|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNI]R BU!LDER DEI,CARATION
<br />I h.r.by rflirm under pcnalry (,r pcrjor, rhar I d eredrr fron, rh. Co rrcrors Li.rn{ bw ror rh. follo*ir8 rcabn (S..70.11.5
<br />Dusi,r.ss atrd Prcfcsi(,n coJ.)r Any cily or Counly whi.h r.qxncs . t. n t lo connrucl. ohcr. i.rrmrc. &nnlish ,tr (IJt My
<br />!rdcr!,c. priffro ns i$uan.c. ilso requncx rhcapplicrnr for such p.nnir h rilc u sisrrd srarcrnr rhar tror sh. h licdnsd lur$r.r
<br />ro th. pmvisions ol thc Cont0ctols Li.cnscd Ij* (chrfln 9. co mrming wirh scdion 7u)0 of Divkiotr 3 ollhc Dusircs rnd
<br />Pmtc$ionsCodc)orrhar fuorshc iscrcmo lhcrclionrnnd rhc h.sis ior rhc0llc8cdcrcnDlio! Anlviololion.fS&ri,n70.rl5hyint
<br />trptlicn nn a Frnil $'hjccls rh. arplicanl bncililpcnul'rotnolnE crhan nrc hundrdd dollm (5500)
<br />-t.
<br />!s osnsol lhc!n,pcny.ornrycnrllores wilh sasc\!\ lhci $lcsmp.nslrtn,. $illdo rh. worl a'rl r,B nnduc t nor
<br />inrd cd .r onar cd f(tr {lc ( Se 7t}il4. arqirc$ nd P(ntsst,ns ('odc Thc C-oniradoi \ l-ic.nr tjs docs nor unly b in owNr of
<br />rhcpmFny who lnilds or iflpmrs rh.di. aid qh, &rs \u.h s.R h n\clforh.scliorrhrougihisorhcroqnc'.pk,rccs.
<br />frcvidcd lhd su.h nnpovcnrnts m mr irlcndcdoroficrcd fd silc.li how$cr. rhc boi[ir8 or in{'m\rmnl h$ld*irhinone rcr
<br />ofco'npbibn. rhc O$nq Auiklcr willhnrc llE bunlcn ofB)vin8 rhll lE or shc did ml hrild or inryolc rhc pmFny for rhc purF)*ot
<br />l.rso{ncrolihcp'ofdry.rn,.(lu\ivcl).onr'rri',A*irhli..n\.otrtr.n'nn,.on{nr(hctnojc.riSc.T(lrl,llu\irtr\r
<br />an lhnl\rir Codc lhcConrra.ntr-\ l-i..trs.1.i$ doc\ tror rmlv ro r.wrcr ol rtr,|Env\h. huilds or nnpmrcs rhcrc.n-
<br />rtrJ who (an rrrr\ fff sorh pn+ch *irh r Grnrrr.tln \ ) li.cn\cn !tr^urni b rh. Conrrrh'\ Li(n{ t-r{ )
<br />I rmrr.m/ xidd Sccri
<br />Ilaf,rE&tratl[};lta1r9l!
<br />D[(;lalSdUAN
<br />I hdrhyrfllrnrundcrl}cnahyol r.rjt'tnnrof rhcn,ln,sin!ld.lrrdi,n,\:
<br />I hrlc dd sillnii'lrLn r CcniiicrrcofCon\cnr ki Sclll'$!'r ntr *orkcN cotrrF-trldnin. r\ pn,vidcd turbyScdnr lilx)olrhc
<br />lrbor Codc. in rhc !.rfornuDcc oltha s.rk lirr $|ich rhc plflnir is n\u.d
<br />lhr\cr d wrll rinhin workcr{.o'npj0sarion i,Nufutr... as rcquncd bySccti.nlT0Oo, rhc L.hor ('odc- irtr rhc pennnmmc ol
<br />rhcsoriforwhichrhkp.anilisi$ucdMyworkcrlco'npcNnriotrinsurutrcccaFicrannp.li.ynuni,.r0.
<br />-lccdilylhirinrh€pcrbrnunccolrhc*orkturshichihi\|Elnirhis\ud,Idtrlln.rcmlkry.yr.rsotrirrn!nt0trcrs .s io lr.\rm suhjrrt tu rhr *ork.*'.o rFn\,nnr hws ofcaliturniu Md r8Ec rh.r ifl should hccorR sut'jccr lo lhc
<br />sor*ctr drhn nl nrn pmvhio.s of Sc.ri.i :17(X) of rh. tibr Cdl.. I \hrll, lonh\ irh .omfly * irh rhoc pmvisions
<br />WARNIN(; Ii3ilu'! r) \rctr'. \orkrl ..nlJ).f\rri,,,.o\crxt. i\ nnlr\hl. rnl \hxll bj..r d.nll)l.ycr t, dimiril,'cn{rrhs n
<br />civil finc\ trp Io otrc hundrcd lhousoftl dollar ($l r.ol[)). ir liri(in ro rhc.o .onrr..\alnnr, dan!'Bcs rs trovidcd rhr rhc
<br />I h.L-h] rtlirm un,lcr rcnihyol'ncrjury rhrl I .'.Dwlun(lc. D(tri\i(r ol( lrnrcr 9 (coN,rtr.i'Ur *i1h S(r(,n l(Xx))rf l)rLi\irn:l
<br />ol th.lllrli'rr$r rlP'rirsi,rs (itr].. rtrd, \ l.!:r{ r ir lllinr.( n (l.ll..r
<br />l.ic.ns.Clrss e lo rlz-
<br />a6 - rB-l
<br />I hcEhy riirm undcr lEntrlry ol'pcrjry I
<br />issucd (sN.1097. civ c )
<br />consnrction lcndins.scncy ior rhe p.rfortunrc ofih. work nn *hi.h rhit ttmir h
<br />A.EIIICAXLDECLA.EAIION
<br />I hcrcl,y dlinn u ndcr Nnrlty olJ'cuury onc olthc r'ollosnr8 d.\lftdnn$
<br />D..Dliri.tr P.rnrirs Ash.{M Noiin.dion Fcd.ral R.grlari{,is r'l irlc 40, Pr'r6)
<br />R.quitul lr(.r ol Norifi.dion
<br />nor rdm\rl rrc for rprli.Jhlc (,r
<br />.8rc ro co'nrly *nh all c
<br />rnes ollhi City and Colnr
<br />r. trknnrrmD i\..rt.r.l
<br />IB- ID
<br />hrtuhy urlxtrizc rcfrcscnl{r
<br />i?c.>J":-,*"66 t
<br />Set Backs
<br />Forms/Steel/Holdowns ilzz/tX tb
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Ener gv
<br />Drywall
<br />Brown Coat
<br />Ir/laso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />FINAL ,lttlt4 1fu.,q*:ealS v
<br />Certif icate ol Occu tl vt :pancy
<br />Notes Remarks, Etc
<br />DATE
<br />Ereclion Pads
<br />Ext./lnt. Lath
<br />Scrri,nr.l076 ol rhc Lntxtr Oxlc-
<br />,,.,"' o6 -\8- \9
<br />I
<br />--r------
<br />=
<br />I
<br />I
<br />I
|