'. work rnr which rhi\ pcrnril i\ is\ucl. I slx'll tror c'npli,y !ny pcrn,d in r.y nutrn.r
<br />w, i, b.com \unl.cl l. lhc workcn compctrsd tr r htrs .f C.lir.irin. rM reN rhd il I should hr{orrc subrccr ro r hc
<br />w.rkrn conp.nerion pmvtionroiScclion lTlrOollhc tjtnr Codc. I shall. lbnhwith .onrply wirh rlm*,rrorhions
<br />WARNING Fdhrc b {curc sorkcr ..mp.Nrrt,n covcruc i{ unh*iul. rn.l \h,ll uh].cr !n.lnrlorr b mniMl rf,nrliic\ md
<br />.ri nN\ !p r) onc hrndrcd rhN\atrJ dolr (1|(x).rxxr). ir (ti of.omncn{ri.n dnrolc\ r! nrovidcd for rhr-/-
<br />*_",,", t/".rfte
<br />Ih. byrflirmlnderpcnllryolpcrjuryth{IamliccnsdundcrpmvnionolCh.lrcr9lcormncirs*ilhScclinrTO{x))orDivtnrn:l
<br />oi rhc 0usincssand PnfcsionsCodc. md myli..ns is in full foncM,clfc.r.Ctr 3r{L
<br />t,,r. ?/U ? c-"*ry$-
<br />COISIBUqUONIENDIICAC.ENCI
<br />I lErcby rlirr uRlcr F:n,lry or Frjury rhd rhce is a .on\rrudioi hnding ,gcey r.r $. pcrrormNc .r lh. work lor which lhis IEnn n
<br />nsued (Sr. 109?, Ci! C ).
<br />APILICANfDEII.A AAIIA!
<br />l irnh!dtr und(pctrrlryof p.rjuryonc.f rhc lollowinsd.cl otions:
<br />D.mlirion Pemils Astcnos Norificalion Fc.dcnl Rcsuhriotrs ('Inb40. Pnl6)
<br />Rcqrtcd Ldrcr na Norifrari..
<br />-l
<br />ccniiyrh,lthc lcdcn I rc8ullr io ns rcBrdirS asb.nos mhx,v,l dc n.r,rnli..blc ro rhirrmj..r
<br />-l
<br />ccnilyrhlr I hrvc rqdrhh applicarionand (rrcrhlrrhcrhvc intnnurion is corcci l a8rahconlny*nhallCnJ n Couniy
<br />ordinanccs utrd Sx c l-rqs Ehrina l. buildina consrrucrion,.izcrcnrcs dncs ol'lhis Ciry lnd Counrylo cnler urx,n rlE
<br />r6.ve nrcDri.md |ffrpcn, ior i
<br /> pDliL{nl or Aaent sitnnluE t /zrlt
<br />I
<br />COMMENTS
<br />UFER Ground
<br />Pool Fence
<br />T-Bar
<br />Flood Zone Certif .
<br />I
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