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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.'COM,I/IENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loorA/enVlnsulation <br />Roof Sheathin s <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Qgputy Final Report <br />E ngineer Final Report <br />Flood Zone Certif <br />A <br />AFINAL?/zo/r0 .,/"v <br />Notes , Remarks, Etc 7 <br />OWNER BU!LDER DE!('ARATION <br />I h6q.rm u..lq Fnalr, or pajury thd I m.rmPl nrm $. Conm.rou' lr.n* Llw tor rh. followin8 iasn (5(.7031.5 <br />Buin6 rn Ptof6lion Co&) Ary Cny or CN! y Bhah t.qui6 . rEni lo connrud. sns. ihprov.. &rclirh or GFit 6t <br />o\.t@, Fn. <br />'o <br />!r. i!se.,.k rcquic tlr +plt n for kh Fnir ro 6l. ! ris..d ctal6 lhrltordEi!lkos.d FEd <br />lo rk ForirioE orlh Conlr.ctd! Li.cnr.{ Lw (CIEF. 9. Coffius wnh Sdrion 7(100 of t)lvilbn I of rh. A6a.d ed <br />Prcf.si..! cod.) or rhar lE or rh. i. qnfl lh6.Iior !d fic tsis lor rh. .ll.s.d qdFio. any riol.lion of V!1i.n ?011.5 b, !n, <br />.pplicel for ! Fmn lbjclr lh. .prlicul to . civil p.Elty o f mt mrc tns fiv€ hun&.d dolbs (1500) <br />_1. a ow oldE FoFir, d Ey.npbr6 *ih srg6 6 fi.ir $h onFdion. rilldo tlE f,at rd tlE didE a d <br />iirq'd.d o.offsld lor slc (Sa ?0t21. Buir6 Ed Prot6ioE Cod.: T1'. ( odr.dr't l{de t r'4€ml tppl,teoffol <br />lh. rn,Fly wno hril.h o. ioF!6llEaq .Dd who &€ rEt wlt fiir*lf or h@lt or rhrouah hn or hd om.mploy6. <br />provirLd thi r.h imFltEfu e mr ii.rddl dolH 6. sL. Il how. tlE hlities or rry$-oEr i! $ld vthn m,* <br />ofNnplrno.lrE (xc &ilb wil lhr E hdc! ofFrng dr tEd JE dil d blild d in$.sr <br />'lE FoFiy for E Flpo-of <br />L a ow of rh. FoFty, m dclNnrly conrdine wirh licas.d co.rr.doB io oBlrucr ttr F!j6r (SE. ?04!. tl6De <br />d ho6si CoJ. Ih.C6 n.tor't Lic6* L* dos 't et,ly lo d o*nd oaFoFry sho bu,LL o. ingN6 rh.on. <br />ud tr lE olndr an sh Foj.(! *ilh . Con*.(t l.au.d pl6@ ro rlE Conhdr'r lilg L.$). <br />I etr€r€mpr 0nd6 Sdnrr .lr. & l'a <br />I h6.tyltnmund6 pc..hy.tn€iuryon.otrh. tollosiru ddl dio <br />-l <br />hlrc rn sill di !i. . Cdifrd. of coMt lo S.lf-lBur. for wl6 @mp.nt 'oq a proriLd for br S6lb. 11700 orltt <br />t hr Codc fd rh. Ff M.ofrh.surtur'tihrh Fmn bi$.d <br />_l h.r.od wiu dlinGio ,o*.n' cofrF. ion iBu!nc., 6 rcqutcd hy Sdnon 17tu 6l rh. kbor (ild., aor rh. FfomMc. of <br />rh. srl fo. *hi.h rht Fon ir i{u.d. My wo 6i .omFGlrio. icur4..nir atul p.licy.rnbd ft <br />Policy N@ba:_Erpn6l <br />I Giiry th, ir lh. Ffolrmc of th. rorl ao. *lich <br />'ht D6hh is i]lal I snlll nn opb) ur Fe. id oy nl.ljE <br />$ arohe6tr.utdioth."rrt6 6rDFEii,. l,*r otcd'aomii a +rfiiif I$o!ldh<oE$b..llollE <br />uorl6' conpsu ion provnioB of Scrion 1700 otrh. t u)r Cod€. I ddl. fonhwirh omply *ilh rhoF ptuvisioB <br />wARNlNc: Fole lo su. mrta @npoBllion ovdasc is u.l.sful, ed slull .ubl..l s aploF to aini l FEhir dd <br />.ivil 6nd up ro oe hu.dEd tl'oN.d dollr! (ll()O-001)) <br />scrion 1076 ofrlE tlbor Codc dt6.n ..d .ndr.y-3 f6 <br />I hdrb, .rm uid6 Fuly of Fjury tL l 6 lico!.d u,'ds FDyiroi of cl!4l6 9 (o,rlj4irB whh setb. ?m)) of Dniin I <br />of rh. t ciIB !d PrcfdhE Co&. ad mr ltoe ir in lull forc. rn .lIB! <br />cQlilBululla.L[dull;lcEx(} <br />I @ lrm un&r Fuly ol Frw, lht rlEc ir . ol(ru.1bn ladlts .sdy for rlr FfolrrrlE of 0r s.l for {trh thi! Fri ii <br />i!.u.d (sd 1097. civ. c.) <br />A PPL'C ANT DFCLA R^ ION <br />I ho*y alfim un& p.n.Xy of Fjury oE ol tlE lolbwi,g d..LrdioN: <br />Doelnio. Pmne^ib<nor Ndrtr{ion F.ds.l R.sullrnd {Ti1..rc, Prd6) <br />R.quir.d t t!6 ba l'+orifi.dh. <br />- <br />I rdr ry rhd rh. f.ddd rcsuLr oc l!8edinB atGros rmrrd d. nor la,r,lrcabL to rh6 Foj.ll <br />-l <br />cdiry rhd I hAc iad rhn rlrlE.iion ai rn.rhd rh..b\. infotur)n 6 I r8ra ro onpt $nh .ll C } od Courry <br />rlrv6 ofrhG City Dd Co@ryro ord lpoo r&odimM6 snd S'dtl t,ss Ehl iI{ ro bu'lding <br />ah,v. rhdrion.d l(rmr r'or iNFlhn <br />.tppli..nr or.\8dr Slan.luF <br />,"-u*-..,0r^,' Ri o. <br />^,. /o-bl-ag <br />b..r <br />-T------