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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER At]ILDER DIiLC RA'TION
<br />I h.r.by,filrm unn r pcnohy ()l Frjury lhur I ad crcmpi k,nrhc Cotrtrrclon l-iccr{ tiw ror ihc follo*ir8 rcavh (Scc.?i)3|5
<br />Busincs , Profc$ion c{ic): Any Ciry or c.xtrty shi.h rcqutcs . Pcnlir ro onndcr, 0lrct, imnrolc. .lc6olhh or trhn Bny
<br />(rucrurc, nrttrh irr issntrN.. ako rcqtrircs thc o,rplicml lorluch lxmir b fib. si8trcd rdcmnl rh hcorsh.nIicnscd lumanl
<br />ro rhc flovhions oi rhc Conrra.tr's Li.c.*d tjw lch.plcr 9, Comrmncins wirh s..'io. 7l)00 ol Dilision.1 orth. ausincsr rnd
<br />Pmacsnrni C.dc)or rh.t h.orshc iscxcmpl rhcrcfK,mund rhcbdsii lor rhc ollcscd ciemlrion nyviDl.tionofSdionT0.ll5hyrtry
<br />Jpt'li.lnr lor a psnJrsubFhrh. rmli.a.t ro aci!irpcnallyofnor nnrc rhtrn fiv. hundrcd dollm lS5m)
<br />-1,
<br />* ovtrcr of th. porrny. or my emllor.s wirh wlgcs N rh.ir s,ko,n[l.tr$lion. *ill d. rh. w.t* 0nd lh. (ulE i\ mr
<br />i crhd or oncrcn lor saL (Sc 704.r, Brsitus rnd ftorc*ions Codc: Thc A,nt(ttr c Li.cn\c tis doc\ nor qlly n, atr oqrcr ol
<br />rhc prop.ny $ho builds or ryorcs lheB),. ud who d{{s $ch w)d( hiDscll or hcre ll or thfl,ush his or h., own c'qk,rccs.
<br />prorntd lhar such i'n tr,kflrnk m mr i.tcMen or ofcr.t ti,t ek l[ ho*cki rhc tuiklirB or ir{mvcmnr is sold wirhin onc ,er
<br />or&nnd.ri.n. rhc Owncr Buildcr *ill tDvc r]1 budcn.rl,t,vinB tld hc or shc dil fr tuird or in{,mvc thc pmFny for rh. flrrFe ol
<br />I. asosncrol lhcrropcny- a'n.rclu\ivcly.otrkr.rtrr8 silh li.cnsdco t3.rors ro mn{rucr rh. Prorccr ( Sc. 7Ol-1. 8u\ims
<br />Md Pn,fssi,n Codc lh.CotrlhrctofsLiccn\c1.,*(hNnordpnltrortrorncrof[orf,rryshobrilt]\orinP(r.srhcrcotr
<br />rnd *ho otrlraclslorsuchprojc.rssirhrC. rr lons)li.cn{cdpu6urnrn,rhcContrcttr\l-iccnscl.Dw)
<br />I iflcx.nrtl ulldcr Sccr
<br />Mnff&::lau[Ellalla!D!!lrI&[laN
<br />I hcrchy rlltmu.d.t pcmlry of pcrjrry onc.frl[ ltlhtrir! dc.larrlnnf:
<br />IhrlcondNillNinloir!Ccnifi..rdofCone toScl!,osuElorworkLrr.o rFctrsdion. N providdd torbySNriotr:l7lX)olrhc
<br />Lrh)r Cdlc. for rfu prdonnonccofrhc suk Lr whrlrrhc lriinit h t\ucd.
<br />I hrvc and will nuinuin work.rs .oiqrNir ion iNlrame- !s rcqriEdbyscdnrliu)oflhcLrk,Codc ror rhc Pcriormonce of
<br />rlr sork r'or *hich rhispcrmir i\ is\u.J. Mylorkc6 .omp.Nolior insuhtuc.,nin,nd !.lty nu.rbcr dc:. STAT'- EIND
<br />6r -?-o I ll-a t -"--\b
<br />l.cnifythrrinrhc0crio!ronceolrhcNo f{n shi.h rhn rt nir is hsucd- I \hrll tror cmlloy rny pc on ir ril tr1ttrncr
<br />s shtEconE suhF{r lo rhd {o&.s .on'rc.qr i.r ld{s ofc{litunir,,nd r8mlhr ill rhouB bc( t{bid Iolhc
<br />workcn comncnsrrion pr'lhions olsccriM 1700oilhc Llktr Codr.I $ill,lodh{irh coarPly Nirh rho$ F)visions
<br />WARNING r.ilurc to wnrc w(rkc6 ..mr.nsxrk .ovcm8c is unla$iul- rnd \h ll sdhjccr (n cDPlolcr t, rininal Pcialrics aM
<br />b om hundred rhousand doll$\ ($lu).fi]o). ir .ddili,,n r{' rh. .o{ or.o mi)cnslrion. dadas.s ns rmviJcd lor lhc
<br />Sc.rtr[:]016.t th. Lrtx, Codc. i'n.rc{ add
<br />- oq -oq-\6 ^ur,,.,,
<br />])I(].l-B -II]]
<br />I hcrebyaffimx.df pcMnyolpctjury lnar l.u liens.d xndcr ptuvisbn olChadd 9l.onnrNins wilh ScLlion 7(xl0) 'fDivGion I
<br />of rhc Busincsssnd PmL$io.sCodc, aDd my liccnsc is infxllfoda cffcct.
<br />qo z\ cb
<br />IaASIIJJCIIONIINDINC.ACE!1;]
<br />I hcrcby imi,nu cr Irnally ol pcrjury rhd rh.rc n 0on{nrcrion bdin!ascn.y rd Ihc Pcrrinnrncc orrhc work lirrNhichrht Fmir is
<br />issu.d (Sd. llr7. Civ C.)
<br />APPI ICANTDFCI ARATION
<br />I h.rr5y ufid und.r li.naXy ol pcrnry orc ot rhc tollo*i.B delrarionsl
<br />Dcnnlition Pcrmih Asbcdoi Norin. ion atdcrul Rcsullr iqF tTnlc &. P,n6r
<br />-Rcquircd
<br />lrricr ot Norifi .ari,n
<br />-l
<br />ccnilyrh r rhc Ld.flI rcAulal ion{ EArdi',g a\h.nos r.nmvll c nor apllicrbL b rhis pft}cct.
<br />l.cnilirhd I harc rcldrhi\ r,,pli.arn aM nrlcrhd rlEnlrvc inronndn h corccr l0sre bco PlysilhallCirvrnd Cou t
<br />Ddindrccs $J Slnlc L!w\rhring hxrld ir8 cofl{dcl ior. ud hcrcbyldhonzc toprcsctrhlivcs.frhisC yrnd Countylocnlcrtlonrhc
<br />.tniv. mcnlion d rnrp.n, ior
<br />\A/Ye Jot>
<br />*", p3-1\ 4
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lation
<br />Flool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL b?b-7e1'I *Jl$t
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />t\
<br />-e4 t?,>=>.=r-=>-z
<br />--Y
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