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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEi AUII,OI]II DEII'ARATloN
<br />I hd.tt rmm udn Funy of F,ur, !h, I rn cr.nrF t B rh. Codr!.ro 'Li..elr" f.r ihc follo$h8 r.Mn t!( 7or|5
<br />Burin6. xd Prof*io. ('od.) Ant Civ or (ount! whi(h r.qut6 ! Fmir io consIrud, iltd, imrrov.. rknolnh or '.rEtr nn,
<br />srtudue pmr lo r inffi., .ko rqo,6 rhc {,plkd for 3kh IEsn ro 6L ! !i8Ed 3rnm! lhd lE or ,E ir hc@qn r,rutd
<br />L,th.Flvi!rocotltE(o,eff!Iicc.r.dk*((h.pts0,Comm.ncinawilhs.crio.7000.foirriorrolrh.Busind!n.d
<br />hof*rens (idc) or rhal lE d itc n .rdF lhs.liod dd rn tB3n f.r rh. ,llc!.d .rdnFbn Anr lhLrhn oasdir 70rl 5 b an!
<br />.t{'lka forrp6n sl,j.G rh. rprli.sr ro !.ivilp<Mh,.l.ornor.lhd tu. hun&cJ Jouar(tt(I))
<br />l. I os ffi olr h. p.nrEnr-. $ me mphrs qith wat6 .r rh.n rn. LomrE sdior. \yill & th. rot md lh. nulr s ton
<br />ddqi or oll6.d tor sl. (S< 704.1, Bdi'B sd Phr6x'6 Co& Dr Co trd'. Lte Lrs d.6 mr qplv h e oun ol
<br />rh. Fqdr $ho hril6 or rF)v6 thson. sd who d.B !u$ mrt himr.lf or h.*lf or lhNu8h his or hs own mnlq6-
<br />Fo\ iJ.n ihd iuch rmForlEns e mr dodql or ofirrd (r 5L lf. hotr6,s- rlE h di,Ill or rr{ro\wr i! a,ld \ ihi. om rtu
<br />of mnlpLrirn. llE ( )$ffi BliUs *iU h.w llE hr&n ol Fnviu rh, h. or sh. did ml hrit or inqroE fi. Ir !ql, for iE plrla)s or
<br />I. .r o$ 6 of rh. FtrtErr, m .r.l6iv.rt .odE<rns *nh li.sn d .od,rro6 h (drud rlr EDFd ( S( ,Or!. 8$',6
<br />d h$rasir Co& 1 h. ( o.truloi3 Liccnsc l.!w d.d nor dpply ro nn own6 of rropcn y sho truildr o n0rov6 rhdoi.
<br />.id {h6 sdrl3 lor e.h leF3 r dh r cddr.cro(s) Ia!!.d FBur ld th. ( otudn'i li.R lr$ |
<br />I rn.r.n,pr unlq Sdr[n
<br />D.," 7-3-\-(
<br />I h6.l,r amrm undd rH.h' ofp6]llo on. ofrhc follotri.8 dclrntoN
<br />I hrv. dd will m!i6r.'n . cdiaEd..f (..Hr ro s.la-lNr. lor trolt6' mnrrMbn.6 Fo\ i&i for b Sdion UOO oarhc
<br />llbor Cdq fd ih. F[o'rm. olrlE *.rI for utkh rh. Fm ir isu.ri
<br />I hs\Grnd sillf,.inltin Forl6 .oF .Nlion iNurm.. B r.itutcd bvSNlior 1700 of thc ljb(rr Codc. lor lh. Fn,mtn.. of
<br />rh. wott tu which lhn p.m( 6 N!.d My trr*6 comFMhn iBunx. cntr rd Inlic) nunbq E
<br />I cdily rhrl r rh. Ffolrl@.of lh. *olr t6 $hrh rhB Fni B !ru.d.l lhllmr dpkt d! Fr$n in rnt muE
<br />$ a ro bcnm $bid
<br />'o
<br />ih. s.nal snp.Mion laM ol( rlifomia. ed r{E thll if I rhould tEom. sb6l to th.
<br />sortd' comFNrio. FDr irirE of Sdio. l7m of
<br />'h.
<br />t tE ( GL. I rltrll. ldhq th omplr. tr nfi lhE Fo\ an'N
<br />\l ,rRNlN(: li'l(re i, qu. \.'l(^' r.,ntusari,r, co\(r(.trnli\lul. rtrd \hnllsrlr(l an 6npl(,yq r. (rnn'nrl l{ih6 i (l
<br />.Drl finB up !o oft hundr.d rhosn! dolla (tloo.O(lj). in ir. ro rh. coi of c.mFNrirn.
<br />sdn,n 110?6 of thc l,htr Cod.. inl66l ad aln,m' r fc
<br />I h6!r,) lllm unds F[lll orFJUh_ rh, I o l(nE d unds tmrirnn of ( hlrnd e ((onnft'n! snh Sdion 7m0) of Dn nion r
<br />ot llE ltlsiner ed ltotRrioN ('odc. !d my lica* is in fuil ntra dd cU(t.
<br />cqtsralJ(Ila l.Edutc-AcEI(l
<br />I hqlb .mm undq FBt) ofFjury rhn rhsc i3 . .onnrudioo lcnding .sdcy f rh. t6fomo.. ofrh. solt f.r $hich thi! Fni ir
<br />isucd {sG loe?, cn c.)
<br />APPLI(' N-I' DE(IINf,ATION
<br />Ihddry.Rim!.dd porliy olp<jury orc ofrh. aollowi.3 &.lrdio.3
<br />D.fr,lilhn Pdmnr^lb.nor N.hicdp. F.d6rl R.auhi 6nr I I l..10- Pd6l
<br />R.qunid lnra of Ndrfrnbn
<br />I cdirr r hn rh. a.ddll l.8lhrhE r.Bsdr8 6h6t'r r.Rn rl ,. nor !ff lic.hlc h rhis pn)j..I
<br />I (dit\ rhd I h.\. rc.d ih6 q,I'l
<br />orni'n d dnd srrrc l.wsEhtr{ t,
<br />rtit. 'Ethn d FoFnr for iEr.d
<br />!r.rharrh.ah\. inromai{r ii otr<t lr{r(to.fmd) trnhall ( itymd ( rrnrJ"
<br />n6ofrhir(-n! ! Con ! m6ra ur{nrlE
<br />\ppllont or
<br />^rdr
<br />SirMrure
<br />p-.rr* -..rr"rr,'E1 UIA Q[6s<-,zvacr
<br />-7:3-/7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing TB AL-zJlt {Y
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />D eputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL q\rq\ t-/Whg
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />G**Au\atzazz)
<br />\\'oRh Itf\' (/(t1$ Paiisa I toNDt(atRltlol
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