|
BUILDING. INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.OWNI]R AUILDER I}ELCATA'TION
<br />I hcrcbyrflln utrd.i p.ndlry (,f l(rjurl, rttrt I m crcnpr itr,r lhc Conrrrct,r' t-iccn\. I:* fi, rhc lollo*itrE rclsrn (Sc.7llll.5
<br />llu\ircss a Pn)rcsi(r C-odc): Atry C[, .r Couniy which ruqonc. a Jf,nnir k, $nrrru.r, nlrc.. inrpii,vc. d.'nnnh or rq,rir any
<br />nn'cruE. nrirrio ir\ hsum.c. al$ rcqnncs lhc {pdi.nnr fn such Fnnir b lllc i nAtrcd e.lcmnr rhnl h. or shc ( lrcn\cd Nrsurnr
<br />to thc [ovisris oi rlr (hnifl.rofs l-ic.trscd ljw (Chrfld 9. C.hh.tuing wirh Sc.rnn ?(Xlo of Divi\ion :] of dr Bu\nr$ a
<br />Pn,rclsbn\Codc) orlhar tEor\hc iscrcnurr lhcrcfron0nd rhc hisi( for rhcnllc8cdcrcm0rion. AtryviohrionolSccrionTl):tl 5 hy.ny
<br />ifrlicrtrrf(rrr.fni\rbjkt\rlk.pplutrrbrcirilr.nlhyofnormorcrhrnfivchrndrddollJi(S5(l))
<br />1.,\ oRturorrtu pnincn!- o ny cnrpkDc\ {ilh wr!c\n\rhcir slccon,pcr\rrior. $illdo th:$ork d lh. \rmtr'E i\ nor
<br />ir cndcd or ollcicd Lr $lc r Sc. 7(}l,l. Btrsi'rcs .id Pmfc\\i,nN C,xlr 'rhc Co h.tn \ I jcisc I rw doG n.r xptly n, m owNr of
<br />ilrctnrpc y whobDildsorinpmvc\iltrof.indwhododrsu.hwn{hirnlcllorhcrrllorrhn)u8hhi\orhcrowtr.m!loFc..
<br />nn 'v idcd rhrr irh ND o\o.nh rn fin iNcndcd rr ol1.(l ntr wlc Il huLvcv.r, rhr htr1ldfl8 or imDovc rnr i\ sld sirhnr oN )ar
<br />ol..iILri,trr, rh({)*tur Buiucr qillhrvu rla hurtlcn olpmviq rhd lt or shc dil Dol huiu or nnpme rhc pn,Idy ttrrtx puqxrcoi
<br />l. o\rnu.rrhcpii,Idy,a.rcl!\ivclycontacrin!eirhli(rscd..nrra.r{r\h.onnfldrhcpmJecrlScc701.,r.3d\i,'.\\
<br />ind Pmli\sion Codc lhc (-otrlr0ciM s Lic.n\. Lrw(l')cr nor tplyioitrowmrofpm!.nywhohuild(orinrprovcsthcrcotr.rid who corrrucrslbrsuchproiclswirh0Conrracto(9licctrsd,r0ru.nrrorhcConhcrolsLiccnscl-rs).
<br />Irn,.rcNpr und.rSccrion_
<br />-,
<br />B & P.c. lbrrhi( rcinin
<br />rlBKti&llaNfrltallaN
<br />DECL3AAI]IJN
<br />I h.tubyrfii'nrofulq F.nrlrrolrcrjLtryoncolihctnlLrwirsdcclnrnriors
<br />-l
<br />hlvc lnd willMinlninrCcf,ificorcoiCon* ro Sclf.ltrulc r'or aorkcn co.wcnslrion. as lrovidcnlorhySslionlT(xroilhc
<br />Lnho Codc.lor rhc rcrlnirmkc olrhc work for which rhc|).nnir i\ issucd.
