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BUILDING- INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS 01!NER AUILDER DTJLCARATION
<br />Ihcr.hyrffinnu.rEnnlryol!.rruryrndIiarcxc'nprfonrhc(inirrctEl-rcDscIaw,nrhcr(nbwin3r'r{rn(Sfrroll5
<br />Ilusincls md Prrr$ii,n C.dc): An! Cily or Cou rl Rhich rcquirc\ ? Ir.rnnr ro con(rucr. !lr.r. improve. cmli\h or rclat onv
<br />nnrcnrc. prtrtu irs issnrncc- rlso rcqun \ rhc,Iflicanl hrsu.h rilnirtu,llc I \isncd {rrrcnrnt Ihrr tr or shc t llccnEd Porurnr
<br />n' rhc fovhions oirhc Contd.ln's Liccnsc.l lrrw lch4rcr 9. CoNncncin! qilh Scclior 70(r) or Divhion ] olrhc susirrc$ ind _t
<br />ProicsionlCo{lc)orrhrr hcor rhc k cxcmrr rh.rcrron Md rhc h$i\ larrl{ rllc8cdcxcr.pri{nr Atryviolali(,nofSc.rionT0ll5hvnnv
<br />l|tlicrnr foro pcrdir suhjccrsrhc appli.anr b r.'vill).nrllyol rx nxn.rhrr lile hund.cd dollrr lt50O)
<br />I. N oumr oi rnc pmFny, or my cmPb)tcs wirh wasc\ as rhct {nc .o r!.n\.rion. * ill do rhc solk md llt dtururr ( tr'r
<br />inr.,xhi d orcrcd lnl $1. ( Ss 7044. Bu\ilcs\ rnd Pmrcsions Cqlc Th. C.dt.clois l-i.cna tiw dcs nor ,I/v ro m ou'ncr ot
<br />rhcrn,pcny sho nriils o' nnp(Ns rhcFn- rl Nho dtrs skh wolt him\.lf or hcr*lf or rhnuAh his or hc. own cmplotEc\'
<br />providcd rhar sx.h i p('vrmnrs m nor inrcftlc{ .r .,lcrcd ior sL li lnrNrcr. fic building or irtrprov.mnr is sru wirhi" tr' Jtrr
<br />ifcoDlnldion, rhc ourcr Buildcr will hr!. rh. budcnof!rcvirs lhar tr or shc dil ml blild or irprot rhc pDp.dv ror Ihc !urP{ot
<br />Lr\owiforrhcnopcny-omcr.lurncly.ontrcrin3sirhlicdisd.o.trclrsb.antrrflcrrhcPtrrjlrrlsc.7(!'1.Bu\nc$
<br />rlxl Pioltsshn Codc: ThcContrlois Liccn\.I-rw do.s nor rlPlyro ano*nfi ll)roplnywho huildsnr inDrov.\ r[ctcofl.
<br />ud who.o.h.klosuchI'(,j.\hwith0GnrracrodnltcnYd,'u^umlk,rhcconhcnnsl,iccnseLj{).
<br />I adcxcnry und.r Sccli(,n-, B & P.C lorthisrcN)n
<br />l!lr86E8frA!lIrNSAIl()!
<br />DlicLtx6.I0N
<br />I hcrcby.lllrm undcr pcnlhyofpcr]u.yonc orllt f{,ln,si'r8 dNhrriotrr
<br />lhrvcrxisillnrinlrira(rnifi.rrc.fCotr{. oScllln{rcf(neok..o'n!.ns.ri(,nr\lnridcdlnrbySccrtr)nl7(x)olrhc
<br />Irtrrr C.nc. fd rhc !.nainrrc ofrhc s.rk tu s[i.h rhc permir i\ isocd
<br />I r.," *u *r, ."i"oi" *-kc^ .oNncns0riotr iNurrncc rs rcquir cd hv s.d i.n r7m ol rhc li$or Gdc. for rh' j)rrronnnn'c ol
<br />rh. f.ik iir whi.h lhis ncnnir is issucd My sor[crr conPc.\nrion tr\urf,ncccad$ od Policv n $.r trc
<br />(or,(*oor(". t.L d
<br />l.crtilyrh{l if rhc p.rtutnirncc ol rhc\uk tur rhich rh pcirnir i\ i$trcd.l \Mllnor c'ry,k,) iy lt on nra y iunncr
<br />v) r ro hcconE sublccr io ihc wo e'ico rNnsaridrh*solC lif(nrir. tnl rg.Lr rl ifl {u'ld h..otrf,\ublcd ktlhc
<br />$.,kcn $Nfctrsit i(r previ\i,)n\ of Sc.rnr 3700olthc lltxtrC.dc.l shrll. ir)nhsirh.iNPL! $ithi
<br />wA|INTNC [rilurc t, {.ur. uorkc con,F.\rti(r $vcrr8c i\ utrhstu]. d nrall \ulriN rtr c ycr ro di'nir{l n nrlrtus a
<br />.N1l Iincs u! ni om hun(lrcd ihousantl d.lltr\ (Sl(Xr.(xx)r. in Jrldirnnt t) rhc.od ol .onlllc d!,ugus ns povidctl f{x rhc
<br />Sc!ri!{r lor6r,rh. l-xhtr(!)dc.irncr.{xn,lrnoff,y.lc.r
<br />'Ot(o6|i0 !9 n*u*.,
<br />DEEIASAIIQN
<br />I hcrhy aitm undcr |cnuhyorPcrjury rhul I anr liccn*lund$ lmvisi(ni {lChnplcr 9lcomrh- cnu wilh S(li'n 7un ) nr Divisi'n :l
<br />ol' ihc Brsnr$md PmlcssionsCodc. dd nryliccnrc ir in tuli fitr.c srdcliccr
<br />{
<br />,"," '0GIqI('a0$
<br />(:(,NSTRUCllON I FrtDlN(i AI;I.N(lY
<br />I hcrht afi n uMcr |tnrllr or Pcrjury rhrr rhcrc is ! con{n.rir lc rlirs llgcncy r.r rhc r^-rfornrrnrc .t lls !o* t' whi'h rhi\ ncmn n
<br />i(srd(Scc :1097, Civ. C.)
<br />ASLTCANLDICLAEAI]ON
<br />I h.rchy o6inn utrdcr pcnlliy orFrjury onc olrhc rhlhsnr8 dccl.rilions
<br />Dcnniion P.nnits.Ashcshs Nurific.iion lcdcol Rcgularn,ns (Tirlc l0. t'!n6)
<br />_R.qx ncd brrd oi Noriar nr
<br />I.c i,yrlir thc lclcrrl r.(ularions rcsnllns a\h.(o.rcNtrrlnr( mrrIlrli.lhlc r. rhi\ P(,i(rI.crliy rhrr Ihxvr rL lrhi{r rli.xri{nHkl {irc rhd rhc rtxN nnninr niflr.1 lr!ru. r,.!rnDly trrh rllC lyr rl( otrnrr
<br />rftcs a Srrr. l. $\'ching n, hDildi !.f {nrcli(rr. rtrd lrrhy l ',1r[i\( ir,r d(,n J_ro c .ruto rhc
<br />rlxr. r.trrirnlyl p&tcn, tur nr$$tiotr lI!x'\r\
<br />,\t,Dli.rnl or,\lcni SixntrlR
<br />l'rnnirft n nciprn,r), !(*at{ Ft)
<br />r r$ (orG / uqrg
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext,/lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />FINAL 9lt>1t9 Frw.,.-'l {r)
<br />tl Ut)Certiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />-,
<br />l.ndc \ AdJ'c{
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