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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNDR BUII,DER DEI,CAIIATION
<br />I hcrcl,r rm.n uDdcr Fnalr, (,rp.rjury rhd I M cxcnpr rmm rhc coitr.ttrr Licc.\. Ltrw fo. rhc follouin8,cr$n (Sc.7o.ll5
<br />Buslncs aid Po&\sioi C.dc): Aiy cny r C.unry *hi.h rcqutd d lrrnii ro (,rtiflr.t. ilrcr. iqrrovc- d.nnli\h or Eron sn!
<br />ntu.rur.. p'n !, ir\ irsu$.., !l$ rcquncs lhcapplicdtrr for su.h tiiinir to lilc ! siSncd stutcmnr lhar h.or shd ir liccnrd N*urnr
<br />ro rl.{ ptr,vi\i,rF ol'rhc Cortaddar l-iltnscd ltrw (Chapic' 9. C.'nftn.iig qnh Sc.rion 7{Xt) of Dilkion ] oa rhc Busincs lnd
<br />Pdasons Cod.)orrhnrh.orshc iscxcrrfl rhcrcfrom.M thc hnsis lorthcnllcscdcxcnrnrion. Anyvi.hrion.fS..ri{ 70ll.5DyrDy
<br />l|plicitrt lor. pcnnit suhj(ls lhc appliunlro !civilpcnrhyolnol nnncrhrn riv. huidr.d dolla6 (s5m).
<br />I. o$ncrorrh.pn)p.ny.or tr1ycnldoyes wilh w.tcsa\rtuir R,lc .onrJ^-tr$rion. willdo lhc{. xndrh.irtrrni{to{
<br />i cd.{ or oficrcd tu {alc ( Ss TOl4. Busincs lnd LYonsi,,N CoJc 'I h. Cotrtr.ioi \ l-icc.sc L a docs nor rpflr lo !n o$ncr or
<br />rhcpm|fn! shobuild\orinp vd Ih.rsn. fil ah d&\ sach sd{ hnn$lf or hcrrll or rhn'ugh hk or hcr o*n cnrrl,)ycc\.
<br />Dnvidcdihd such inrtoEmnhftftn inrcnd.d ff oflcEd lnr$le lr. ho*cvcirlt buiklirB or irnt,mrcrrcnr i\ nnd Niihi'rotrt Flr
<br />oa.on{l.tiod.rlrOw..rau*tclwillh0vclhchurdcnofprovirBrhlthcorshcd rort ild or i'iprn!. rhc ln)lEly for rh. Purlbcof
<br />-1.
<br />is owncr.l rhc F)pcnx 0mexclusivclyconrraclins *irh liccn*d .ontactB u .on{fl.t rh.0roiccr (Scc 7o1t. Busincs\
<br />un [\I,f*ir Codcr Th. Conta.kn s Liccn* Lrq dms nor rtply lo !nowNr oll)ropcny who builds or improvcs rhcrco.,
<br />lnd sho conrrrh lor slch preFcrs sirh a C-nincro(n liccnsd !ur\u,nr brhc Contickr\ Li.cnsc t w).
<br />-l
<br />amcrcmpl undcr S$rio
<br />llraK[8sillufENra.uoN
<br />DECLARATIoN
<br />I hcrc6y affiirnunder l).n0lryofpcrjlrronc ofrhc tulh*ins dcchrarionr:
<br />-l,rvcand
<br />* ill roirhin a Ccnificlrc ol Concnr r. sell lislrc lnr wo dr .onwc.qriotr. 0r pmvidcd lorhySccrknr 1700orrhc
<br />hb.r Codc, ntrthcp.rformamcolthe wod{ inwhich rhe Nrnril is isslcd
<br />-l
<br />h6rc ard *illmainrain rut.^' co'np.nsarnnr nNutuicc. r\ mqxncdhysNrionl7(xlollhelitorCodc.forrh.Paf.flrtrr.coI
<br />irsucd Mywork.r' c.n|,!d\dn insurrD.c.rricr rnrl|l,|]cy DUarbcr rc
<br />\.\.\?:9il\r\rc or 9 ,
<br />Ic. iryrr'rr rhct).ri.nn.rccolrhcworklnr$hi.hlhi{pcflniri\irsucd.I\hrllnorcndoyrtry!cr{ inrtrynxrrcr
<br />sr s ra hccornc sh,ccr ro rhcw c^ cotrlpcnsnrion hs\ or Cllirorni,. ntul .!rc llul il l \hould hccom {lbjcd b drc
<br />*orkcG' onrncn\al ion pm! i\n,n\ of Sccr ion .l?m of rh. tjb(r c(xt . I \hll. latrh$ir[ .unpl, $]rh lhos Ptri!i\i,)n\
<br />WARNIN(;: Iirilurc tu e.urc w.rkcrs co rNnsnri(rr covcrr8c is unlirful- ! \hall {rhj.cr ar! cmpk,$r r. airnnrlFnrlri.s and
<br />.ivil li'rs up b.nc hundrcd rlDusand Jolln6 lsl(xr.ulor. ir nddilnnr l. rh. co{ or .onln.nstrrn,r. d..mscs rs Proridcd lbr rhc
<br />Sccrion 1076ofrh. bh.r Codc. irtcrcn.nd lllorrcy s ltcs
<br />-,"l{JG 0 L2010
<br />DEIIdBAIION
<br />I lErcby aiirnrundcr p.MlryofF,ju,y lh{r l.n liccncd ll\4cr pmvkior.rChrlrn 9l.onnNncir8 wilh Sc.rion 7O{D) ofDi!hn,r:l
<br />or rh.8u\rfts Md Pmrc$?t'odq and mylicen* h in turr Inrc
<br />'nd
<br />effccr
<br />\ oo+? "r 't
<br />,"," AIJ t{-"4rner.-
<br />AIILICANLDECI,ASAIIQN
<br />I hcrcl,yolrnnu cr lenulry of Frjur, oE or rhc rollowina d hrnrions
<br />Dcfrrlli.. Pcnnik-Ashcslos Norificdion Fcdcml RcBulntions (Tnt 411- Pan6)
<br />Roquirl{ tdd of Notifi carion
<br />ll!cr'l) rhr rh" '.dc'nlr-sdl,rtr r\ " rrd'nF J\h.i,\ '. nnrlr' r,{.'lr".,hLc !.rhr n oi".r
<br />u/t-"*r,",,t*^..,nrilnlEdiotrrnrn.rhd,,hcrholcint,nurioni\core!.Ir8iab.omplysihelrc,rnd(i,!nry
<br />odiDnmcs ond slatc Lrws alalins lo 6uiUn,r con(rucrion. lnd lrrchy rorhorir. rrPr.*nrdrivcs olrhh Cirylnd Cour, io cnid ufx,n rhc
<br />nho\r nrnriondJ proFny nn inspc.lion
<br />ADDlicinl orArdlSirnnlure
<br />e\1 Prt,t irili i0 E ?018
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq x/6/rv ia66
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Ceftif
<br />FINAL f/lzt\tfl t -.4, /)"tl*-{u, ,/,/,aAie /
<br />Certificate ol Occupancy /
<br />Notes, Remarks, Etc.
<br />CONIIBI]CIION.LINDTNI;.{GENIjI
<br />I h.fthyatfirnund.rlennxyofFrjurylhir lhcrc is,conslruclion lc nrs rscncy for rh. lcrronnrrcc orihc work lor which lhis pcrm n
<br />issued (Sec.3097.Civ C I
<br />I.nd.i. N. r
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<br />trnrlci\ Addrcs
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<br />Sublloor/Vent/l nsulation
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