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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation /
<br />Roof Sheathinq t/2-//2,212,-/H/z/l,
<br />Shear Wall
<br />Framing
<br />ln su latio n/Ene rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />ttFINAL / l'Yvl)D)1.-F-N4U I oq
<br />Certilicate 6t/Occublncy
<br />Notes, R m , Etc.
<br />u
<br />Zt;
<br />- o*nbR Buri-iiEh DEL(:ARATToN .
<br />I hcrchy oflnm un cr Fnalry rn n rjuiy lhrr I d cxcmtr tom lhc Ci)nrracnm L,ccnsc hw ti,r lhc lollowi.8 r.a{i (Se.7orl 5
<br />Bu\inc$ dni Prolis(n'n Codc) A.y Ciry or O,unry whi.h rcqurs i Fm n) con(ocr- alrq. imorcv.. iLnollsh.r rcfrir rny
<br />strucrurc. prkx b ik iisurc., al*, r.quncs ih. .,)t'lie.nr lnr such I'cmir lo lik a siSRd nitm rh.l h. or slE is lic.n{d nxisudr
<br />ro lh. povkions ol rhc Conr.acnr s Lic.ns.d hw (Ch.fl.r 9. comn{Nnr8 *irh S&ri{,n 70txr .r orvhon .l ol rhc Burncss ..d
<br />Pdisn,ns c(dc)orrhrrlE drshc i{ cxcmpt rhcr.tiom atul lhc hasis l'or rhc ruclcd crcmnlion. Any vi{rhlionolS.cl,on 70:r1.5 hy,ny
<br />applicn ror r p.rnn subjR..ls lhc .pplicanl lo a riv il reMlrt ol rnn nn6 rlan ivc hun lrc,l ,.l. $ (55Cx))
<br />Las owmr or r hc pn,rEdy, or ycrpbyccs qnh w!8cs ns lhct a'lc (omp.nsdnnl q Ju rh. qGk dxl r; iturm n fri
<br />inrcndcd or orLrcd lbr salc (Sa ?04,4, Blsincs rn.l Pn,fcs$nr Cnlcr Thc Conrmelff s LLrrsc li, docs nor ryly ro anowncr ol
<br />rhc F)pcdy wlx) lN Js or in n,vcs rhd!& dnJ wl$ des su.h wrt h im\cll or hct{ll or lhmugh hh or hcr o*n cnl'loy..s.
<br />provllctl rharsu.h 'nptukmn( m ior ricd.{ or oftcBl tu elc.ll, tx)xRr. ih. tn'ilina or nbpn^tm rhllw hinoncytr
<br />of $n{rlcth)n. rhc owncr BlilJcr w h,!. rh. hr,Ln of 8)vm8 rhd h. or shc dil mr huiu.r in{ft)v. ih. tmlEny tu lhc pqr{ of
<br />L a\ own.r .l rlE nmlEny, rnr cr.lullcly ontrrms wirh h.n{d eonh.br t) rondtucr rlr lft&d (Sa 704n. BNoss
<br />a,rr Pnissirn G,Jc: Th. ConLackr-r LiLcn$ Lru docs ml nplly r,, an o*ncr dlfn)Pcny who huilds or inprcvc\ rhtcon.
<br />a.J who {nk{cts ,ir $.h ImJc.rr wnh 3 6nrknl(s) hc.n€J Puruinl l,r th. conkrcd'\ Lf,cn{ tjr )
<br />I dnrc\cnrprun,lcr S.cri,,-,11 & F.C. n)!rhn.cav,n
<br />D.k
<br />-
<br />owtr
<br />!91(!8S:CO!lfENl rlON
<br />I hcr.hy rlts uhJ* Ir.alry or t ",j,.y o* ,t rt
<br />"
<br />t,ttu*inrffiHA
<br />-l
<br />hnv. ail will minrd, a Ccniticllc 01 Conscnr ro S.l nsorc ntr Mrkc6' .onFnsrion, as Ftrvii.d for b, S..tio. .1700 .f rtc
<br />l.dtxn G!..|u' rh.Fnom !col'hc*orql"rtrh(h,hcn mtrr n n\u",1
<br />Zl hrvc an,l wrll md'nrar *, trk.^' (
<br />'
<br />imn n$(
<br />'un 'mur.Ec. .s rc1luirc,l h, Sftr ion r70o or lh. L.bor Cndc, for thc p.domuM of
<br />rhe mrt aor ehich riir tEmn F ir.ucJ. My workcB' o,ftpeastiotr ins8,M ffEr ol Plry numb.r m:5./4 /e f u,"--
<br />>a -772 g*=^ )-2-@
<br />-l
<br />ccdny thrl m lhc ncrrormmcc oirhc work tur !h{h rhir r.rnrir N i\ru.d. I null nor cnDk'y rtry Pcron 'r lny manncr
<br />$ .rb&.om slhFr brhc woikcrJ cotrrt .s.rDn l.wr olCalilomir. rnJ aerc. rhirif I sbuld tEuoE stbJ.d t,rhc
<br />wollcG' (rmpen\rroh pr,vslrn! or Sc.lnnr .!700 ol rhc I atrtr C{Jc. I ihtrll, tud hw h coflrply *irh rhos Pmvaions
<br />WARNING Fdilurc n) r.u,. w(trkcrs'c. ,rcn\arbn Lovc.a8c r unlnwhl. lnJ shdl \lbjer e mfloyct n, mminal p.rulr.s atul
<br />.iv,l llncs up l. on. hundrcJ riourmJ dollds (S100,0(U). rn ad! n)n r, rhc uxr ol comP.nsation, damaScs as povitl.tl rar rh.
<br />S(drtri 1076 !n llN lntxtr(nd.. n .R\r
<br />I h.rby artthuhdf FnnllyorFrjuryI nr.'l trnJ.r pn!'!o oi C'hil,.r 'r r( onnrf,N ! N h S..rntr ?lr(x))oll)'usi,tn.l
<br />k:
<br />my li.cn\c t in tulllokid.i.Iact.
<br />It
<br />I lrrcby rltirm u&lcr p."rhyor !.rjrry rhar
<br />is.u.J (se 1097, ci! c.)
<br />nnrudrn Lndin8 {EcE-.y nr rh. pcrfornukc oitlrc wotk in qhrh rhlt Fmn rs
<br />AIIUCAII.PECLAXAIION
<br />t h.rct y altim unds pcnally ot Frjury om of lh. lollowins dc.ldll bns
<br />D.frnlbn Pcrmik-Ashcskr M'rif$arion FcJchl R.gul,rons Gnb 40, Pan6)
<br />_R.quft d hrlcrol NotfLllirn
<br />I.c'r'1y thrr th.liJc.al rguIri,)n\ rcp!n,rnt ddr{o\ rcnk'vrl]'c trorrptl'.ihlc h rIrl anlcrr
<br />kr'l rhnrml'clk,n ud {rrc rhd rlr rrr)vc 'nl,rnHtotr '\c.,rcrr I !!rcc b.omPly wirh rll C ydndCotrnry
<br />llwi Ehrn't lo buildiry consln'.lit)n. ud hercbyaurhortc rcrrcscnralivcs olthn Cn! dd Counlylo cnrq ulon lh.2-20
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<br />tJnJc''r AJJr$
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