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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII-DER DELCARATIOI
<br />I hd.it rmd undE F.n.llt of p6joF rtd I m .rmpt non tht Conlrrlc' I 'cds l,{ lor rh. follo$int tat (ri( 7(,rl 5
<br />Bosin6s .d Pro a63nn ( od.) Any C v o, ( ounly shrh r.itur6 ! Ff,ir h .on$tu.I. .1t4. inPro\ .. ddol6b or rqrr ht
<br />srructu.. Irxtr ro irs i3suM(.. rlsn r.qun6 rh. rpllrer for such rEsi ro lil. i .i8nd rilmol rhn tE oi shc ie lic6*n I,trNM
<br />kr rh. FoltioB of rh. ( onrsro.r Lrco*d l.w (Chapt6 0. (.rm.ncinE *nh sfttio. 7000 of Di's$n I oflh. Buriid d
<br />Pror6$B Co&) or t l lE r 3lE s.r.qr rh<dom d lh. lEir fnt ilE alL!.n .rmflion An) \i.bli'n ofs.nbn 7l).ll ! bt rn)
<br />ap,hco tor . Fmn tuhrd-1r ih. .ppli.,nr !o . .n rl pcoh) of mr.thf 6r. hun&.d d.ll6 (151r|
<br />l, f,i o\nd ofttr ForEny. or myorlolB wlh sa36 s th.tr slc c.mFslon, *ill.h tlE $o* dd lt {ner@6 nor
<br />intddil 6rofi6.n forsl.(s< 7044. BGodr sd Pmf6rm(i)& l1l.Gntocktrsl,icwli{doBnorimlyiono$n6.,
<br />(h.pnJFny *h. tlikt or improrB tlson. edsh.d.6uhsslt hims.lroi hell or rhmuth hi! orhd.rn.mphyc,
<br />Fov'd.{ rhii ruch inF.\.ffis e mr daLd n ofi6l for $l. lf.lFtr6s.lrE tliuins or intFnrmr 6 $ld trhhin.( !
<br />oacor{'ldia rh.(rs B{ laq har lrr htdn olFo\iry rlld rE r rE dd mr i! l or if,F.or. fi. I'oFt tor ltE F,ltx.l
<br />l. BoN.qoarh. Fotdy, tunctl$r.ly conrdina $irh li.m3.d cooradoF r, nr{nl(r rhe Iroid lSd TOtl.ltNrn6s
<br />and I\lf*in Codr 'l nc ( ilrrock,i l.iccns. I is do6 nol lpply n, d o$ nd nl 0 (,rd v trho buildr or imprcvd !hra)n.
<br />and \rho .onrhd! rtrr ru.h pmjds wnh 6 (n r.cro(s) li.meJ fuBult to lh. ( ont.cror's Lro* I rs )
<br />I fr.\opl und.r S.t0n .A &P( Lrrh6r(Mn
<br />D.t. Oind
<br />$oRl(Elis' ( ontPinaArt(lri
<br />DICjr!3^II!.IX
<br />I hn.hy,mrn undq !.slrr of Fju,r. oncofrh. a.llowin! d.(l{diotrs
<br />I ha\.-d*illrui u. CdrifEn. of Coisr ro S.lf lNur. for *rtd'omFdirn, s Fordcj tu t, asri6n u(ro of rh.
<br />t hor (ii.. lor fi. Ffrffi. of rh. so* ft *trh llE Fhi a is.d
<br />l hnv.lndwill marnhin ${116 cohtcNtrrn i.surancc, s r.qtrr.d btsdrion rT(xr otrh. f{txtr (i\l., ror
<br />'h.
<br />pclomrnc. of
<br />lh. sork lor phich rht p.,nir i! isal My turld .6n!o6.tion iNuranc. .mid Md Btli.y numbs r.
<br />/",-, n,-*\c\o\3\\ - 20 r-1-rrptr. 'r/r /rls
<br />I cdrfy lhd n rhc p.rntrminccollh. trorl tor trh(h tht FEir N irsu.d. I shall nor onploy riy t R,n in lny mannf
<br />sr E! ro lxa-n subjcr ro r h. sorl6 .omtadn'n hws of c.lifomi.. Md .AN thot ia I rnout b€(on. $,hit' ro lh.
<br />{orIB.ohFsrionl()r$n,Bolsdk,nr7(x)ofrh.tibr(i{..IslBll.tonhsnh.omply*rlhrh..I'o\irion
<br />$ARiYlN(;: r{ilu. r. su. $0116 comrEcdnrn mr6.r.c Lr lnhnful. dd sh,ll ruhJ.d m dph)o kt rimiEl FulE a..i
<br />rtr1l liE up ro oE h dr.i llFgnd Lhllrr (1100,000
<br />S(rxrn 1076 oaln. lrtnr (-a.. i.rd.nd dtum) r aG
<br />f (or{t@xon- d,mg6 ts p.o\
<br />(,,",6/rc/t+
<br />I hor6, .rm urdd Frhy o t Fjur) lhr I e I'ctG.d un&r Flrtioi of CtuFd 9 l.ontrI*ii4 tr nt S.nnn ?0@) of Dnirion !
<br />rl llE thG nd PhaabE Code rn ry lE@ i! h tull toE id.fiEr
<br />7,,.,,..,,".. c3ci
<br />\",," e/t2111-
<br />-1\636t
<br />s"..r': RcrS15
<br />(alilf,ucrotrIllDllc-Ac!!(}
<br />I fiEd'y rmm ud( Futy or pdjury rh, ina. t r $nfudnn laiinS .Btry for lh. Fao.lMc oa lh. rvt tur *iich lnir Fmn t
<br />isu.n (S( 109?, Civ C ).
<br />altllcall.ltlicl4Sarla!
<br />I hortry .fm u.dr pdllry of pajury on. or rh. followinB d.il.r.! ion!:
<br />Dcdolirioo Pmirs-Asb€los Nolificarion F.ddal R.guldiooi (Tilr,10, Pd6)
<br />R.qun.d l:1t6otf(rtrtoan.
<br />I rst 't lhd rhc fqrnr, r+uhrioN Elrdrn* Bb6tG rmoril ,. nor eplr.bk k, rnB rroF
<br />l.drryrhd I ha\ri..dlhhnpplicatron d Ihc r[\. tr'ntrDJr)n N..roc. rrl\ {dh rll( il! ifrlL,otrr\
<br />orJrnan(G i.J star. lj"i r.l!lmt ro bur
<br />'txn. mrion.d Fop.nr f(n tut dio.
<br />ain6 ofthi ( iry md (i'unlylo drE uF . rhc
<br />y'pp orr or
<br />^16r
<br />sirururu
<br />\\PemlrF r.m. (prlrr):A *s>
<br />,/4+-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing b h i,/o 5l,t**x ,/.b \n
<br />Shear Wall
<br />Framinq
<br />ln s u latio n/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<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 K
<br />Certificate of Occupancy
<br />Noles, Remarks, Etc
<br />7
<br />I
<br />I
<br />Brown Coat
<br />h ..iY)LL{414 I
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