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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathino C{*/rf )
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Depuly Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />,/,
<br />FINAL I /-,t/r/n
<br />Certificate ol Occupancy Y/ /o/'f)''t'
<br />Notes, Remarks, Etc
<br />-a
<br />(,WNER BTIII,DER DEI,CARATIoN
<br />I hcrcb, trfn'r u.dfil).nrlry {,f pcrjury lhar I crrn,pi ft'NrhdC. tnnns Liccnsc llw fitr rhc f(,|n,*ir! rmrnr (Scc70315
<br />Bu(nr$ xl Pnlls\ion Colc) An, Ciry or C.unry wlri.h rcqurc\ u Iarntii ro connfl.r. dlrcr. nnptuvc- dcm,li\h or mrrn ri!
<br />srn'chtrc. tritrr,, ih ilsu.ncc. rhu rcqnlrcs rhc rpnliclnr lor $chfcrnrirt, filc, \i8ncd $rcn{nl rhrrhcordt is lL.cnscd Puruirn
<br />ro rhc nn,visnnN ol lhc Conrrlcror! I-iccn*d ljw (Chrnr.r 9, Conrmcming sirh S..rn 7(XD .l Dni\ion ll or rhc Btr\inr\\ rnd
<br />lmlt$ ions Codc) ar rhal hc or shc i\ cxcmpt rhcrclin rtr lhc h.st turrh.!llcscdcr.nDri(!r Atryviohlionolsccri{,nr(lll5byrtry
<br />ipnlicrnrtorrrcm,irsrhiccr\rhclpnlic,trrtorcivilpcnrlryolnolnnErhanrivchudrcddollrn($5m)
<br />l.rsowncrollhcnmpcny,nrmrcfrttloyccswirhwag.sasrhcnsohconucnsrti{,h,silldorhc*(trklnlrhcnrknrtn
<br />inrcndcd or oficrcd fitr qL ( Se 1014. Busin ss rnd Polc$n,ns C{dc: Thc Co.trdois Ltcn* l rw d€s trot r0 yronnosn.rof
<br />rhc pmp.rly *ho hilds or im/orcs rhcBtrr rnLl wlm docs \uch worl hinrcllor hcnctior rhmulh hh or hcr osncmphyccs.
<br />pblid.d rhrr su.h impmvcn.nh art mr inrcdlel or uff.R{ for slc Il hout\tt. rhc huilding or inprcvtnEnl i1 sll wirhin .tu FJr
<br />of.omplcrion. rhc O*i.r Buildd will l',rvc Ih. tntrdcn ol provins rhd h. or shc dil nor huikl or imp(M lhc Pmpcny r.i lhc puln{ ol
<br />l. rso*n.r ofrhc PtuPcny. rn crclNivcly c.nrricling {irh liccn\cd coikr.tt\ ro c.Nnrcr llE IxI..r (sc 7(!9. llunn.s
<br />rfd Pmli\shnCod.:'l h. Cotrrrrcktr \ Licctr\. Ltwdocs rorr,'Dlyt(, .*ncr,,frn,rc yvho huikls or imfiovc\ rh.rco
<br />and *ho c nh.N ntr su.[ rrejcds wirh r (i,nractn(, licci*d ttr(u.nrro'hcConlracrois Licci\c ljw).
<br />B & li C lt{ rh.\ rcJ\nn
<br />D{!. Onn€r
<br />lY{)RX[&5 (:llNlPENSAII()N
<br />DECLAS{I,UN
<br />I hcr.hj- rlnnrundcr lEmhy ol Frjuryonc otihc tulk'sin! ilcclffdrion\
<br />I hrlc nnd $illtr{ir rio!Ccnill.dcofC.i$nrt'Sclr"lrsurc,i,t+lrkrF.onlP"n\aridr,rs lro\idcdlorhySccri, lTmolrhc
<br />htxi t.rdc. tur rh. Nrlormoncc olrhc *ork nn *hich ihc pcrnrir is is$rd
<br />-lhovc
<br />ond willmtrnirin wor*cra confcns{tiotr irsun rc. n\ rcquncJ bySc.rionlT(x)ollhc l2h.rGdc. fitr thc |Erlbmrrccol
<br />rhc $orli for Nhichrhh p.nnn rs i\{cd MyworkcG conrpcn*,rion i.\rrdmc (ani.r mdlx'lty nnmh.r ac
<br />.4r'pa2 F-t
<br />14L+L\tbz alclra
<br />l.cnrryrhrr i"rlrc JtrrlanNn.c "lrh. $.rk itr hic[rhi!Illnnir r\i\{td.I\ llnor c'nPl(,t r r_fcr$nirrntn nmr
<br />$ sh hcom subjcd ro !h. *urk.^ .onFtrsol i.n hs(ofCalihrni +m.rh r if I \hiuklhe.oflf, {'hj.crrorlf,
<br />*. cn conrpr n\rr i,ni pn )vnir ol Scdrr.l7lx)ol rh.l rhn ('h(i,[..n,D]] *irh rh.{ fmvisidrs
<br />W^RNIN(; F lue r. {curc *lnlcr confrtr\rri, c.\
<br />rLv,L rnl! n], t, ,I htrnrlr.,l 1hotr\rnJ Jollr\ (S]l)1).000
<br />lz'LG t<
<br />DEIIABAIION
<br />I hcrchy lilirn ondcr Dcnalryol !.rjury th0t I rm li.cnsd udcr nmvtion.r chnllcr 9(comm.cins *irh Sc.lion 7000 otl)ivkiu':1
<br />oi rhc Busincssrnd l\ofc$ions Cod.. nd my liccnsc h itr lull forcc und cffc.r
<br />c-3 .1q.++ln'ts1>tl,(*'*"* >-O t'r1 eDffi i -F&-4 r-Ltni-tr .
<br />CONSTRTI(:T!(IN I FNDING ACI.N(:Y
<br />I h.rby rlltmundcr JEnrllyofllerjurr lhlr rh.e h a.D.{fl.rnn lcndlrS lscnc, fttr rht F.rfonrun.c olthc sork fu $hi.h this Frmil is
<br />issucd (Scc l(,97. Civ C.)
<br />APPI ICANT OIiCI ARAT|oN
<br />I ltnby,fim u.dcr p€trllly ol !.rjdry dnc orrhc fou,rwinS dshmtions:
<br />Dr hlirn,n P. nnl^stEnos Nolilicarion Frd.rrl Rcgnk n n( {IirL ,l0. PrnO)
<br />R.qun.d trxcr of Nolii.ali.,o
<br />-l\."nir*,hr rh" r",i-"I r"ur.
<br />f,qd7l",',,;.,,
<br />^^,",",.,,,.,.,",,l$p(r(- rn,r s,Jk t Js( rlrns h,
<br />$.t. trnrnnctlnnrEdl lnr inrrrr
<br />:EardinE rsh.(o\rc'no\rl . ni rffli.rhlc lorhn proicr
<br />crhnrlRrh,vc r,i)rfr(ion l\c()rc.r l rlr€!,conrtilywirhaucnyr ('outrry
<br />n- tr hcr.httrurh ri-rc|rcscnrarils olrhi\Ciryrn'l Counryio cnrquflrIhc
<br />/1Dpli(onl or ]\A.nt SiSnnh're La :*""4et1""4
<br />,.*u**.",,n",,, X9!h?-{3r ( tP V' e/*@
<br />U!ED
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