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SITE.WORK DATE ID/SIG-.COMMENTS OWNER AUILDER DTI,('AR TION
<br />I hd.tr,! .mm undd Frhy of Frur! rhr I m ddF iD6 rh. Codr&rod- Li..e l,$ f.r rh. follo$in* re!. (s( ro\ I 5
<br />It6'n6 itn Profsion Cod.) An)( !or(oud) $hkt Eq!t6 i Fmi 'o.odDd,.t6. inprorc &ml6h.r rqu a)
<br />rtudr. F.r ro . i3sie.. ir!. r.qund rh.4?lrer for such Fnn b frk r rsn d rrn@r rh, lE or slr a h.ds<d p{md
<br />lo lh. F$t6hB ofdE Cont*ror ! l-'(6rd lts' (Cn!fl6 s, (-omftrr Nnh SNlion TuL of DnisFn ! oa lh. UuiiiB ind
<br />FrolBu. Co&) or rhal lE slc B-opr llF.tom dd thc h.6ir for thc ilq.d .rdFmn Anr. rhlronnls.nhnTIll5 b\,nr
<br />ryt'li.. for.Fn subjer!rh..!t[c^nr!.!.irilD@!yofoolmr.rhe6\.hundr.ndollrs(t5m)
<br />L .s o$ n( otr h€ Fop<ny. or my .hpl(,yG s h wal6 6 lh.ir slc coDpdranoa. $,ll & rh. $rt dd rh. shk1r. i! fr{
<br />idaldl or olt(.d ror sl. (Se 7(L14, Eurin* ind ProfBiotu ( od.: l hr (irntku r Lrdic l,$ do6 nor trpnl, kr ai f\ n6 .f
<br />rhd nFthy *ho hlil& or i,nl'ov6 rhn)n. Md rho d.6 ruch *r)r} hims.lfor h6.lfnr rhN,lh his or hd.*n.mflot.6.
<br />p(,vid.J inlr such imForffil3 @ @r inr lqloroll.r.ntorsL lf.n s6,s. rlE h,iklir* or inFormdr ssHsirhin n.r.r
<br />ofc.oDldio( rh.(nn6 Boilkr willh.rt rh. hnknofFo\r.! ,Irorsi.diln h,i! or inD.ov. th. FotErr tu tlE purFr of
<br />l. a ou E of rh. Ftrpdrv, D .rclun€l! .odral,.8 s nh Lc.rB.d .onriloR '.
<br />(drud rlE FoF (S( 7or.r. &!'6
<br />..d Plnlsih Codc: Tlr Co.rr..roir L(dk I-!r'&6 mr rpply to u ounq drFoFnt *h. builrL! or inprorB rh6d'n.
<br />ud trlF o'rds aor $.h p.oF3 tr nn ! (-odra:lonr ltdE dprl:d !.|h.(hdndors li.r L,w}
<br />I en.rcm u.d6 s(rion
<br />llrr. O;r.r
<br />uaatrf,as:grtft:Ns tta!
<br />OES,AAAIIA!
<br />I hftbr ifinn und€. p6aht ol Fjur,- otr. ofrh. f(nlosinS d(ldari.nr
<br />lh,\.adnillmi.in,cdifi.{.of(i'ifrrhs.lfI6u.forr0116'.omFMion.aFolid.dforbrStrlionlT(x).frh.
<br />Lhtr (.ddc. r.r $. Ffolrr@c o I rh. *ort ror
<br />"
<br />hih th. Fnn u asu.d.
<br />I ha..d u ill m.inl.b sorld comp.eti'n iBume s r.qut.d b, licrion uur orrlE kbor Co&- tor llE Ffffi..l
<br />llE u.rl fc tr hi.t
<br />'his
<br />p.mn 6 iecl M) trml6 .omD.Mbn i.se..ui6 lrl F lt! nunb6 d.
<br />Itlicy Numb.r
<br />I.d'fy rhar in rhc p.rfom!n.. rfrh. solk fitr rh'ch rh's Fn silstr.d.Irhillnormtloyrntp.rs.ninan!n.nnd
<br />e .ilolE o'n. !,bjdt to th. s.dd comDaslion l.ws of c.lifomi., sd.rKth.r itl should h.(o € subj(l lorh.
<br />rv.lt6s' coht asrion pmlishns of sdion r 700 of lh. kbor ('ona I shall. fnnhwilh comrly $'th lhos FovisFnr
<br />wARNlNc' Failurc to su. Iork6 co'nran$lon cov6a8. ir unlastuL ind rhall $'bjd s dpbt* tu lTnninal Frrlri6 atrd
<br />.rir nnd up ro on hundr.{t rhousnJ dollu. (ll0o-fi10). 'n addili.n r,, rh..od ol.onp.Mrion. d.hap6 a p.r!i.d nx rh.
<br />Sdrion rl)76 ofrh.libor Code nr6!r rnd i onr)'r f6
<br />DzClAsAnA!
<br />I n.E!.J llIm undd F !h, of Fiurt lh. I D lic.nr.d un& Fo\ uio. of (lutl{s 9 tcomttrins snh S.(lDn 70001oll)'\uhn I
<br />.r rh. a6i6s sd Prcf6io6 (_odr. nn ny ltrru it n! fnll fok. &n dY*r
<br />(\414ttoc
<br />G-'l.1-,r ,,,,r,.r",r. k UC=
<br />(axsralcr]oNr[lDtxc-a{i!!(I
<br />I hd.t'y lnm u.d.r Felll- ot Fju r- rhn ih6. ! r @onrudnn bdins lrft) for !h. Ffolrl1e. of rh. rnrl for $ hi.h thn Frn'r K
<br />n3u.{ (s( to97.cn c )
<br />I .n&'r Nm.
<br />AIEITANLDESIAAI]OT
<br />I h.t]1tarm uidd p6.hy.apdjrn on. ofrh. folhtrnu &.lar iDn!:
<br />Ixmol bn Prdnr Asb6r6 Norin.dn,n l;.ndrl R.gtrhrions (Tnlc 40. PM6)
<br />R.luir.d l.1tn otNorifEllion
<br />Ird'lirhl| rh. fatdrl (ruhrb8 l+edins 6n srorrdorald.. t,lrli bLh rhls Ploldr
<br />Icdifv!h,Ih,\.radrhnrftlrrlirnarl ar.rhd
<br />'h.abor.
<br />rnfotuFn 6.(E<1 I a*rr lo smpll. q ilh lll C \ dd (i'unr)
<br />ordiMk6 md srdc ri*! EhilB r. turt nI tr dn hd.t( 5dhru. r(F.d, tr 6 oa rhi! Cny ad Counr! r. drd uB,n rlE
<br />.hr\. i6r$..rl rreFn) lor i.{d6n F,lrE
<br />\ppli.r.r or \E6r Skn.rur€
<br />T n, G-11-t'r
<br />Prmlla mm.(prinO:(t*t, fic{qr\
<br />Set Backs r .t irr
<br />Forms/Steel/Holdowns \ .,a
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor -l \I
<br />Subf loor/VenUl nsulation /l
<br />Roof Sheathinq ll 1'l L l:7 )
<br />Shear Wall t I lliy ltr /
<br />Framing (
<br />lnsulation/Energy
<br />Drywall
<br />E lnt. Lath
<br />B-rown Coat
<br />I\rlasonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />7Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
<br />$uv-,..
<br />I I\U I ./t'4t)
<br />1r )* I vwll14
<br />/w/.7
<br />//trt
<br />,^., b-11-9 h
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