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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />I
<br />Roof Sheathino 1l.tAIril,'r-rJflll)
<br />Shear Wall I
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />/..,\
<br />FINAL 7-71-l(tt)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DFJI-CARATION
<br />I hcrchy ,ltnm undcr p.n.lly ol rrjury l har t dr cicnpr fron rh. Grnart,^ Ltcn* ti* lor rhc inlb*in8 rciinn r s,Y ro ! r (
<br />lrusirrs and Pdtsn,n Codc): An, Ciry or Counry *hich rcqrnc{ . fcirn ro con(tu(l- 5llcr, i'npovc. d.'nolhh or rcrrn rny
<br />srrucrurc. p.itrlo irs tsuancc. rl$ r.quircs rhr lpDlicnd lor\u.h lE.ini h filc tr siBmd slrrcnf,ir rh,r h.or shc is liccn{d PuFUanl
<br />ro rhc l,rovisiom orrh. Contractols tj.cnrd L!* (Chlplcr 9. Connnc .in! *irh Scciion 70(l) of Divhioi 3 of rh. 3u\incss rnd
<br />Pmt!sionsConc)orrhrr hcorshc iscrcipi rh.'rlio'nrnd rh.btrsiq fd lhc trllcgcd cxcnrprion Anyvnl ionofsc.lion?0:ll5t'yuny
<br />.prlic.nr aoru pcnnir $bjccrslhc rypliconr ro !cililpoalryoaoor ntn.rhrn nvc hutrdrcddoll.r\ l$5&)
<br />I. rs o$no or rh. pmFd y. or my cnrtnoyccs wilh wuScs $ thct slc .oi1pciuriotr. will do rh. wo.t nnd lhc slnrclfc i\ ton
<br />inrc lcd or .lT.rcd lor elc ( Se.?044. Busim$ and Profc$ions Cod. l h. Coftacror s Liccnse u* {hcs nor rPply ro an osftr .i
<br />rhcpmp.ny Nrm huild\ or inrrmvcs rh.ft\nr. nfrlwho dfts such rb* hinN.ll or icrcllor rhdAh hi\ or hcr own cnrll,'yc$.
<br />proridcd rhat luch inDrotcmnk re mr inrendcd or oflcrcd for sak ll h.wcw. rhc tliklir8 .. irwovcnrnr i\ $ld within onc Flr
<br />ofc.nthrin.tlf,OwncrBur.rwillh0vcrfubudcnolproirsthirheordEdidn.rhuildornlll)ro\trnepmPcnyfo'rtf,Pu'l,scof
<br />l.asoPrcrolthcpror'.rry.r'ncxclu\ivcly.ontr.rin8snhliccn\rdcontNonroon{n'crrhcPnFr(Sc.70{.3umcrs
<br />dnd tbLs\ni C.dc th.C.rrmctor's Liccn\.l.rq docs nor ltplyt, rno*ncroftopcdywhtr huildror irPovc\rh.rc.n
<br />and *ho onrracr \ tor \!ch pmids wirh s C{,.trknG) lt.n'd pur\uinrrilhcConlra.l{n i t,ic.n\d liw).
<br />-l
<br />rmcxcDrlr un{lcr Scrio
<br />Dor.: O*&r
<br />wonxrns' ttnrirL.r.s,rrrotr
<br />D[CLd3 UqN
<br />I hcrcby rllirD trtrdcr pcnrllyolpcrjrry.nc of rhc foll.si.g.lc.l*trri(rtr:
<br />-!
<br />hatr 0.dwill nEinrain !Cenificlrcofconrnri. s.lali\!r. r.r wo,kcs lannp.nsltion.,s pr.vid.d forbysNthn 171x)oIrhc
<br />kt r Codc- rbrlhc Dcrlormnccotrhc sorl rorwhichrhe Fmir ir is\x.d.
<br />_lhrvcrnd*illn i' Jinsorkc^-ron1r \rhotr nr\urdRc. r\ (qtrirci 6yS. i{,n 17(X)ofrhr t-rtw Codc. iorrhc Pcrfonm.c of
<br />rhc $orl nn $hich rhi\Fnniri\ i\\ucd Myso.kcn comNtrsdiotr inntrrrcrcrnicr Jxl nrynu rbc!dc:
<br />4.+*1e- C*.i -
<br />r,",,",q lLI lijLt t*1-iq
<br />I
<br />lcnrryrhrr rhc PtrLnmrccofrhc sqt for *hichrhis p.rn,ir ir i*trcd.l \hnllnor cmPl(iy rny Pcron inany mMtur
<br />c) ns ro htcom subjcd r,' rhc wd c(.. rt trs rr hwsof(lrlifonrin. ini ryrcerh3r ifl sbuld b..o'ft sub.rc.r rolhc
<br />*oder con]Pcnsrion povisn,n\ olSt.ri(,lTlX)ofrhc ljtsr (hdc.l shdl. fonh*irh comtl, wirh rh.s rmvnions
<br />WARNING: lr.rlurc to surc sor(cn co'l|{nurnm .o!crl3. i\ uflrslul. 0trd \hrll su},jccr 3n cnPi,ycr k, rininrl Fnnhrs !.d
<br />isarn,n. d, recs rs rmvided nn lhc
<br />Itr xtrCod.. i' cr.n rndrrttrioy r
<br />I hcr.by rflnnr uidcr |Enrlry ol |trjury rhnr I rm liatrrn undcr ro\ tnni ofclrp(d 9 (.omtfEirr! lirh S.crin ?(xxr)olD'!i\id 1
<br />of rhc B!\i',r\\ md Prutcr\n,sCodc. r nry li.cns. is in lulllnr.c kl.ll.cr
<br />1 I
<br />CAI TBIEIIIJNIINIIATi.ACENI}
<br />I hcEby,fllrm umrd lcnrlty of p.rjury rh3r rhsc i\ r d,n{tucri{,n lcndn8 Jecfty for rh. nct,onuncc orilt *.* lor rhich rhh pctn,il h
<br />ksucd (sc. l(r97.ci!. c ).
<br />ATTLICANLDEIIA&IIII]N
<br />I trrlbt rfinn uid.r Fmlry or pcrjury om olrhc bllosin8 dcclarlrbns
<br />Dcm,lni(,n Pcrnn\ Ash.{os Nolificition frcdcril Rc8ularions Ilirlc.1{). Prn6)
<br />R.qun d brrd ofNotificition
<br />I.cn'lirh r lhruc rcnd r[isrrip]allnrr darcrhrrrhcrh)vc i',1(nn n r is.onc.l I a8re lo $
<br />snrhoizc rcFrcscnlolivc! of lhi\.rdnrn ctand Srrrc trws rclitirAro
<br />rlxnr nrnri{rr nn)|{nyi'r irl
<br />14*-ir"" ",-" rn,i,,rr L.NiTLA%
<br />nrply wirh rllCiryitrd C.unry
<br />C,yanJ Cuu yro cnra F ,rhc
<br />,db\tb
<br />)Iil!&)
<br />Set Backs
<br />Sublloor/VenVl nsulation
<br />Ext./lnt. Lath
<br />V"*"*- 0-E\F,"ltu1t6
<br />t,1,r1'. \,ti'"..
<br />-l
<br />ccnilyrhrl lhc ltd.ra I resu ld i{nr ftlndi'rg dsb.(os rcm)vxlMc nol q'|rlicnhlc n' rhi\ In,l.rr
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