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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor SubfloorA/enVlnsulation \ Roof Sheathi ng lC-tt.. t nl E* e/t) Shear Wall Framing lnsulalion/Energy Drywall Ext./lnt. Lath Brown Coat Ma sonry Pool Fence T-Bar Handicap Req Final ReDe rt En ineer Final Re ort Flood Zone Certif FINAL //4-/1 1Z c/e.\le/bs 2D Certificate of Occqpancy Notes Remarks, Etc. OWNEI BUTLDEi DEII'ARATION I hd(bv .rm udrld Fdy 6r Fttu,, lhrl I m dcnPl nom ih. CofrdoE' Li.@ t w for thc follo*i!ts r6)n (Sa.7oll J aN'n6! rnd Prcfdnn co&I An, C , or t-6uln' whth r.qui6 ! rETit to onnM.lha, itiF.?( dshlirh or r+ir Ey nrudue Fio. to n! islec. .&. Equi6 rlE rpplkdr aor e.h Fni to 6L . rbEd 3rroE lhr lE or tE a licaEd ,lrud ro rh. Fovaiotu ot tlE Co .*rmi Lk N.d tr* (Cn pd 9. Conffihs wih S..rbr 7000 of Diri.i.n 1 of rlE A6iB od PDt*nB co&) fid lE q irr a <arF llE.non rd rlE hci! fn rlE rlLe.d .a"Fio.. Any yioldion ot Sarion 701I 5 by sy .ppli.dl lor . Fbi qqd3 rlE Sli.d ro. cil il p.dly of et mE lin fiv. huldrd dolbs (1500). l. a o\E of lh. F.Fir. or ny mplo!6 vnh w!s6 s lh.t $l..omFE ior, wil! & rh. svt dd tE rnsid. ! bt iddrH or olta.d ror slc (SE 7044. Buin6 od Prcl4io6 Codc 'tlc Coit*ttr 3 Liw llw &16 ml +ly ro e o"E ol IIE proFly who br{d. or hprcr6 dE( in *llo dc sh $on hi@lao, hd*lf or t&U3h hn d ha o*r dphf6. pr.\idal thd kh mrm\drEEEd iidiLdsotu lir r]. If. hol^a6. Ehritdi,! d itslEEr ii rtd vithin orc ]dofo,plai6h. ltE O$c B{ilild ril IEE rlE h,.rri otFovilB rlli h. .r itE dit tun hitd or i,urcw 0r. FsF9 tu th. p4o.. ot - L a osE oarh. FoFry. D qcls'rcly coddi,8 *nh fi..6.d ..firroB ro o,rirud tL FrFl (Sr. 7or.l. &EN.d As,sir ( o& Th. Cotrrr-loir Lkru t * do6 ht q,plr., ro u otrn6 of FoFny who blild! or inprcld rhd@tr.nd *ho o Et! for ruch Fnjan, r,nh ! Codrr.to(s) lkdE d pu6ud rorh.(\nrr1oa! t,ic@ L.r) I m.rmfl und6 scrbn J .8.&P( ro h6lwi/D.,. )A *M.,8..,,.#,*=- tt^* ,/ \ DESI.BAIIA! I hn?try lmm un(h Fnrnr ol FrudoR ol rh. blt s !B &(lerhE: I hl\. id eill roinr.iD . cdiakri. of colsl to s.lf-lBur. for $o.td NDFts o.. s Folid.d for by Sdion 1700 or !h. lritr ('odc fo. th. FtoljM.. d f rh! uolr for u,hi(h ln. ,gfin ir isu.d ! t E .nd $ ill niintii. sort6 (np.65ihn iEms. s r.quEd by S.d ion !'7u) of rn Lbor co{., for rh. FfornllE of llE r.rl f shi.h rhir FEi b i$.d My rcl6 6mFdir. inlllt,@ 6ir r'd policy nunb- e. I (arirylhd in th. FIo.IeG olllE sorL aor whkh thir Frmil n isu.d.l th"U not dploy !f,, p6on in rny mdn65 a lo bc.om. 3uqd ro rh. *.rtd or9dlnion t.s of C.lifomi., .rd .sE rhd ia l lhould bcoE 3ubj6l to llEwortd'mmr'.MrhnpFvbio6ofS<rio.lT00oflh.l,borCod..liilLdlsi[omplt*rhtto*Fori'n6. WARNTNG F.itu.lo cnc *mt6' otrp.Mb. 6\F.sc ii uL$.tu! od snlll $bjct e aplotu !. aimid Frla!.rxl.nil [.6 ul) ro oe hundcd rhoMd &lb^1 lm,ooo). itr ddni)n lo rhc.o! of c.nFBrion. d,ul6 d Frorid.{ aor lh. Sdlioi 1076.f th. l,h.r CrL ini p L!ll\:!l:ar)\ I tt \( r(,R aflim utulo pcn vof Fturyrhd I m DECIJSAIIA! urds F$virion ol(1dl'r6 e (..nmftina sirh s<rion 70Oo) oIDivB'on l ot lhc Bsinc Md Poldrd cod.. ed dy lic.M G m flll forc a{.fi(i (.ONSTEUCTION LEltNING AGEN(Y I h*by alrm undd Frlty ol Fju.y lhd rlE. b . o,lrtu tbi ladiis .sdy for ilE FfM. of rh. trrI 6r rtth fin Frn ir isu.d (sr t097. cir c). APPI I(:ANT N'(I AR,{TION l hdrtry .rm u.d- td.hy ot rsjuy onc of th. followins .k ls ioB: D.molili.n Pm 3-Asb6ro! Norificalnrn Fcddrl R.guhlri! (T 1.,10. P 6) Rcqur.d l.lr( of fiorifrnirn I cdiry lnd tht falqrl r.suld bN Es&dms 6sb6lG r6ov0l s. nor ryrh.abl. b ih'r pfl)dr I h.\r rad 'h6 r@l*dio. r'd nd. rhd rlE !t \. i.Lmdhn 6.@.n r.se ro ompl) trnh rll Cn) un Counry.1.l^!ElrirB'ot!i!di.e.orrtudnc!dh6.hr.dls.t..F..dui\6.trhirCity!dCou yl.6tc uFnfi. pr.Fdy f in{E rion Frpo6 10-26- 17\Z-h;dL - -L:/2L-!;rl