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BUILDING. INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BTIII,I}ER DELCARATIoN
<br />I lrRhy i ll]ru undrr Jxtrhy .f Ntjry rh l rm cxcmnr rrom rhc C(r tr.ttrr Ii.d sc t-rs ft'r rhe lnlk^vng r.rsnl r\q'rr'll 5
<br />Bu\incs\ rBl l'roilsioi codc) ny Ciry or counry *hirh nqutrcs . tcrrnir b $n{nrr. llrcr, in,Pni.. &nFli\h or rll)rir rrv
<br />nn'.rrtrc. print) ir\ i!\urn c. lls..qunc\rhc {pli.rir td luch ncnnir nr filc t (i8ncd {dtn. rhl h:or shc i\ licctrtd ntrru r
<br />ro rhc prorisiotrs of rh. Conti.roi\ l,ic.n\cJ tie lChrftY 9. Comnrcn.itr! $llh Sccri(,n 7(Xx) ol l)i!i\nrn ] of rlt Ilu\i'rr\\ h
<br />PrtnasrnrsCodc) oriharhcorshc Ncrcnu rhcrclio'nand rhc hd\i{ tur lhcrlLlrdcxcmflion Anyli(rlrridt.lSc'rirtr70ll5hyrny
<br />0t,flicrnr ntrrtcnnir {rhic.r rhc aPplicrnr ti rcivilNtrrlryormr mirrhri frv. hur(1..d doll *(35(XJr
<br />l.rs owncr ot lhc Imllcdy. or nty cmtlolecs $ilh su!.s i\ r ltrir solccotnt nsark,. trilldolhc*o ,.dth.(Mru n i
<br />inrcndcd.roffcrddfdklclsaT044,Buri'rcsrndProlcssionsCdlcTh-Contactn\l-i.ctrsl-rwJoc\noraprlvlouoencr'f
<br />ihc pR)acny *k) hilds nr inprorc\ rhcRnr. srxl wlN de\ \u.h work hnn\.lfor hcrelfor rhnruAh his or hcr own cnrPlorc's'
<br />piovid.d rh0l su.h imporcn.n* m nor irrlcdcd or o,lcrcd ftr srlc Ii ho*crcr' rhc huildirS or inpnrdmfi h soH 'irhin '
<br />tr't Jtr
<br />otconDkrion. thr Osftr Buildcr willhrlt ihc hurd.nol'pmvir8 rhtr h.or \lt dil mr huitl or invr.t rhc Pmp.rly ft" rhc nrltEof
<br />I. r\ .rncr ol lhc !nD.n y. .trr cxclurirlr c.ntrcrnrg tr irh licctr{d o rNton ro conntud rlc Preiccr (S'c 7(}l-1' Aurmss
<br />lBl h.ra\si,n Codc 'lhcC.trrru.ntr-s Ltctrsc L{\ (locs norrtlltro rtr.sncr otlr.fc v{lr huikl\or D!ruvcs rhcr&n
<br />rnd qho .onrracr\ tn su.hprojcclswilhn cootrcro'(n li.ctrscd |UrsAnr trrhr(i, rictn i I i..n\c trs)
<br />I d r.r.nrpl u cr Sccrn,i-
<br />TTABKIIBIS)TTENSAIIA.N
<br />D}:l:LA&rIl()N
<br />I lrrchy!rliruundcr ll rhy ol l,ctiuy onc ot rhc tullo$in! dLtlmri,,n\
<br />-l
<br />h,v. rnd sill minlaio o Ccnific,rc ol Consnr roS.lr ld\urc lor *orkcr' comlcnsr ion. rs prclid.d ror hvSc.lion:1700orrhc
<br />lihorGxlc, ror rhc lcrfnirMmc orrhcwork for which lhcFrmir i\ nsuLt
<br />I h.vc.nd willmainrai. qorkcrs .omPcnn ioi i'rsuran.., rs rcquncd hysc.rtn 1700ollhc lzh.rCodc. fo. rh' IIIhnr nor