<br />lhr\crnd *illtrflinrrn, \orkrri c.n,rtr\rrion insu'rncc. r! rcqutud nySc.ri, lT(Xlofrhc lf,horCodr. f{rrhc lf,rfomuncc.l
<br />rh. *.rk fttrsh'chrh'\ p.nnir i\ n\unl Mv*.rkc^ .on,t!f\rri,)n in\urrmc.xris xtrd Frliry nr hcr rc:
<br />l..niry Ihrr nr rhc pcrformncc ofrhc wo fu shich rhi\ r.iinir h t\ucd. I shrll nor cmtn,y rny p.k,n in rnt mrnncr
<br />s, r\lo bcconr { F_rr.rl[workcrlconltrrsalionlrw!ofCrlilnrnia.indrgrcrlrrillshouldbccorrc\uh]ccllolltrso ctr' c.trrltrtr{r i(nr t,ovisbnr ol sccriotr :1700 ol rh. trbr cudc. I nrll, fodhwirh conr/y with rhosc |n ovhions
<br />WARNINGT hilurc k, rcurc sltrlc'r onpcnvlion corrrsc i\ urhslul r rhtrll \uhjc.r o c'nnl,'rcr b cri'ni'r] prMlri.\ rnd
<br />.lvil ,nrc\ trp lo.nc hundrcd rh.u\in,l (lolllA lSlL{).00)), in rdJinrn lo lhc co{ ofconrpcr\rri,trt. d,nr!.s rl pn)vid.d lor rh.
<br />S.crion :1076ol'rh. linranl. inrcn{rnd ormv s lic\
<br />,",..6'6-/r
<br />DECl,A.8AllOt
<br />I hcrcby.llirr uftcr !.n,lryoipcrjuryrhd I 0m li.ctrsdl undfi irolkotr orCh,prcr 9 (com,mncin8 *ith Scdion ?ftr)ofDivhion 3
<br />or lhe Busincs od Pofcsnrnl Codc, d my li.ers h in full torce lnd ctfa!
<br />tsA [, Fr 76r
<br />,,," e^ /4,r .-"*"4
<br />CONIiITIJCITIIIJ.ENDINIiICINCI
<br />I hcrcby rlitn utrdcr lEnrhyoip.rjuryrhd thcrc n a.onsfl.rbn lcndinS.gcrcy ior lhc rcrformrc oirhc wo.k tor shich rhn Frmir is
<br />i\\ucd (Scc .l{r97. Civ C )
<br />d.erug[uJEg.AxArq!
<br />I trrhy a,lid undcr Fmlrvol p.rjory om otrhc rollo*ins dcclarlrtfi:
<br />D.mlilion I'cflnih Ashc(os Nolificlri,,n Ftdcral Rquliliflr\ lTillc.r0, Pan6)
<br />_Rcqtrncd llrrcr or Nolillcrlion
<br />I..difyrlurrh.lcdcrrl ftgtrldions rcgiiding $t {or rchovdlr. nor ritli.nhlc t, rhie,rftrjcdt
<br />-l
<br />ccnity th.r I h,vc rcad rhk lr/icd ion od sritc lhd rhc atsvc itrlolmrion is coE d I a8rs to ompl, *irh all Cir, rnd Counry
<br />.ftlin.mc(.nd srflc kw( rclarii8 r. nuitnr8 con(ddlLnnd h.r.by,urhoii2c rcnEscnbtivcs oflhis City rnd Countylo cnld upon lhc
<br />i*#,-^".I#--)W2 4- ,.,",6.6-1/
<br />P.mi,FMm.(pnn,,, g-L; l<be.. l,
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />-UFEfl Ground (a*^t^9"zy'/8 t 7-Pz-?
<br />SLAB Floor
<br />Subf ioor/VenVlnsu lation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulalron/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif
<br />FINAL ?zv -/t .344'.7)
<br />Certiticate ol Occu ----7pancy
<br />Notes, Remarks, Etc
<br />,n I
<br />COMMENTS
<br />I
<br />I
|