BUILDING- INSPECTOR RECORD
<br />SITE-WORK tD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Eneroy
<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 />Engineer Final Report
<br />I
<br />FINAL )/2.//l ,n ffi471
<br />Certif icate of Occupancy /
<br />Notes, Flemarks, Etc
<br />OWNI]R BUILDI]R DELCARATION
<br />I hd.hy afl,rn und.r p.n.lly of !.rjury lhsl I Mr cxcnpr fmnr ltc Conrruch^ t-i.cn\c La{ ror rhc lollosirs reason lscc 70ll5
<br />Busnrs( md Pi('fcssio. Codc): Any Ciry nr Counry *hich rcquircs a p.nnir ro con{f, , ahcr. nnProE. dcd,li\h or Epan My
<br />slnrcrurc. Drior ro ns issuancc, llso rcquircs rh. ipplictrnr t r \kh Fnnit ro filc0 sisncn sl cmnr lhlr heot ahc is li.cn{d Nrsuur
<br />u rh. F)lisiotrr or rlr conrmctors Liccn\cd L0w (Choprcr 9- Commcncirs wirh s.cri.n 7fix) of Divnion :l olrhc Busint\\ ,rd
<br />Profc$iur Codc) or rhar ncor!h. iscrcnrpr rbcretomsndlhc h i ftxrhc rlhScd crcorrion Anyliohrn,nofSdrbnT0ll5hyntry
<br />apnlicrdn,aFmir\ubic.Brhc{'!liGnrto!civiltcn.llyofnrnEcrhlnlivchxrdrcddollrn(t500)
<br />l. rs osncrol lhc rrroFnI. or m!cnDl,,rccs sirhsrrc\ N rhcn wrccomFNnlion. silldo rhc iorl rnd rh. (du. n tur
<br />inr. cd or olitBl thr {lc (Sm 70il.t. Bu\im\r rnd Pn,f.sri.0( Cclc: Thc a! racroi s l.kcn\c I r* dl,c\ n.r .rnl, to rtr o\ rcr ol
<br />rhd pn)n dy who hrilh or inuo\ c hcBn lnd *h. der such sorl himsclf or hc$c]f or rhhoEh h is or h.! o*r cmployccr,
<br />trulidcd rhrr s'ch inlPnivc rih .rc tr ir dk!.r! or oftcBl f(, \,lc ll lrw.r.r. rh. 6uildif3 or irxrtnrnr i( {td wirhi" onc )t
<br />of co lpldion. rh. Oq'*r Buildcr $ ill h.rc Ilt hnd$ or Drcling rhd h. or shl did mr tlild .r nryrt,( rhc nn,Fny i, rl[ Purtr'e ol'
<br />l.rsoqncr.lrhcpn,nny,nrcx.lu(ilcll.ontNir!rirhlr.tr\crl.orlrrcroFroconntudrhcrn+.r(SG-7rrt1.Btrsi,E\.
<br />.M lh,fdsirn Codc Ihc(otrlrrclois l-i.ctrsc LrN(bcs nor $plyro an.wkroflioNir, s[o nuik\ or inun,rc\ rhcrco.
<br />and *ho conlrrc(lor su.h projc.r! trirh r comnKti s) ltatr{d PoNrrrr kJ lhc Conlrid,,\ l-iccnY hw)
<br />I rDrd\.,npr rn,lcr S.rrir)
<br />I)!lr (hftr
<br />rvrtlxirrs trntpr:rs,rt (lr
<br />llD(l .8Alll}r
<br />Ih.rch! xlfnmrf,ld' |xrrlr! ol ti'I ry oN .l rhc n,lI rnp(lc.lr ioN
<br />lh,v.irxl willnun nm0Ccnific.rcofconr.rroSclllnurcforworkcrs..nrrcn n,n.is providcd lor br Sc.rn '.l70lr.rrh.titxn C(xlc, r{r rh. p.rrodhn.c ol thc work for which rhc Frmil h issucd
<br />Xl hove rnd will miinlain wqtc6 .omri.isirn,n insorat.. as tquncd by Sccrion .l?u) of I hc lj$or Codc. rot thc Pcrr'ornurce ol
<br />lhc work tu rhichlhn pcnnir is nsu.d My *orknr' dnn .nsar ion intunncc caricr an l Ix licy nunh.r d.l
<br />o D Qor- L l''-zt-t7J/ct nrrr".Z-:
<br />I.cniryih r i', rhcFnnrrnr ..olrhc v.rl lor Nhi.hrhis D.nnir is i$tr.,|.1shrll orc .yrny |x6.r irrn, nrMNr
<br />\' r! t, tr.orrc nrhFcr ro rhc wor [cr' conrp. nuri,n, la*s of Crlitutr,ir. rnd iglcc rlrd il l (h.uld bc.om sohi.lr h r)t
<br />workcr{ onlrn\{nnr fl o\ i\i,ins ol S.cr i(r .r7 rol rhc ljktrGxtc.I sltrll liJnhsih.omply * iih rho{ pnr nn !
<br />IyARNINC Flilno h \c.urc w.rkcis'.onlF.siriotr carcmgc is unhwlnl. xnd shJll rulc.r r c.rDloycr lo cnn,i' l If,t hics Md
<br />ci\il fiu ur k) o d hundrcd rhouend dollrr (Sl(xr.(x)O). if rddirnnr k, rhc.o{.1..n{cnsrri0n. dlmrgcs r* lloridcd ht rhc
<br />,,"*.- r-)- /k
<br />^ppl
<br />)C
<br />!!l!Lu!ul
<br />I hcEby .ritnr uMcr pcnahr oi pcrjuy rhar I !m li(n*i xndd pt,risiotr of Chrfls 9 (com Eciig uirh scrhn T(xro) ol l)ilhion l
<br />or thr Businc\s rl]d PruacssiflN Codc. and my liccnsc h in lull fitrrt ,fd;ft.ci
<br />a I ?7 07Y
<br />-itr .tV- (2,..,c)
<br />co!9rBl]cllNr[lDllcaiEN(I
<br />issue.l rscc :l0r?. Civ. C )
<br />Irndcrs NnDc
<br />-At,t,l,t( AN I DI.t( 1,.\R,\t 11 )N
<br />I hcrdy ofiim u.dcr pcnait, ofFrjury om orlhc r.llowin8 delarations:
<br />D.nslirion Pcrmiu'Asbcslor Norilicario. F.ddrl R.su lcr io6 (lirlc 40. P0n6)
<br />R.quncdkllcrolNolific ion
<br />A.crrly lhn rhc ledcrol rcBdhrFn( m8dd'nE trh.{o. mmlrltrrc nor.nrlrahr. rc rh" I,mJ.cr
<br />-l.cnifyrhar
<br />I h,v. iead lhis trrplicariono'dslalelhol th. atovc nriorturi.n is.omct I 0Bre to coryl, wnh sll cny .nd County
<br />onlnrmc\ trd Srrrc l.nN\ (_ld buildinr condruclion- und hcrcbyaLrhorizcrcfrcsctrl.riv$ollhi\Ciryrnd C.tr rylocn,ctut.nrhd
<br />oir nEnrioned pDpcdy fff in "z--
<br />6-e5 Tey/o-",,,-r-)- ltr
<br />IDATE
<br />Erection Pads
<br />Flood Zone Certif .
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