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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG COMMENTS Set Backs Erection Pads UFER Ground Subf loor/Vent/l nsu lation Roof Sheathing Shear Wall Framing lnsu lation/Energy Drywall Ext./lnt. Lath Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report FINAL /,2-/U ./)zf*6rq \ Certificat e ol Occupancy -=-Notes, Remarks, Etc OWNER BUII,DER Dlll-CARA])()N I h.rchy r,rtn u cr lEnrlr, .n pcrjry lhor I m cxcnu ltu rhc Con&rom Liccne lil rbr rh. lolr,wir8 rcnrn 1Sc.1rll.5 Bu\in.\\ 3fr1 Pn,ie\\i.n G c) Any Cir, or Counly lhich r.qut \ r pcrn r k, cooslrucr. alrcr. tnprovc- &'n,lin, or reprt mt ru.tur. pnor r. ir\ huri.c, dl$ (qotcsrhc Jppli.rnr tur such pcrlniri, filc r stncd iicnrnr rlrar hcorsh. i\ li..nscd , rlxmr, ro rhc prcvhbn\ olrt{ Contrcroi\ l-iccn\cd u* (Chltrcr 9. G)nxmn.ing wirh Se.rnD TltX) of Divtiol:l oi rhc Bdsincs ud I'rel.sidrs Codc)or rhii lror shc tercnrr thcrcliotrr i.d rh. hrsn for rh.rllc8cdcrcmfli.n AnyviolirimolSccliinrT0!l5by.ny amlicr rtur rrinnrdhjcchrhc.tpli.,n'bqrivilpruhy.lnornntrclhrnlivchutrdlcddoLutr(s5rn) l. r\ oencr ol rhc pmpcnr- 3'n cxclusiEly conrrocring wirh li.cn{d .onrr!.106 h sndrucr rtE proFr ( Scc 7O$. Bustrs 0M PnfLxsio. Codc: Thc C..rrcroC\ Lic.trsc Lrw dds nor lltly k) rtr o$ncr ofpnrp.dy who build\.r inprovcs rherco.. rnd lho cotrrocts ror n'ch pn'jc.r\ enh a A,d rucro( I lic.nscd punulnrbr,n (onr,acr{n \ Liccnsc ltr*l I !ncicnpr undcr Sarion Ihcrchy rinn tr dcr ncirlryol p.ru -lhdvc.ndwillmrinrainrCcnilkircofConscrloscll-ltrruEfdworlur'.omFnsari.n.NrovidcdlorbyScdion3?uJol'ltclnhtr Codc. ld rh. p.rf.rnukr of rtu work for whi.h rhc Fnnn k issucd ihc trorl tur $hich r[i\Fnnir i\ i$u.d My * orkcri .onrrf\il idr ir{rin.c. tricr ndFnicynnrhcr ir.: Poli.y Nrrb$r Errr.s I ccnily lhrr ir rhc lrrn)nnnncc orlhc !ork tur which rhis pcrnrir is is$cd. I shull nor ctriploy any pr6on in xny nrnncr so ashr li.onr {uh cttorlrsorkds compctrr rirn laws of Crlinrtrix. .M agm rhrr if l should bc.onr qrhlccr h lhc workel c.nqrnq n pmvnionsofSc.rion.l7IX)oirhctihtrCJxl.,I\tu'll.f.dhwiih.o.rdyIirhrh.sfmvnions WARNINC Fr:rilurc ro ecurc workcr( cornFn\ rion c.vcrrSc is ufl.trtul. rtrd \h.ll subFlr on cnlrloler ro rinrinJ Fnalris lnd ciril fircs uI, ro o.c hundrcd rhouslnd dollar (Sloo.(x)()). iI .onrNtr\xr.f. trrnltrr\ r\ To\ (l.J ro' rlr Sr.r(nr.1016.r rlr lxhn(itr|.. 1.r.{ rDJ r I hcrchy rlllrmundcr Ntrilryol F.jury r r I .nr li(cn\L{ undcr !n,visior nChrDrd 9 (omruk-.nr8 sith Scclion rfixr) olDivi\ion 3 .t rhc Bu\ir.slrnd Pdas\ion\Codc, n my li.. sc i\ in tullf{xoud.llccr AIIUCANLDICI.IIMIION I hcr.6y !lln. under ltnalty ol Dcrjuly onc of rh. nnb*ine dccl{fllion\ Dcm)lirion Pernrirs^sh.(os Norincdio,r Fcd.r.l Rc8u,,rnN(rrb40, hn6) -ll.quircd txlrcr ol Norilicnlior I c.nify rhxi rh. i.ddrrL r.guhrnin\ rc!rding rs&no\ r.nn\rlrr. nor rpfli.rhl. t) rhi\ p(td \ It)tli.rrio r rM n rt rhrr rlr rh,k i',tunnni,n, r.o'r.cr I nt'cc t).o iplyuirh.llCIy.trd C trfly his Cny r Couolyn) cdcr uJur rtf, """t,,r*.y rr.hyrurlnnt rrltr.\r rxr rt\ rlr s4!9 Forms/Steel/Holdowns SLAB Floor Brown Coat Flood Zone Certif . -1. !s owrcr of th. l)rotEny. or nry cnunr]es wirh Rrt.s rs rh.n sh . np.nsrnnr. silldo thc work Id lhc{mrE k ml inrcndcd or oflercd lor slc (Sa.?044. Busircss and Pron$ions Codc l h. (t,llllrcrol s Liccnsc L.q docs nor apply lo in owne! of rhc ptup.ay whr blild\ or i'npnrts rlthtrr. d*hodocs\thsorLhinNcltorbc^cllorrhrou8hhisorhcro$ncmFn,y.cs. ,ovidcdrharrrh iDnoEmnlsmBn inlendcd oronaE-d hrsh ll howctr. rhc tDiklin8 or inpmvcmm is $ld wirhir onc yc.r oicon{'lction. thc Owmr Auitn sill h.\c rlr hurdcn of!mvm! rhd hc.i $r dil mr hrild or imrmrc $c tln,Fry for rtr pu{Dc ol !:QNEIruCU!]NJ.DN!,INEIIiENQ I hcrchy riftm undcr nculry ol pcrjury lhul rlErc h rconslru.ri)o Lndin8 qcncy fo! rhc Frr'on,rncc ofrhc *ork lnr Nhich rhi\ p.mn i\ issucd (Sc. 1097. Civ C ). I-cndcas Nd.rl hMcr's Addrc$