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BUILDING- INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BI'II-DER DELCARATION
<br />I hcrby rfl-rnn undcr Fnalry of pcrlur) rhar I am.rc,nnr frcn rhc Co.rrador' l,icci\c Lw fin rhc following rc!$n (Scc.?o:ll 5
<br />Busirc\s r.d Profcsion Codcl Any Cily or Coutrly which r.quiEs r ,trnnr ro ..nnnd. rltcr. imfmve. {lcnFlhh or rcrrn Jny
<br />{nrcturc. flntrro ils hsuancc, {ho rcqun srhcq, icrnt lar\uch lFrinir tu iilcn siBncd natcm lhar heor she h li..i*d tusuml
<br />Io rh. F,vnk,n\ ol rh. Conr0ctols Licetrrd Llw (Chlt'lcr S. Conrmcncing $irh Sd.rion 70lX) ol Division 3 .f lhc B!\incs ind
<br />Pmfesions C.dc ) or rhat hcorrhc i\eichpl rhcrcaom and rh.iEsis ior rhcalL8cdcxcmpt,.tr. AnyviohlionolS.cri(nr70rl5hytny
<br />appliclnr r'or ! F.mir subj(rsrhc appli.anr r. a.i!ilpc.rlrror.dr mft rhln lilc hundrcddolllF (55u))
<br />-l.NorrcrolrlEtir{,pcny.,na,ycn,
<br />oit.\*irhwtrgc\r\rh.nv,tuconrlatrrdi,nr.villd.rhcw.rkridrhcn r!toi'r(i
<br />icnd oroltarc lnr srlc (SN 10'14. Axsirc$ard Pmltr\ior\ (-.dc:'l hc Contrcttr \ Lic.n\c l;rw d.cs,rortrPplyr,rfosD.rot
<br />ihc pmpcny *h. huikts.r i'np'{)vcsrhc(nr. d qho e\ {rh lork hnnscll o, hcmdll orrhnn'ghhh or hcr owtr cnnlo\tN.
<br />.lcoDlrldi{lr. rhc Owmr Buiklcr *il1hr\r rh. builo olproviri! rh, hc o, shc lil n.r tuikl.r improlc rhc pR,!.t! Ior rh puqD{ol
<br />l. r\n*ncr ol rhc ftulcnt, ,r c\clusivcly coma.rir8 *irh li.cnrcd .onrrxcktrs h con{fl.(h. [,r].cl (Scc. ?(}1.1. llu\i(\
<br />rRl ftdirsion conc IhcConrnrttr s Li.rn\€ tr* d{f,\ norrpplth rowtrn oIflopcnywho tuildsor nnpror.\ thcrcon.
<br />rnd *ho conrru.(lar su.[ ttr.]r.rs wilh r CoNrcrn(s) li.crNcd pur rnlt)rh.Co t .kr \ l-i.cnsc l-n$).
<br />-l
<br />rmc\cnro unds Sc.ri{
<br />]laBru&l:g)ut i!.tAIIQx
<br />ITEILASAIION
<br />I lff.h! rltuni rfd$ Nnrlrt or|truyonc ollhc rollowirg dccliflli.rs:
<br />Ih'vcrmleilln inrxihaCcnill.dcofConscnrtuSclf.lrFurclorworl€^onp.nurion.n\!n)vid.dforbySccrionlT0Oofrhc
<br />ljhor Codc.litr rhc Frfon.M.. ofrh. *ol* forwhi.h rh. n .inir s issucd
<br />lhNcnRl willnrirnri. *or[cra .o'nncn\rii nNtrrnn.r. rs rcqun d hySc.ri(n]7Ix)olrhc l]&trCodc. f.rrhc &Ylrnnn.c ol
<br />rlE rvork li, whichlhis nc , trorkcrs con!f, trunnr nrn..rrcc cnnicr sfrl In,li.y numt'.r rc
<br />ItktllQko-rlto e.
<br />-lccnilrihJri',rh.pc.rrun..lrhc*rrtf(rshi.hrhr\tcnnirisi{{,c.l.l\hrllnorci\n(,trny|froni.nny'natrmr$ isn, h..om \uhjccr b rhc N.ik.rs .omncn$rion hss ol Crlilon,ix. rn{l rgtoc rhar ill durld hcco"E shjcd n, rhc
<br />workori .omFnsrrn lhvisions olSccrion:l7troolrhc l.nhtr (-lnlc.lshrll. lnnhuirh c.trroly sirh rhos !rcrhion\
<br />WARNIN(; I'rinnc b s.urc sorkd'\ .oilFnsrn .ovcrigc is nnl0$fin. aDd \hrll suhrc.r rn cnitl,,ycr b diDinnT lxnrhis rnd
<br />.ivil fincl u! rr .m hundE-rl rhon\rid do
<br />Ssrion.1076.lrnc bnn C,nc- inrcrcn and
<br />,",", 8)zz[te a
<br />X)), i..ddiriin h rh. con olcon,p.n\rrnni. dxnrgcs i\ rfuv
<br />I,EIId.BAI'ON
<br />I h.rht afinn trdd$ pcn.liyol pcrlnry rhrr I rm liencd under ro\hion nfChrprcr 9l.ommncirr8 wilh Sccrion ?(XXl) ot Drvisi.n l
<br />of rhc Businc$rtu Proic$ionscrdr. nnd iy lr.hc is n full f(r.c nndcl'lcci -'
<br />o C3 ---- d L^J 4t 4
<br />BI Irs
<br />caNSIIIJCIIONIENDINCTIQINI:I
<br />I hcabi all] nundcrpcnalryol!.qurrrhtrrrhcr.i\rcon\r crionk'dineigcncyhrlhcFni'rnunccotrhcwoikn,qhichrhnlEnnin
<br />t\\u.d rsc. tn?.cn ( l
<br />ATTIICANLDECI.AAAIIIJ!
<br />I rs.l,, ulIm ! ndcr p.ndlry or !.rjury onc olrhc f.llowin8 d6l.rationsl
<br />DcBririm Pcnnils-Astr(os Norificnrn n F.ddrl Reguhrn,nl (Tnb 4{, Pnn6)
<br />R.runcd lx .rol'Norificorion
<br />I cdilyrhd rhcfcdcr rcAullri{r\rc!ulingrs6r(o\rrnnnrlr'.norn )i.rbtnJrhi\proic.l
<br />-l.enif
<br />rhlr I hrvc lcrd rhis i( rnnrr drl.rhrr rlrnlt,!c rn)nmri,r n.omd I rgrccr)contl)ly*[hrllCirvitri (,n'nrv
<br />o inancc\ ind slrr.l,rN\ m
<br />ah,vc nrtrriinrd m)jrny fo
<br />ADplionl or AFenl Sienalu
<br />hrllln trr ..ninrridr ntr(lh.r.hy rulrrir rclllcscdrfl
<br />*.,.--?-v€<4L<
<br />t\ olnn\ (\rtxtrd Co rryni. nJrnrrlf,
<br />,,.'" Slze Jtq
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Su bf loo r/VenVlns u latio n
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Energy I 1l'16lnn \t \i)?) L ,r)
<br />Drywall -t I ur
<br />Ext./lnt. Lath
<br />Brown Coat
<br />IVasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL e[b[txf fu<tt,nr-rzn )
<br />Certiticate ol Occu nc
<br />Notes, Remarks, Etc.
<br />Shear Wall
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