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BUILDING- INSPECTOR RECORD
<br />SITE.WORK .DATE ID/SIG.COMMENTS OWNER BUILI'ER DELCARATION
<br />I hcrhy alfinn undcr prorlry ,rf pcrj0ry rhrr t ar crcorr lon rhc Conkri{tri l.kcnr b* hr rhl L,ll.sir8 rctrsotr (Sci 10.11.5
<br />Busincsr rnd Ptufcs\n,n C.dc) A.y Ciry or Cou ry vhi.h rcqutcs d F,ann ro .on{rucr. rlrcr, imDmvc. d.rnolish n cNn any
<br />(turrurc. Fiorro its i\uncc. rho rcqut \ rhc lptliflnr in n'ch pcrmir ro filc r r igicd drrc'tunr rhd lf or shc h liccnsc lusui.r
<br />ro lhc F,vni.ns ol rtu C.nrracnni t-iccnscd l,a* (Ch!flcr r). Connncncing wilh Sccrion 7(Nlr ot Divi\ion :l of rhc ausinc$ rnd
<br />Pn)fc\sn,nsCode)orrhrr hcorsh. is.rci1Pr rhcrcfromrnd rhc b \is tu.rh. illctcd cxcnrrrion. Atry viohtim ol Sccli(,n 70.1I 5 h, rny
<br />aprlicrnr for r lcnnir {uhl(hrh. dtlli.rnlro !civillctrxhyornornlmrhntr lirc hundrcn dollff\ (S5(xr)
<br />-1.
<br />ns otrNr ol rhc rol)cny. orrrcmpkryccs with wascs trs rhct n)lcdnnB.nsulion- *illdo rlB work a,tl Ihc ntr(uc ir trur
<br />inrcidcJ or olicrcd for slc lsd 704{. Bu\inc$ i J Profcsinn Cdlc 'lh. Grnra.rois l-icctr{ trs docs trot iptly ro rn o{ncr oi
<br />rhc propcny who huild\ or impmlcs rhcm.. aJi sho dms srh $ork hi'nscli.r hcr{lfor rhmulh ht or hcr osncnpkJyc.\.
<br />oiconDlcrinr. rhc o*ncr Buildcr uill hrtc rhc l,ur(lcn ol provn[ lh.r ltr or shc di] nn huild or impmv. rh. ropcny rhr rhc rutht or
<br />l.rsowncrollhcnmp.ny.anrc(lu\n?ly.onrrrding$lrhl(cn\ci.ont!.ror\ticotrntodrh.tr,,j.crlSc.7(B.l.Bu{trc!!
<br />rtrdth'rs\hiCodc:ThcCotrkr.k(-\Li.cn\cl-nudoc\i.rrpplyhrno*$of|m)|tytrh(ihuild\o,tnptrnr!rhcrcotr
<br />rn,l who cotrhd\tnrsu.h pr,!cr\ wirl,aCo n'.n,ns) 1i.ctr\cn ltrsur r'rh.(i)ntr.ktr'\ l-ic.i\c Lns)
<br />I rn.x.D,,, trn(ll' Sd.r
<br />-?/z+1tr
<br />I hcrrhyrllirDtrtr crncit'lry.1tr4trryotrc.lih.li,lk)Biig
<br />lhrrcMdqill rnairrCcdrfic colConsctrrr' Sclf l'trurc frtr $nrkcN.o rxn\ ion.0stroridcdli,r6yScciion.lTlx)olrhc
<br />Lrlxtr Q)d.. lnr r hc l[rroirn i..olrhd work fdwhi.h rh. prmir i\ i\stcd
<br />-l
<br />hNrand qillnni .irEork.s con'ncr$tn'n innmncc. N r.qnncd byScdi.n.lT(x)ofrhc Lrh.r Codc. for Ihc pcrronrtrtc or
<br />Ihc Lvorl lorwhichrnir pcnnir is isucd My workcB .DnDc.\dion irFrnmcc.{rklu [nicy nunrhcr arc
<br />Poli.y Nunrhcr
<br />lcdifrihtrr i'rrhc|xrfonnJnccorihcsorkturtrhichrhn|}cirnir i\ i\\ucd,I \hxll orcnlllo:-rtryfc's irrtryn Dncr
<br />$r\l',hL\onc{bjcdn)rhcwor[cr'con]pcnsdiorld$olCrlrroanr.udrtrccrhrlill!honl(!hcconf,\uhjccrt,rrt
<br />s.rkc,{.oDlrn\dnrtrovti.n\ iSe.rir lTotr frh. t-.hr Cud.,l dDll. $n[wirh.onrnlt *irh rho{ pmvisi,nr\
<br />\tARNINC l:rilu.c n) r.trrc *orkc^ con,Fnsxri(in.ovctug. is unh*1iil. rnd \hrll {rhjccr ri ci,pk,ycr ro dimnlill.mlri.s rrri
<br />sc.ri(r, 1!1J6,'l rfu l.rktrc.Jc i'rcrcd r
<br />?l74ltY
<br />tr.( t, \t( \ r Io\
<br />I h.r.hy rllirn nfdcr Btru ryof t).rjury rhir I In li..ndcr prniliur of( hrpicr I (conn,Encing silh Sccri('n 7(XX))ol Drrisidr l
<br />ol rlE Busircss rnd Pn,fcs\i.rc Codc. mylicctr\c i\ ir full hrcc rxlcllccl
<br />IONIIXI]CII9ILLI;NI2INIi.dGEN(I
<br />I hcnhy rnnnxndcrFnrlryorFrjuryrh ihcrc i\ncon(fl.tion LtulingA[cmy ntrihc Frloanimc oi lhc suk lnr *hichrlis pcnnir is
<br />nsucd (Se. 1097. Civ C )
<br />alfulLliul[tl,llaAllo!
<br />I lulby fin r!lll]$ $ rlry.r ltrttrrv otrc.l thc li)ll,)tr rg rl.ch'drnn\
<br />Dcm,lirn,n l'].nnir\ Ash.sos Norili.rr n Fcdcrrl Rrgrhrnr\ (Tirlc J0. Pt!r6r
<br />RcquncJ t.cttrorNorili. r(r
<br />lrcnilyrn rh.li(lcn'lrcrtrl i,)tr\ !rArnlir! rsl{{o!rnr*ilr'. n.rqrdrrhlc r, rhn p'{it.r
<br />rrh.xhr. i',ktrnn.o ^coft.(r I rF.rr)tunolyrirhr l(-iryx (,n j_
<br />rchy trrh.rnc rDcscrrnrrcc ofllri{ Cily rtrd Counlyt, cnr.. uflr rh.
<br />lr.nilr 'h lhJ\r rrrlrhn,,nFl,rl' ntrr. l\', r I: u. khrf,rr'
<br />.'hi\c nnri nl n',,n'r\ t,,rl'F.r
<br />rpnti.onr..
<br />^g"nr
<br />sig,Lzr
<br />PemirN nsm€ rpritrrr'12
<br />,'",.,-7f2tt/lV
<br />Set Backs
<br />Erection Pads
<br />SLAB Floor
<br />Subf Ioor/VenVl nsu lation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />[/]aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />E ngineer Final Report
<br />Flood Zone Certif
<br />FINAL 5'tc'r1 'Pez')
<br />Certif icate of Occu pancy
<br />Notes, Remarks, Etc
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />Brown Coat
<br />n)ag.(fe-N
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