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BUILDING- INSPECTOR RECORD
<br />DATESITE.WORK ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/E nergy
<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 />Flood Zone Certif
<br />FINAL z/ lo /zo D*nrlo-'. r+ s-1
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWN}:IT BI]II-I)}:IT D':I,('ARATION
<br />I lrr.lr .frB'.Jgdd F{l\ of Fru^ rhn I m cwd fiDm rlE Codrrl6' Lr.e l,r t!, lh. fo otrins r.en Is< 70rr 1
<br />Bch-r ud P."f.shn ('.&r An) (ir) or loud) {h'ch rquc i Ismi r, coNtud,.hd, 'nJ,o\e dan lsh.r r4.s u}
<br />31ruc1@, Fi,r t'
<br />"!
<br />isumc.. .tro Equn6 rh. .prlicar aor ru.h Fm[ h fiL r sisncd siddd rha lE or !h. it li.mEd p6u,rrt
<br />ro llE rmvisioN of tlE ( onn*loi. Li.n d t I ((luod q. ( omnfti.s $.h S6lio. 70fii of l)ifLnn I oI ltE Bur,lB dd
<br />Pml*hB ( od.) .r rh.! E or 3h. tr Adpl rhacfrem od rh. tEn for lh. .lh.d cdriFi. Any vmhoon .f s<iion 701 I J bl .nt
<br />iprliclnr lor d p.rdn ruq(G th. .rplicer ro ! .ivil ,@ly ol.dr mr. rhd nr. hun&.d dollas (1500).
<br />l. s o*ffi .r rh. FlrEtt. c mI 6r?Llc $irh s46 s rhd $1. miF6don. r'in lh rlE qqt i'd ilt rtu@ i! m'
<br />i,rd qj or olIs.d for el. (Sa.7044, BBi.6 ed BnlsioN (td. n. Conteloii Lt* lr* &,6 nol @rly lo u oMn ol
<br />it Fnrdy $lh tuiltlorurForgllEq.rd *hr dEuhs.* hinr.lf or h<*lfd thhush na o. rEr osnsrDby€.
<br />ForiLd rlln s.t icFordid! e ml id6d d oft rd for ql I( t s66. rlE ttrilditB d irFuEEr i!,ld $ihin @ ta
<br />of$mpkiotr th. Oqrq Buikb will ftlr. lhc Uldor orFrhs da h. or +. did m! tnrld or n{r.v. lh. IroFt, i)r lt plrFE or
<br />l. a nMa ofrh. FntHy, m crrLsn.ly conrdint wnh lic.G.d codncroE ro ol,rucr rh. pmjrr (sc 7fi4, &BrB
<br />e.d Fokt (i'd. l h. Gnl'acr{,! Licd. Llv do6 @r lpply ro m o*n6 o f t oFny $ ho buildr or inpmrd rhssn.
<br />.nd {n offis ror rch F!F(s u'fth. ( onrxlclr ltdsd FEu&i lo rh. ( oln.ar '. Lide lis)
<br />I ur!\eN ondcr Sccru,
<br />D.fu Orrr
<br />\YORI(ERS' ('OTIPETSATION
<br />D.US.AXAu0!
<br />I h<d\ !m.!n lndcr IEo.ht of FJtrrt oncofrh. toll'sm! dcLartrd
<br />I havc .d snl
<br />'mintlin ! Ccnificarc oI CoBdl k! s€lr'lGu,. ror sorl6 .omFMior. 8 Fovid.d for b, S(tion I700 ofrfic
<br />L.tid (-oda nr rh. pciw. of
<br />'h.
<br />*.lt in qnth lh. Fmi ir su6j
<br />I hrv. nnd will nainrain workd conp.N.rnrn iNur.ft., a r.qut.d hy S..lio. 1700 of I h. llbor ('bd.. lor rh. FfolrM.. o f
<br />rh. rst Lr qhi.h rhir Fnnn ir i$.d My work6' conFMirn iEurffi. care td pola) nunta ,.
<br />--l c.nily lh.t ii rhc Ddtulrr@. of lh. worl lor whi<h rhn pamn i5 Lsu.d, l3h!ll.ot 6ploy any rEEon in lny hen6
<br />$ E i. b.rom rubd ro th. sort6 onpdsnion Lu! of C.lifomia dd lsr rhd rl I .rhuk b.<nE subjdl lo lll
<br />f,!*6 comrE!.Iion Fo!6hB ors..lirn t7@ofrh.ltE ('odc.l rull. fMlhrhhomdr r'nh th.x FiirnE
<br />W RNINC: Itilurc lo Bur. Mrld ..nFMion .ovd.g. n unhrtul, Md rhall sut 6l mploF lo omintl patti. od
<br />rnil nn6 up t, o.. hutulrd rh.trsd &nlds (oo.txxJ). in d io. ro rlE .or of .onF6nior d.ntssd B Fovit.d for rh.
<br />::. ii'
<br />orrh. trk{ (i}d.. midd ell ! ry\
<br />4-l_c_\--Crr\C\
<br />i l{ r \\[) ( ()\ llr \( lr)
<br />I hqLl)\ rlI'n, trn&r IEtrih) ofrrrLtrr Fortnrnf r(-ha|1ld') (connnctr.in* \ill'sdrctr 7lr(x)r orI)'\$nn, I
<br />of rh. BGiI6 ad Pr.f6hB Cod.. an mr licG i , full tuc,n.n<r
<br />.. ".4, czl
<br />,,", l[ f1f t{.J Hr t,rt>
<br />I hr.l,y amnn und6 F,l'y of pdjury
<br />iaru.rl (sd :1097.ci\ ( )
<br />l..rd6 r N .
<br />ninrdiin L.din8 rsdEy ao! th. rEfonndnce orrh.Nor[ tu$ti.hrhsFmn B
<br />AfIIICANLDICIJEAIIO!
<br />I ha*D .fi'rf, unLr Fuht .l F)!ry oD. of rh. folh$ if,B rk Lr.l ionl
<br />Dqqlli.nPoT r AltEdNor'lkd6nF.d.r.l R.suhhr(lil. 10, Pd6)
<br />*rcqu"ca r crrr or *r,rrann
<br />I c6rif,lld rh. aalsi r.Sul ioE Essdi"s 6bcnc,mr.lrc mr q)pltrbl. ro rhn pNFd.
<br />r ..,,6 ,r', r h./-l,r'i "pprgln ort rrc rtu rrrc ato'c inro hni9cn.6 I.sr6ro smdr *nh.tlcny.,rl county
<br />W"ffi ;:-'-*-"' ": ufi /'i{
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<br />Erection Pads
<br />s:!_rg.Sir_
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