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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNDR BUILDER DELCARATION
<br />I hcrcby affiir! lndcr lcDrlry of Erjuly rhar I anr exe'n lnnrrhc Codrrtun l.icci{ Lra lar rh. tullo*ins rc qn rslr'7011 5
<br />Busnr\s a ltot$nnr Cclrr Aiy Ciry or Coutrry which rcautcs f'.irnir h c.Nnr.r. rlrcr. iflprorc- & ,lnh or rclan any
<br />nn,crurc. ri,nti ns n\u,ncc, rlw relutcs rhc lpdicanr ror such pcnnir h rilcrrigtrcd irr.,mm rhar htordr i\ h.cn(d pu^u!trr
<br />k, rhc Fd ni{m\ of rhc Conha.k \ Li..n{d tiw ( Chrrr$ 9. C.m rtrir8 } ir h Sccri,r TrXx) ol l )ivision .l of rh. Bu\incss a.d
<br />Pnfc$i.ns Codc ) or rhd l[or shc nex.mpi lhcrcinnond lhc hrsis lorrfu rllcg.d cr.nr i{nr nvviol ri( ufSc.ri Tl).11.5$yrny
<br />nlllicrnr,(tr rFinir sul,lc(rsrhe appli.aor ro acirill]fnllrrolnorn{rcrhrtr fivc hundrd dolh^ (S5(x)l
<br />l. N owndr or (hc pi.lf,ny. or nry cmllorcs with wa8cs rs rhcir elc compcnsarion- $ ill do rtE *ork dl] rht iturxrc i\ rhl
<br />inrc .n oroicrc lor elc lsa.?01-1. Buim$ond t\.icssi.ns Codc: Thc Onnrmn,'\ l-i.ti{ t-rsducs tror inflr_1,,rtro\rrcrof
<br />rhcpn{xn, trtk, huitls or inDnr$ llf,Nnr d whodcssshtro*hnnscllorh.r*ll'orrhn)u8hhi\orhcrn$ic r ortc(
<br />pruvi.ld rhar su.h nnfbr.'rcnh nE n inrclklcd d .lTLnl for slc. Ir. lxrqcrcr. rhc trikliry or irqrmvcnrnr is qnd wirh oft ttr
<br />ofco'nrhlioo. lhc Ol mr Buius will hrv. rlE burdc. olpmein8 rhd h. or nt di.l n huikl or inf'nivc E lo|lny r,r rhc I[rF,r or
<br />l. r\osncrofrh.fntPcny, r rcr(lu{Lcly..ntdir!wirhli..n\c'l..nk0.rtrsh).on('uurrlrpr+.rlSc.7(*r.Bu\iLt.\i
<br />ul l1tri.\{rr Con. Iie(n ncttr r l.i..nsc lrN(locs flor rmlyk) r oqn.r.fnroF*ny*h. hrikl(or irntro\r\ lh.rcon.
<br />rtrJ sho .unr' !s tur \u.h pn'lc.rs wirh r ( otur.to(s ) lic.trscd pururnrtilh.Co rxcntr s l-i.cn\c t- q)
<br />Irmcrc r|n uMcr Sc.rio. .B &PC tur rhtrclnnr
<br />Dore osner
<br />uaB$ltrslaurrNlaruN
<br />DEI:I,I.BAIIO!
<br />I hcrcl,v rllirnufdd |{nilryol p.rirtryorcollhc hlhwirp(lccln'!li,nr\
<br />-l
<br />hrvc d willtruirlrifl! Ccl1llic colaonenlroSclfltrsulcfr*orkc6.otrDcnsrri{nr.r\ pn,vidtd tur b} Sc.ri,nr lTlr0oithc
<br />LrhI C.dc. (,
<br />'h. |)crronnMcc . f rhc qo* r'orshicrrrhc lcnnir t hsucd.
<br />Ih trorl rn, Bhi.hrhi\ |{n li i\ n\!M My *orkrr\'.onlr \rri,nr i'Nu' trcccdricr rtrl Nli.yNnrh+r rc
<br />I.cdiryrhd in rh.r.rrDrnDnool'hc work (, shi.h rhistc.nir is ksucd- I \hillnolrnlnli)tant ncison irrntnunrcr
<br />$ .\ r(, bc$nE {htcd lo rhc w{ cr' mmpcnerion lass of Cllifomir. rtrd tr!' N rlff il I \h,uld h.! trt uhr:d ro r lr
<br />w.rks{ otr'pcnsnrior pmrisn,ns ol Scci ion 3?(xJ of rhc lltxr C{xlc. I dbll. tudhwirh conUly * irh (l[$ lr.vnion\
<br />WARNIN(; rtriluru tu *.rrc wolkcs conDcns.rion colcmac is unhslul. md shrll \lhjcd D'r cqnoycr tr dnrinil fttrrlriN and
<br />civil fincs ur t) o.c hutrdrd rhou$od doll.,s (3100,0fii). in rddilion ro lhc.o{ ofconFn\rrion. d nr8.\ rs,)rlvidcl fo! rhc
<br />Serioo.10?6 oirhc hnrr Cdc. inrcrcs rnd arrorEy s tes
<br />t orc: Applimnrl
<br />LICENSEUl:OlIntrcrAA
<br />DIiCI,AMIITN
<br />I h.(hyrflir und( pcndlry of Frjury ihur I nn li.ctr*l u crfnnisio.oaChlprcr9lconurnri'ig$irhSccrin7(XXr)o,Divriotr3
<br />ot rlai Busi',c\!sid Ptr,fcsi,nr C.d.. d rvlicdn* h i'r full f.r.c xlcflccr.
<br />CANiIAUqIIANIENUINjTTjj.!:NII
<br />i\{rd (S.. :lo')?. (-i\ ( )
<br />AITLICJTLIJEILASAITQ!
<br />I h.r.+,ydtttrrundcr E-.ally olpcriry om nf rrE follo*inF dcclrrnrion\:
<br />I),rnFlirnr Pcnnf$Ashc(os Nolificrrion lidcnl RcAuhri,].s ('fnh 4). Ptrn6)
<br />Rcqui,c hrrnoiNorificdi(nr
<br />I rcnil.rrhrrrhc liJ..rlrrgnIri,] \ togmli'ig rdf,n.\
<br />'
<br />c mvrlar.i,Irl,t]uhL.k,rhi\nr!.cr
<br />I cdifyrhrr I ll'rc rcad rlri\ ,Ipli.arnnr drd {rr. rhrr rlr rh,vc infdnNi(r l\conc.t latr.!x)dnnllywiihdllCiryr Cou ry
<br />od nnc( J Srrrc trss rL[itrB h htiklrE con\lrdion. rnd h.rchylurhoriTcrcprc*nrrrilc\ofrhi\Cirytid Coutryk).trcr u|nn lh.
<br />rh,vc trrnrn,ncd I(,pcny nr id\p.rrion purtx,\cs.
<br />.\pplitnnl {r '\lcnl Sixnhltrrr o
<br />Set Backs
<br />Forms/Steel/Hoidowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln s u Iation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Depuly Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL l-< -/8 -U.S"/a 7,
<br />Certiricate of Occupancy
<br />Notes, Remarks, Etc
<br />t ndci\ Addrc*
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