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ILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Brown Coat
<br />l\4ason ry
<br />Pool Fence
<br />Handi cap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />D\*<.^/11"?, + fzo^^t\,*\L/lq la ,D€nt'l
<br />FINAL (fll I tts t\cal
<br />Certilicate ot Occupancy tt
<br />Notes, Remarks, Etc.
<br />O\ryNER BTI!LDER DELCAIIATION
<br />I lrrc6y nlljrfl undn !.nalry of pcrjury rh{ I m .rcnfl ftun rhc Conra.b6 Lic.nq kq f(, rh. folldqin8 ica$n (s( 70l l 5
<br />Bu\incs ! Pmlessiotr Cqlc)r Any City or County w[ich rcquircs rycrni lo onslrucl. dtcr. n.pro!c. dcmli\h or rptrn any
<br />nru.rxr.. pdrb n\ issuunc.. alv' rcqltcsrh. aplli.unl io, sucha.flnil r() filca \tncd dnrcmnl lhlr hcor shc is liccoscd Fr$anl
<br />lo lhc pmvhions ofrh. Cotrlrlclois l-iccnscd Law (Ch,nrcr 9. Cbm.rn.inS eirh s.clion 7Om ol Division I ot rhc Businc$ rnd
<br />PmlcssnnNCodc)orthdhcorshctcrcmtlth.rctinnrndlhcbisistorlhcallcgcdcxcmplion.AnyviolorionolSccrionT0:1l5byany
<br />lprlicanr lora pernrir ubich thc apnlicanl ro acivilncnalryolnol mrc rhm fivc hund,ed d.llan ($500)
<br />-1.
<br />as owrcr ol'lhc F)pcny. or nry cn1|,o)es qilh precs $
<br />'hcir
<br />slc .onrrnsd n'n. will do dc "olk rdth. lMrurc is ml
<br />i cft]ql orollcEd lnr salc 15(.704-1. Ausims and l,r,fessions Codc Thc Conlrldor's Liccnsc Law dms mt apply h tuowncr ol
<br />rhc tmlrny who hxilds or i'rworcs rh.bd, rnl *h. d{x! strch {illt hinrelfor h.r+lf.r rhbo8h hn or hcrown cqrl.y.cs.
<br />Inlidcd rlur su.h impovctnnh e mr i.rcndcd or oflcGd for slc Il howcvcr. rlE huildtr18 or imlormnt is $ld wirhh onc yr-
<br />olcoftpld n. dE olr.ui Auiklcr will hrvc rh. buftrrn of E.riq rhd hc .r +. did nor buiki or nq,6\r thc lnstxnt fo. rtE IurF{ of
<br />_1. Ls o*trcr ulrhc pop.ny. Lmcx.lu\irclt.otrr ri.E wnh li.ci\cd .onkrrrs r, cotr{ru.r rh. pmrLti (S.. ?O14. Bu\inc$
<br />rnd h)rcshn Cndc: Tnc Conrrrclo.r t-iccnsc L.w docs nor rrnly ro nn orncr olDroncrty who huilG or nnnruves rhcron.0nd who .o ocis toi such rbjc.rs wirh r Conrhcn,( \) lic.i*d po^urir r. rhd Cdnra.ttr s l-i..n\c Lrw)
<br />l rmcrcnlPr u.dd SLrrior . B & P.C turrhi\ r.rs.n
<br />}YAAKIBI_CQIIIENIAIION
<br />DECIAXAIIAN
<br />I hcrcbr rltuD undcr Fnillyoipcrjuyonc ol rhc rolbwiDs dc.lrnrbnr
<br />I hrvc dwillnDir in r Crnili(rr. ofCo scnrt,Sclflt{tclnrs.'l.rr'co,Nn\rri,n,. \ !x'!idrdf(nbtSccri.nlTmolrlr
<br />l.rtxrCixtr. tnrlhc nrrlonnJnccollfu work lir shich rlr |EirnI is isucd
<br />Ihavcdtrdsillnr rilrw.rkcrjc. rtctr\rri,nr ihsrrr c.-r! rcquncdbyS.crr :1700orrhcl-rh{tr(1 c. forrhc Frhnnrn.c.f
<br />a nr/
<br />?_1,
<br />l.c 'fyrhrr iirhcp.rla nft.ofrh.worklnrtrhi.hrhnl}-rn,iri\n\udd.I\h!llnorcmrloyrny n innnynntrmr
<br />$ n\rotclurc suhjcct (o rhc * olkcn' c.mFnsdion l{*orCrhlaaria. rnd asElhd ill shruld hcconE suhjcclro lhc
<br />wor[crr .oo]l}cn\!lionpovi\ionsorScdionl?(xrnilhct-a I \hnll. li)d[sirl,..n yq thrh.\.trivni,)ns
<br />$ARNL\(; F.ulLm h {ctrrc \ork'\ cof,I{n\rri(n,
<br />rnil lnrc\ rp t) om hu rcd rho!$iJ dotlxr\ isl
<br />,,^.,v4-t4
<br />O!.!!!2!-8/!l!!l!
<br />I hcrcby,mrmundn p.nalryofpcrjur! fiar I 0m lienrd undcr rnxniotr offh+tcr 9 (onnrE Ei.B with S(tion 7(l()(]r ol Division 3
<br />ol ihr Bu\i'rcsl rid Pmfc*k,n\Codc, rnl mytic.ns i\ in fx ll tu'( d'rd cfli{r.
<br />e lo
<br />,rr"(J
<br />CAXSIXJJCIIOAIINDINC.&GENCI
<br />I hcrhy afirm u.dft ,enalry .r l.rjury rhar rh.e h a coono.ri., lcnd,ng agcmy ror rh. pdammn c of lhc wort for which lht p.mil h
<br />isuql {ss 109?. ci!. c.).
<br />afftrc NfDr.cl,1l&tllllN
<br />I lmh, rnlnn u ndcr plmlry oi,)crjur, onc ofrhc n,ln,*n,S d.clmri{,rr:
<br />Dcnrniion P.rmi's shcnos Norifi.rrion Fcdcrxl R.sulirions lri c 40. l'Jn6)
<br />l.drilyrhxr rlr rrdcrnl
<br />I r8ie r, mflrply *i'h lll CirylDd County
<br />ollhis City and Counry ro cnlcr lron lhc
<br />at$vc nrtrli.nLi pro|.dy tor in
<br />,\ppli.D l or ,\srtrl Sixnnl
<br />\i(
<br />I-!A-\{
<br />Ext./lnt. Lath
<br />T-Bar
<br />t
<br />L.ndci\ Addre$
<br />4Y
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