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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDiSIG.COMMENTS OWNER DUII,DER DT,LCARAToN
<br />I h.rcby rl6rn undcr n nally oi pcrjury rhd I lnr cxcq)l fmnr lhc (tNacnnc Liccnsc tiw hr lhc rbllowin8.cu$n lscc703r.5
<br />Busilrcss nnl Pn'r.srn,n Cod.) Any Ciry Dr Coutrry rhicn Equncs r Fmir t, mnn rr. rlrcr. in,prolc. dcmlGh or klrt rny
<br />strucrurc. nriorlo,is isuarcc. !|rc rcqutcsrhc arpli.rnr n, su.hltnnirro nlc r si8ftd sldcnEnr thrr h.or shr k li.cnsd nusurtrl
<br />ro lhc phvhioi\ ofttr Conrr.ror's l-ic.i\cd lj* lch3lrcr 9. Cohmncina wirh Sc.rn,. 70fi) of Dilhi.n I of rhc ausinc\s ond
<br />PnLssions Codc) o. lhrr hcorshc iscxcnpr rrf,r.rr.'n dnd rhc l,aris ror rhc allclcd cronp'ion. Any viol i.tr olsction?03l5 hr rny
<br />lprrlicaNnnapci'nitsu$jNkrhc.mlicanlroa.ivilpcMktorflornucrhannvchutrdrcddoll.r(Sslx)).
<br />-1.
<br />ns .wmr or
<br />'h.
<br />pioFdy. or nry .n1l)luyrcr wirn slscs rs rhcn sh .o'nPtn$rn,n. *ill do $. wor* dnd rh. (Mm ir n.r
<br />i' cxlcd orolTcB, for qlc (Sa 7(,,1-t. Busim$und Prcfcstuns Crtc The Cotulcroi s Liccnsc lrwdocsn.r amlyt',no*mror
<br />rhc nmtrny wh, huilds or i'np'!v.s drh[ md wlx, d@\ $ch w)rl hi'n\clf or hc^c li or rhlongh hh or h.r own c pbrccs.
<br />pmvidcd rh3r u.h impnrcmnts aE mt inrcndd n offcrcil for $k ll. how.rtr. rhc huildirt or iqmvcnbnr h sld wirhin .m Jer
<br />oionlphtion. tlf Osncr Buildd will hrrc rtE burdcn ofptulin! rlllr h. or sh. dii fr, hoi}l or ingftw rhj ftuIdt ft" rhc ,rr|bs of
<br />-1,
<br />nsowtrcr oflhc pmpcny. amcrclusilclycont,.rir18 sirh I iccn*d .o I ri.lon to d,.(rucllhc lnjcd (Sa 7ur4. Buiirc$
<br />iM lhlf*sbn Codc: 'l hc Contrctx ! Li.cnsc l:N doc\ nol npl,ly ro !n o*ncr olpropcny *h(,l'uilds or inptuvcs rh.r.oi.
<br />aod who.onhcrsro,su.hpojecrrwnh!ConrEchnrli.cnscJpurunr'orhcC.nrd.lsl-iccn*ljs)
<br />-l
<br />mcicmpt undcr SElion-. B &PC forlhhrc0son
<br />Dater Ownerl
<br />IvQBxEB.StloMtENSlrtoN
<br />ull;!,ltBAlra!
<br />I herchy aflnm undcr DcmlryotFrju.y om ofrhc hlk,wir8 d(hnriotrsl
<br />-l
<br />hrv. uxl will mrinr0ir r Ccniic.rcoiConscnr b scltlNurc lnl works{ $mpctrs.lion. ns pnrvi.lcd r'o, byScclion lTlrO olrhc
<br />btxrCodc, nrrhc Fr|rmin.. of rlr wort for whi.hrhcpdhir h is\u.d
<br />jdf *o *'u.".ot.**cn comrcnsrrion insurancc. rs rcqnrcd h, sccrion.rTtx) orrhc l.lhor codc- nr rh. l).rr(trmte or
<br />t\.tr'IfnNhhhlti.I]emir'\trq.{Vy*n.loilnrnnctrqt\rn}urrrcc,nrrDrdF,lr)numtrrc
<br />,.,,",". lr';2il -l,a.c,r-2zr-DcD 7D ,r -7'/-/7
<br />I..nity rhr fi rhc Frfor@n.c ofrhc wort for which rhis p€nnir is h\rcd. I shullnor cq)n,y any r.rson in 0ny nunNt
<br />n) $ k, bco,nc {rb]cct b thc workas onDcnsdion hws.rcrli,nmir. dnd agrcc thtrt ifl (lEuld b.ronf, sunjd kr rlr
<br />sorkd^' conlansoli,,n pDrhions of Sr.-r ion 3'70() ol thc li&, Gxlc, I $rll. Ion h*irh dnnply wirh rtx'{ pmri\i,nr
<br />IYARNIN(; F,iiur. ro {.xrc work rJ.onDcnsarihn.ov.rdsc ir Dtrhwlirl. a d slfill {rhici atr cmth}tr lo dimMl pcdrics ond
<br />cNil finc\ Ul) ro om hundrcd lhuusand doll.s (Sl(x).lXX)i d.lnnnr ro rhc .os ol cotrrt'.nerion, danm8cs os trovidcd hr rhc
<br />of rhc bh, cdlc. inrcrcsr aM r onf,r\d4_
<br />DICI.ABAUQN
<br />I hercby6mrmund.r pnalry oa r.rjuly ttut I lnr liens.d und.r pmvhio, orChqrn 9(comnf,rcin8 wilh Sdiotr 7()()l, olDivnion.l
<br />ol rlr Busnr* d Ptufcsions Cod.. aid my li..ns. h in tuu for.. dJil.lf..l.
<br />c--24 t/
<br />l\
<br />SJNIIAUSIQN"LENIIINJ;.AIiINCI
<br />I hcrcl,y aifirmundcr pcnrlry oi pcrjury th.r lherc is a cotrsrucrhn Lndins a8crc) lorlnc nr.lnmncc orrhe *o'k ror whi.h rhi\ Fmrir Lr
<br />isncJ (Scc 1097, Civ C.).
<br />AIILICANLPECI.Af,AUA!
<br />I H,y o]Im under p.ntrhy ol pcrjuy onc oiltu lohwing d.clmrions:
<br />Ixmlii,on Pcrmih Ash.(os Norilicdion Fed$al Reguldlions (Tirlc 40, P{d6)
<br />Rcqun.d hrlcr of No.ifmlion
<br />/-l rcn rry rhar rh. fcdsol rcFU bri.n. rcelrdhg .\treo\ fr rvJl xr rn' drplr$lc r. rhn pmlcd
<br />-l
<br />ccnilirhot I hi$ rc{drht opplic nrn ntrd (rrclhd rhc{tnvc inlnrn ioiscoEccr lo8rLrloonrplyrirhallCirylndCoriry
<br />ordininccs and Sklc tiwsrchin8 r)irs con(nErion. iM hcrcbyournorize reprcsenl.lir\ oirhis Ciry and Counryb.nrcr ulx)nrhc
<br />itl]rc trEtrti(rrd lbpcny d
<br />iDpli$nl o. la€trt siaDrlore antu
<br />()I ^,"*-3'tt'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Shealhinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />!'lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif .
<br />-\
<br />FINAL ?20 t9 ,ffdz',
<br />Certif icate of Occu pancy
<br />Notes Remarks tc//lzo
<br />'z-
<br />Sublloor/Vent/l nsulation
<br />"",", *'3-/k ...,."",.#
<br />l. Jcr \ \Jd.{
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