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BUILDING. INSPECTOR RECORD
<br />ID/SIG.COMMENTSSITE-WORK DATE
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif A
<br />lloubt+ {out\_t2-t7"/g y-\411
<br />lz-7.Certilicate ol Occu anc
<br />FINAL
<br />Notes, Remarks, Etc.t\-/
<br />()l\Nt,:R Bt It.DUR IrF:t.( .\ R,\l t()N
<br />I hcrcby irfirn undcr p.trllly of pcrjury rh l m cicmrr rro$ rh. C.Nerns l,tcn\e Lxu f.r rhc rollowinS rca$n (Scc 70.11 5
<br />Busincsr and Prcfcssion Codc) Any Ciry or Coxnry which rcqutcs r Frmir b .onnflcr. rlrcr. inrlrovc- dcn,lth ,t rlnn rnv
<br />srrudurc. prinlo ils n\uan.., als r.quncsth. amlicnnr for such pcrnil t, filc, signcd n cnEnl lhfll tEor \h. is liccnsd t'nruad
<br />t, rh. F,vistuns ofrlE Contriclols l-ilTis.i llw (Charr.r 9. cl)nmncin8 silh Sccrn,n 70(n of Drvkion I oi rh. Rtr(i".{(.nd
<br />Pmfc$ions Code) o! rhor hco. sh. k.rcnrr th.rcfromsnd thchlsis for rh.llltr.d.r.nqion AnyviolalionorsccrionT0ll.5bvonv
<br />lpplicad nrap.mn \ubj(G rhc applicanl lo rcivilpcrohyornor nn. rhan livc hundtcd dollnrs($5(r)r.
<br />I. .s o*mr of lhc nrcIrrl y- or dy.trDkJy.c\ wirh wdlcs is rh.n qrb conrFnsar i(tri. will do rh. vo uxlthe {turm i\ Jk{
<br />inlcndcd or oitcrcd n, eE ( s-- 70,1-1. Busirrc$ ind Pmltrsiotrs Cklc l hc Conri.d's Liccnsc L.w d(rc\ nor sltly nr M ow cr oi
<br />rh.ln,r.ny who boilds o! inlrot$ thcR)n. ri who do.s \eh k)rk hnnsclf or htr*lI or rhn,uxh his or hcr own c Phyccs.
<br />pnrvidcJ rh{ such inrphEmnls m frn inrcnd.{ or olTErcd f{tr slc. ll howcvcr. !h. hui[ing or i rnrvcnEnr is $ll w hin om )Etr
<br />olconrphrion- rh: (n!ncr Bu'B.r willhrc thc lrklcn oiproviDs lhlr hc or \h. Jd nor huild or irprx! lhc ImFiy tur rhe Nrllrs oi
<br />L J\owftrofrhc pNNny. lnr crclu\iElyconrr!.rin! wirh lircn\L{ .ofi!.nns kr con{rucr rhc In,J..r (Sc.. 7i!4- Bn\i'r$
<br />a h,lcsirn Codc lhc Contackr'\ Li.cnsc Lawdocs not 0|0lylo rno*ncrorpn,Fnyqho huinhar inprov*rh.rcon.
<br />rnd who conrh.N fd su.h,r.lccl\ sirh r Conrrcn(\ ) lircn\rd Pur{r rolhcCotrrr.kr'\ Li.ctr{ tiq)
<br />I mcxcmpt under Scl
<br />w(lRxERs c()NlPt NslT!()N
<br />DIiSAMIIOB
<br />I hcrcb) nltu utrdcrNtr.lryolpsjuryotuof rh.inl[){irgdc.llrdnnrr
<br />IhavcrxlwrllnhnrainaCcnilrrrrofC{,n*nrt)Sclf-lnsurclbrrorkcn.om!.nsati( .rs lrevidcd ior hy Sccrb. ]7Ur ol rltr
<br />ktxn ( i c, nr rhc pdformrcc of rhc work fir *hich rh. Fnnir is i\sucd
<br />rcqumd hyScd otr l7(x).Irhc l;'horCodr.lnr rhc Nrloa'rrn'tr
<br />rc cris ud rDlic, nrhbcr d.
<br />y't It1) (
<br />,...,,, ".,,,,^., t)c S 07 6 o t g o 3
<br />I c.nilythrr in rhcrcrlonn0rccolrhe worl for whi.hthn l. nrl is hsucd.l \hrll nor t Dh)y rylEson in.nymnkr
<br />s sro lEcoE sh].d b rh. worrd( onPctreriotr 10qs orCrliturnia. dnd +rc htr ill (houu hc(n,E rubFcl h ltE
<br />{ rkc^ (annp.nsarn,nfbvirion(ofScclion:17(Dotrhc ljkn C(x]c., \hrll. lnnh$irhomPlr" wirhrtbc Pmvnnrnr
<br />WARNINGT r{ilurc lo scurc workc^ .r,niFncarnr.ovctu8c r\ unlJqrul. "l $Jll suhrrr ,\cmnlit)tr r..T'n'nrl|cMllh\ alld
<br />.ivil fifts ut lo om hundrcd rh.us d dolia ($loi).fix)). rn !.ltlirFn t,rhr rNr nr c.mBy'sdi n. ,lJrusA ] UNidcd lq rh.
<br />\.\r'on n,r6.rrhclih cfrlc 'm.'EJrnJr.rkv')lccs ,// I //
<br />,.,", Lb1!4{,,*tk!i"fu (tcua,-(t
<br />DECI.A8AIIO!
<br />I hctuh!rfin rutrd$ Nnrlryolpcrjury rhrrI an liccn$n u.dcr trornnnrolChrPr.r 9r.o'nntRinS wirh Secrion7U ).f[)ivti{nr l
<br />I thc llu{tusrnnl\.1.!-);;;liccnse i\ in lnllfffe indcll(i
<br />clo
<br />lo-il1(
<br />cljlisTLuc'rloN I FNDINc aGEN(lY
<br />lhrrhyrllir'nundcrFnrtly.lpcrjuryrhrtrhdcna.otr{ru.rionkndingr8cmyf{nrhcptrlonnrmcolrhcworknrshichrhisFnnirh
<br />i$ucd (Sc. :1097. Civ C ).
<br />,Ittut !]I1llj!rdxrua!
<br />I hmtiy llllmr u ndcr Fnrli y or Srury o.c of thc rbllo+ n,3
<br />Dctrrnik,n l!.irn r\ A\hcdo\ Noririrdi( Fctlcml RcBulr
<br />-Rc!uircJ
<br />lxrrur of Norifi .drion
<br />k, rotrlply *irh allCilyrnd Cotrnry
<br />sotrhisC y and Counly lo ctrrs llx,nrlr
<br />t ,,,,,. 1c;-t/1(
<br />';:;ta1ffial,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />\)
<br />17i7,r(
<br />"f9alqr-
<br />hnd.i. AJdE$
<br />I
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