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BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall l-//-t
<br />Framing lltll///*4t ,/
<br />lnsu lation/Energ y I T\1e, (Y41j.1L
<br />r\t1'IB Yfr\!.st6nnLhn.t L1 @\ytuL3+
<br />{own Coal exn "€\\
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL tl tb V+
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />-)
<br />OWNER BUILDEi DElCARAIION
<br />I h6.rty .lTm und.r !o!h} ol FJur- rhn I @ .rmrl from l,E Cod.xloE LE@ Li* for llE foUo$ins r@n ( 56 70l l 5
<br />B6in6 rrj Ptofdion co&): Any Cnr or Cou.ly stiLh r.quii6 d Fmir ro .onrtud. ,lrd, 'mpNvc, d.inolnh or qEn dt
<br />3rru.ru.. Fior to irs is@.c. Bla' r.qut6 rhc applrel for such p.mn lo 6l.ds{ncd nd.lmr rhd lEor3lE 6 ncducj pumdr
<br />lo th€ FovnbB ot rtr (t.lrrto.s Lrd\r] t s (n 9lo 9. Comn'nE F h sdon 7000 ol oiviron :l .arh. Ircin* sJ
<br />ProfdiJnJ Cod.) or thd lE or th. t <.frF
<br />'h(.from
<br />ad rh. hdi! aor rh. dLC.d R@Fh. Ary\iol,rionofsalln?011J b .nr,
<br />appl(mr tor . Fnn $bdr rlr .ppl'cDr lo ! c,v il p@h y o f mr mor. the fiv. hundt.d doll&s (tt00 )
<br />4(t, * u* ottt'. prop".ry. or nry.mploF6 wnn s.g6 s rhcir $k omp6Mro.. *ilit' th. *ut dld rh. rME 6 mr
<br />mrdldj oronqtij fd eL (s< 7or4, B@Bud PrDtdirB CGL In ( odr(ors l.aos Ii$'&B mr lpply lo 6.un6 ol
<br />lhcFrFlr $l[ txil& or itrqlr 6 thd@ dl wl$ d.E uh s* hinelf nr h@lf or lhNugh hi! or h6 oM .mpn,v6,
<br />pravd.d lhal 3uch inFo\Emts e mt idoddl.r olldrl t* ek I[ hoca. trE hritlne d in+.\6Gd a $tl *ihi. "m )6
<br />of conDk16.. rlE ()ll nd lluilld $il h.w tlr hrrld ofFrnS lhd lr d rrE dd d tliu or @Forr l,E FIE!y nr iE F,FE of
<br />I, G oMn of rn Flpsry. m .r.lus'v.ly colnrdllu snh h.dsd co r.cloR ro cord.uci rlE FtrF (Sc 7O.l-,1. tt5tr6
<br />dd ,iokin Cod.: It. (-ontrdorr Li..e tr{ .ta ktr .p?1, ro u o* "d oaFoFry sno b nd! or impro!6 th6a'n,
<br />sd $ho rdid. for 3uch Fojd. wnh a Codr.cro(O liccnial plBunr lo rhc Comradort l.tN tzv)
<br />I m.rmF u.<to S.<lidn
<br />3lzlB o*.".7.
<br />I hd.by nmrm utrds penslly of psjury on. ofrh€ li'lllrsinr
<br />_In!\crdyillmi lid r CErift.rc of CoM'l 16 s.lf-IM. lor s!rl6 omrdtion. a Fovid.d for by Serion 1700 of rh.
<br />lior Code for th. psfolr::a. otllE wort aor wticn rh. Fnit i isu.d
<br />I h.v. ur, will tui,lrt roila NEp.6.ri,n ilnl]ee 6 r.q{ir.d by Sdrh! l7m of llE Lrlor Co<L: lor tL pqfolM. of
<br />lh. wt fd eltth fiir p@,t b i&.d My *orld @npdBrion i uecc 6i6 6ld poli.y numbd dc
<br />Ceid-- ____
<br />Poli.y Numbar lrpi6l
<br />/r{!rrl& rro in r* paro11ffic oa E $orl tu { hrh lhir Fon '. isu.rl. I dDll ft{ dploy my pdsn
<br />'n
<br />.nv mdnd
<br />e a io b<oe tuqd lo lh. sdd conFEd nrn bs! o f C.lifi'mi!. ed rsE lhl( if I rhoul.l b..omc rut E lo lh.
<br />worrd comr.r&lion l'ovi,oE ol s..r'o. l7fti olrt llbor Corlc.l iEll. t(Ilh* 'rl camrly u
<br />'rh
<br />ilrE F!\ ai,6
<br />*ARNING Flihn. to ff $nt6 s,rFision dvds. i! dhntul, d .hrll rhJ..r s drrloyd ro dinin l FMkttn n.6 up ro oc nun&.d lhosnd d.ll6 (tl(x).Oo(J), in add ion b rh..or of comp.Nrion. du.g6 s txDr;6l
<br />S(itr)n 1076 of rh.lrhnCod., inr.cs ind s orc' s fG-zlz lr?,
<br />I llglb.v rmd unds Fult) of Frury lh, I m [6!t d u.d6
<br />of th. ItNilB.Dd ProadioN Cod., d ny li(ffi i! i. flll
<br />,nt \ h S.rri(n, rlr(i1r).ll)\'str,n 1
<br />CqISI3ICIONTADIIG.ACIIIX
<br />I harq lIImud.. F I,of ,Eju.y lhr llEc t ! oiEru.rbi laddU.ga.y aor rh. FfollM.. or$. "ort tor sni.h lhis Fnn t
<br />is.d (s< 3097, ( iv C.)
<br />lrdq i \nn.
<br />atfttc6dlD[(llaal]o!
<br />I hodry lfrn !ftlq p6!h, of pqjury orc of tlE aolkr$ i.3 &rl,dhG:
<br />l)cnmhio. PdtneAltaos Ndilicdhn rak.l R.suLiioa ( I 'tl. 40, Pd6)
<br />Ratun.d ldrd of Norificdm
<br />I .d 't I hd th. aoisll rqublnB Esudiru atEk's rdm\ dl sc nor !0rlicdhL lo thb rtrojd
<br />!(Lrdit rhrr I h$. rc.d rhs rn tkdhn rn {.r. rhd rn. .tb!. dromitn 6 $f,al I .*re ro NDd} N nh ill ('nr .nd ( ounr}
<br />odnift6.nd sl,i.lr*! Eldiie ro hril,.lin!.odtud &rlhd.b\,uih,rt rFMlrif6oflhiCirted(ounrtto6t6uF,nth.
<br />rt$\ c nHlion d pr.Fnr" aor iNrE lion
<br />npp ..nrorAsdrsisrrur. X
<br />x_m0 t(rrF{^Jr
<br />-".3(zlB
<br />I DATE
<br />Set Backs I
<br />II
<br />I
<br />I
<br />I
<br />I
<br />Drywall
<br />I
<br />I
<br />I
<br />I
<br />I
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