<br />rhc work rbrwhichrhi\ p.flnit is hnrd. My*orkc( ..nlcnsarion insursi.. .0ricr . Policv nrmh.r !rc
<br />I'dicy Nutr$$-Erpn.(:
<br />-
<br />lcc rfyrhalinrhcpcrfo.rutrcc()lrhcs'orklnr1$ichrhs,tnnir i\ l\sucJ.I \hdllnor cmPl{)rxny Pcrvt rn!ny Dtrtrtrcr
<br />$ ns 1,, hc(nm suht{r h rhc $o*.n lomltisrri,rn hss olCalii{,trir. ttrd iPrcc rh r ir I \hoold hsonc $h,cd ro rlrc
<br />tr or[cr\ .onBtr\ tn po*i.nr of srcrn,n :] Tm of rhc Llhn (i'dc l shrll. bnh$ir h c. lPly wirh rho{ pn)vi(i.ns
<br />TVARNIN(;: i'r'ltrrc t, {cut wo*crr .on[.tr\aiion .o!c'Uc ls u.LNh'1. ani] shrll \uhjccr un cnlPk'tcr h fti'ninrl Pc 'lr's JnJ
<br />.ivjt tjrcsuflr)oD.hundrcdthousond.lollxBlsl(x).(xx)).Iiltl(lirt,nnrrhcco{of.onrprn\rrk.drnmS.stsPtJvi,l.(l lbr rhc
<br />Sccrior ll)76 oathc lrhrtrCodc. inrerc(xnd oirrystcs
<br />IEqABAIIAN
<br />I hcEh,![jr und.rp.nrltyofpcrjoryihrtInnli.ctrR\tundcrpo nD of Ch.Iirer 9 rmn rmirS qith Sccri{ r70(l]rorDivi\nrn l
<br />of lhc Busincssand PmltssbnsCodc- end n,y li.cn\c is h lirlllieJdcrfd1.
<br />c-3t ?a>'Gf
<br />o*.,7:4:ll
<br />cljNs ll{ll("t()N I ITNDING a(:}_NcY
<br />I hcEhy rlfifln und.r tcnrliyorPcriury rhar rhcrc n r.rrNrtucri.r lcn,lillg xgcn.y f.r rhe pcrlonru .c olrhc $ork lin *hi'h rhi\ PLnnir ir
<br />n\ucdlScc 1097,Civ. C )
<br />l.nlci\ Nxn!.:
<br />l.ndcis Addrcss:
<br />-
<br />ATIIJIANLDLEIASAfION
<br />I ffiy.,limunncr pci,hy ollcrjuryonc orrhc roln,wing dcchnriotrs:
<br />I)..DlilionPcrn lrAsbedo\N.ri6c.lionlcdcrrl R.s!hrn,n\(Tnh4{J,l'an6)
<br />Rcquircd t llcrotNorifi.arbn
<br />I.. ilyrhd I hNc rca(l rhisrPpli.nri .nd
<br />ordihnn.cs ud Srdc Lrsa rcldiigtoburl(lin3.,
<br />srircrhxrrhc trrrc irlornnrnn, i.conccr Iaar(ro..hrnlrNirh!llCiryandCoutrrv
<br />xnl h.iciy atrrh.rirc .ctrc\cnrili!.s ol rht Cily rtrd C.unry ro cnr.r nP.,n rlr
<br />rhxr Df,nr i,)turl pr.Nrry inr i'NIrcri(nr
<br />Ap!lic,nl or ABcnl Sign.lure ,.11.414s*",,,"
<br />f -7-/s
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />I
<br />Roof Sheathinq q /)/t{.1+$.76
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL rPb /r8 -.&4,t
<br />Certif icate of Occupancy a
<br />Notes, Remarks, Etc.
<br />Subf loor/Venti lnsulation
<br />Ext./lnt. Lath
<br />7-'z-lz
<br />l.cnifrrhar rhcltd. lrcgul!li()ns E!rnlina ish.{os rcnnivalar. nor.l,tricrhlc n) rni\ r'ojc.r.
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