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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />l\4asonry
<br />Pool Fence
<br />Handicap Beq
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />1..\
<br />FINAL l-\\-7\Ut[t\0l
<br />Certif icate ol Occupancy U
<br />Note s, Remarks, Etc
<br />oWNDR I}OII,DER T'EI,(]ARATX'N II hrrrhy rfljrr trn,ler p.nilrl,)I faDry rhir I r )crc r0r ,in r rht (btrtrtna Liccn\c Lns lbr thc ioll ringrcnv'nrs.!rlrll\
<br />hr\i',c$ rnd P(ncs\i{nr Co&} Ai, Cily or Counry $hirlr rcqurr\ d l.nril nJ (r{rucr. rltcr. nnl)rolc. dcnFli\h nr rcn'ir Jtr) a
<br />ndcru'c. prhrn) ir\ i\{,nmc.rl\or.qri'r!rh.lnflrrirturiu.htrdirn,hlc.rlSncn{rr.nrnrlhrrhcorshcnlic.r.cdrur{'inr
<br />n) ihc !(xi\n)ns of rhc C.nrrckn r l-i.rns.d Lr\ ichrlrcr 9. Conncn.i',g lilh S..nn 7ffX) f Divisi$ :1 .l rl[ llusir$\ rnd
<br />appli.rtrr n)rrp!flnii {'hjrcrsrhc 0pplicrtrr k, r.ivilactrrlryolnor nxmrlr n\.hr drcddollrrs(15( )
<br />-r.
<br />.s owmr ol lhc tlr.pcdr. or my cmployccs with * i8cs N lhcn $h comrcn\al ion- wi]l do lhc iort lnd rh. {turm i\ nor
<br />imcndcJ..ollcrcdfor$lc(5670,l.il.Busi.rsandPr.fcs\ionsC{xlcTh.Conr(ktr\Li.ctr*Ltrwdocsnor.pplyrornowmrol
<br />tlt pmtcny who trilds or iopmvcs ilLasn. ind Bho dcs such No]d hnnscll or hcrsll or rhNu8h his fi hcr own d yl.y.cs.
<br />Fn,lidcd rhar skh inrprov.mn6 m ft inr. ld or oflcrd f{n sh ll. ho*c\tr, rlr huitling or irqr.Ermfi h sid wirhi. orE }!u
<br />ol compLri.n. rtr O*rcr Build.r kill hnrt rtc tnrd.n ot proving rhd hc or shc did frr buikl d i'n!b\r thc pml' ly for rhc puqnc ol
<br />l.asowrur.frhcl)lolcny,an.x.lu\ivclycotrtrr.rinewirhli.cn*d..nri.rrslo.ntrstrucrrhcpmjc.r(Scc?(rl,l.Bo\incs
<br />r'xl lhltsionCodc:lhcConrrucroisLiccn\cl-rwdocsnoropplyt'otrown.rofForcntwhobuilds6rnnfrovc\rhcrcotr.
<br />lnd who cotrtrdsiorsuchpnrj<tswirhaC.nrnrodOli.cnscdpuru.nlrorhc(-o.trrcror'sl-iccn\clitr)
<br />-l
<br />rNcxcnrpr trndcr Scclirnr
<br />Dote OPnrr:
<br />wonxres' t:olrprws,lrrot
<br />DICLAXtrIION
<br />I h.rcby rflnnrnd.r pcnrlryofp.rj!ryonc oflhc n,ll.srn8 ilcrle,n,ns
<br />-lhorcflnwillnEinrrinaCcnific{cofconscnrr.scllnsurclmwo.kclroarpcnsrrion.a\provilcdr(xbySdrn:l7tlodrrh.L0hoicdc- rdlhc pcrfoirs.ccoflhc wo aor whichthc p.nnir ir issucd
<br />I harr nM will nhnfunr workcra .omp.rs.rion nrurnn.c, as r.qutcd hy Scct ion lT0O ot rhc Lhor Cadc- fo! rhc FnnrIWc ot
<br />thc "ork lor {hich lnk p.mil is hsed My*o.kcs .o'npcnsarion insunncc.a cr anrl loliy nun$.r uc
<br />lccniryrhrr i', rhclcrlormrn..{)lrhc s.r( for whichihi\ pcrmir k i\\ucd,I shrllnor.nfloyrlyr.N,n tn rny ntlnncr
<br />\o .s lo hconc nrbicd h lM workcs conrrrctrstlon l,trs olcrrifoirid, rnd urcc lhrl il'l should bccolr s'l'icci k, rhc
<br />lnrkcn.on{cnurionpmvi\iotrsofs(rionlT(r0.llhctitrrCodc.I$nll.Innhwirh.om0lysirhrtnscpretisi{,ns
<br />WARNINC: l'rilurc ro arurc w.rkc6'comF.srli,rr covcrr8c is u.lawlLn, nnd shill suhj.cr !n crpk,,rr t, aimiful tcmlri$ trnd
<br />ciril uncs ur lo one hundrcd lhousrnd dollor ($100.fix
<br />Sccrbn .1{176 olihc t,ntr (tdc. nrcrc( md artomy s ltcs
<br />.n{ ol .on,Ftr\rirn,. ,lxn gc\ x\ fn,viilcJ lin {h.
<br />r","' B 23'/e
<br />Ihc,rh!nllir r dor |[nnlrr"ol l)crttrryrhd lr r r. !1lrt iry 9 (.onnmN irg *irh Sarion 7(XXl) oI Divhion 3
<br />oi rhc Bu\irrs a,'d Profcssions Codc. afti my liccn{ h in lulliorcc nndcfic.l
<br />I h.rhy amn.lndcr pcnllrloapcrjury rhar rnsc is E consl[crio
<br />hslen (Scc 3097. Civ. C.)
<br />i,rg xgc'r\ ln thr p.rlon,r'h--c,)lrhr rhrk litr $hi.hr)n\ Pcrnni i\
<br />AI]TIISANLDECI.II.BAIIO!
<br />I tmb, dinnn nndcr penrli, ot pcrjury onc o,rnc lollowins dcclituioos
<br />I)ctulirion Pernrils Ashe(os Nolificoliotr Ircdcal RcSxlarions (T lc 40. P{n6)
<br />-Rcqutcd
<br />L.rtcr of Notifi caliotr
<br />l.cnilyrhd nr fc,lc rlrcsul rions rc[xrtln,g Ah.nosrdnmv:'1 c nor rtt]i.rhlo n' rhis n'ol..r
<br />Iccnifyrhar lhlvc rc rhndfp,icnrionuxl$$erhdrhc.hJvcinli)iinirioniscotrccr lo8rcho ply'irh0llCnynndCotrfly
<br />o,rl nxNc\ rn,lsliI ln\\ ohlilS ri hr]l(l tr!h.rchyrurhorizcrc|rcscfidncsolrhisCiryaMCounlyrocnrcrnlx rrh
<br />rl\ivc ornri(nrd fn,pcn! ntr in\
<br />,\Dpli(anl rr,\gdlSiBnal"tu
<br />IrrmrilN n$nre ( prinl ),
<br />b d)-/?;
<br />T-Bar
<br />B & PC lnrlIisrcr()r
<br />|dlcyNtri$cr:
<br />'2219 c-r-a*,D(
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