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BUILDING- INSPECTOR RECORD
<br />SITE.WORK OWNER AUTTDER DEl,('ARATION
<br />I hatby rrm un& FrI, of FJury thr I m crmF 6om th. CodndoE Lic@ t w tor lhc followins r.&. (5(.70.11 t
<br />Buind .nl Prof<ion Codc) Any Ciry 6r Coldy shah ,.qut6 r FDi ro odM. .nq, iE mre ddmlah or tq.n u)
<br />ntucfuq Fatr ro ,$ iBu4c. rl$ r.qni6 th. tpplird for soch Fni lo 61. . siSn+lrmt lhal ll or rhc ir I'caq.d puB.,i
<br />rorlEFotliodofuEco.rld!l-i.sB.dLr*(crr[Jl69.conllrwrswirh!,<rhnrooooloivirionIofrhcBuindrnd
<br />Pmfdi..t Cod.) or rh.r lE or ih. ie 6@p{ thdlnom xd rh. b6b for rlE n4.d ddF br tuy vi,h ion of Sdnn 701 I 5 by ,.y
<br />lpplicd for . Fnh rubja:l! th. lrFliol lo r civil pmhy of mr mor. lha liv. hun(H dolld (1500)
<br />l, d 0*6 otrh. FoFnr, or my.mploF6 *tu wrSd B lh.t a,h.omFro8lion. will(h llt s{t ad tlE rn re 6 mr
<br />il,drd.d m ord.d fn rL (Sa.?O{. BrBilB ud PFrBioB ( o& Tl! conrtd'. LidE l,s dG mr $rly b D {*rd or
<br />thc pr.rEty who blilth or imF.r6 dEo( lrd who d'6 sn q,* hid.lt or h*lf or rlhush hir or lE of,n 6rblq
<br />FouiLd rhd kh iliFo\ax E d irctddorollEal nr d. I( hotr6€.
<br />'lE
<br />hildinS or trrFlrqE tsEwahinotu)@
<br />of .omplcrbq tlE OsG Brilk wil h.t. lh. hrdo of F\tB t,6 lE or sh dii ml buit 6 irForr lh. |,UFtr- 6r dt F,BE ol
<br />l. s oq n6 ofrh. Fop6ry. u dclNEly conr,!cr,n* v h li.tu.d comrldoB ro c.nsrtud rh. Fojd (SN 7L!4. u6ins
<br />8rl Pn'kiB co.L: Ih. ( o.tkro.r l-ic.e L.{ &6 mr.!t)l! ro dotr.6 ofFopqlt *ho bu,ld! or inrhrd rhd.'n.
<br />and who codBds fo, such Fqdrs w'rh r Co.rEclo(s) li.o*d puuu.d ro rh. conua.ror'r l-icG ti*)
<br />I !nc\cnr un.lds.clnn
<br />D.re Or&r
<br />\t orui El{s' ('ot\t Pf,NsaTloi
<br />urclrr8lro!
<br />I hd.6] ,mrn' undd Fnnlr).lpdlu., nn. olrh. nn[$ rn8 dt\lar{rnn$
<br />I h,v. drl *ill mi.riin r cd irEar. of( .86r lo s.lf-l Bu? aor s$tc' comral!.rion. s Flridcd for by s(rir. I7(xJ .r rhc
<br />L,rrtr Cdr., lor tL Ffo.lre. of tlE $.n ld *irh rh. Fmn . i$.n
<br />lhav.lnduillmoi .inno*d compdstion 6urNq6 r.gutr.d by s€ri'n 1700 ofrhc l$or cod., ao. rh. Ffoman..of
<br />lh. wort for whkh lhn Fhit is isEI My wmt6 ompasdion iNuk. cd6.rn polay.(mbq e.
<br />I .sriry rhn in rh. Ffotuc ol$. $orl lor $hrh rhB Ff,n i. s.n I .h,ll mr mplo' rny F$n h uy dd6
<br />s a ro bc.onc aubJ..l lo th. wrl6'conFEnhn las. of CJinrmia dd 4r lha if LhooB ba.m $b6t h rlE
<br />r!.16i omFsr.n tmrtnB ors€iion t700 ol rlE l!U, Corj( I {rI. rollhu irh .ooply wnh ihoF pmviroN
<br />WARNING lrilur. lo gu. $ortd @np6i6n .o\'6.s. a @lr$ful ,i ndl abtal 6 orphF to mild FULE ,rd
<br />cill lin6 up nr onc huRlrqj rho@d d.,1,6 (l lrurio.. damflsd s px,vid.1j for lh.
<br />7
<br />I h6.by irm undd pa.lry o f pdjory rh.r I dn li..lkl u6dd n of Ch.fls a (comn@hs * nh S..rEn 7(100) of Dirtsi'n I
<br />ol th. B6iB ud PnfBirN Cod., and my li.@ s ,. tull ro,c. r clldr
<br />r.i".*(.1* c-n
<br />rhr. 1L"L,1
<br />y1-
<br />I hdrtry .frm u.da F.hy of Fiury thr rta. i! r odN(rioD lddi.a .s*y fot llE Ffotuc of lhc e.l li,r {ti.h rhi! Fnn i!
<br />isu.d ( s6. 1097. civ. c )
<br />ATIII(ANLDE(IISAIIOX
<br />I hc*,y anim undr !6aly of pcrury 06 oarh. rolbwior d.ckat ioc
<br />l)srlnion Pmng^rt dG Ndrlic.rion I.d.El R.8uhionr t1nt {0, Pin6)
<br />tuqun.d Lclt6 of tdiifi.iFn
<br />I c6i
<br />'fy
<br />lhar rh. fiddrl r.suhno6 rqrrdms ahdor moval d. n.r apF i.ahl. to lhis pn!.cl
<br />ion ed sr!t. rh.r th. abor. inf.tmr ioo i! coBd. I rs* io codply *nh all ( n, .nd Counl!
<br />ildhs conftdbtr rn lE.tr.dhoM r.lrerrrr6 of rfit cny Bd cou.ryro dra !!on rlE
<br />t/t-'*
<br />i{. vtzt.- w\l l, t (//-
<br />z1.l,l
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathrng
<br />Shear Wall
<br />Framinq
<br />lns u la tion/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL tT ll +t t Dt.t riix 6{
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />DATE IID/SIG. I COMMENTS
<br />2+"'..^U
<br />I I
<br />I
<br />I I
<br />I
<br />I
<br />II
<br />SubfloorA/enVlnsulation I
<br />I
<br />I
<br />I
<br />I
<br />Brown Coat
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