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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OITNER BTIILDER DEI-IL'AN,\TION
<br />I hq.ty amm undd p66hy of p(iury rhal I en .rcm8 lrem ln. Conlraclo6 l.icdsc tis fir lhc lollowins r.Dt'r (S(.roll I
<br />Bu!i.6r and Prof<rn ('ort ): Anr (\rv or Counry uhth r.qutr6 ! pcsi lo s,nrrucr. !lrs. inpro!.. ds.{nuh or rqdn fi
<br />rtudE.. Frrb h3 isu'N, rh. BqniE fi.4" xd for tuch rlmn r. nk i rlrn.n xrffirlid tE or slt 6 lrdB.d FNd
<br />ro rh. FrnoN orlE Conlncior'! l,icau.d tis ((lqi( 9. (i'mntrin3 $irh S..1in Tctxr oa Dnnior ! of rlE Bsi.N .nd
<br />Pmf.!$..r ( od.l .r rhr! h.orsn. i!.ronpr lhdcfiom dd !h. tEsN iin rh. alks.d.rdtri6n Anv rx,l.ri.n of SdiJ.70:rl 5hlinr
<br />,pDlic6d nr a psmil suhjds lhc sppliclnl to ocnilp.n.hyofnor nw.lhan fi\cnundr.ddollsr(t50(r)
<br />l. it 0$6 otrh. F.Fn). or nr mployd \ irh tr iS6 a rhor vrk.onFMnn. r &ilE\(rtarlrlF jtuiEirn!.
<br />irndtid or ofrad foi * (Sa ror'r. BBiB Md Ptoa*ioB (-.& Ih. (nr rdois l tffi l rtr &6 not 4[h t, rn ou.q .l
<br />rfi. FrIEn, sho turl& or trntr.!6 rlEo.. od nh, d6 $ch r!* hmi.llor hnslforthmuSh ntr or lF o\n drrlq.R.
<br />pro\ id.n rhar such nnro!ffirs r. frn inrnd.d o. .rTdld aor eL r( kJ*a6, rh. hrildinB or imFN.m ir eld wirhin one \.ir
<br />of..mplain! ft. (Na ltdLtd { ill hr\. rh. hrd, otFrin€ thd h. or Jr dd mr tnild or ni{ro\. rh. F.Frr ior $. F4nk o,
<br />l. f,r o\nE ofrh. F)tqlr, o .rclulv.ly c.nrrd'n8 trIh hc6d cofidoEr. (,ncrrud rh. F,r..llS< 7(!l.llBm6
<br />edlhiie$nCod.th.(ontr.htrrLi..ns.Lr(dodn.raDplr- hdn.snd.lFrpcry*hohuilds.rimp *rh6mn.
<br />and rho conlrlcc rq ruch proj.dr rirh a Conrrccrorl!) licd.n ntrFunt toln.(iinr'adoas Lto< l-a\ )
<br />I n.ropr un!.r SdFn
<br />1!llB(&8s:(0!rfrNtall0!
<br />DECIAEAIIA!
<br />I hd.b . mm unlkr Fi,lr) of Fjih ok of rh. fdlo* inr &cl!.rnB
<br />I hrr.d*ill dn'nrlin a C6linc .ofcolMr lo S.lt-lNuE ltr *ork6' conlP.Ld nJn. Forid.rl for h) Sdkrn t7{Xrolrh.
<br />ljbor ( ode aor tic psfo,rMcc of rhc rv.,k tor efiich lhc pctnil ir i$uol
<br />I h.\. tnd tr'ill mri .in*orld (omFMion Eorm.. a r.1 tr.d b! sdi.n r7(0of rh.Iior ('orL. for rh. Ffolrmc. or
<br />lhc *{rl fr rhin rn! Fnh i isrdl Mr- \ort6 onFdion iNle. ffi rn FIb} nomh6 rcl
<br />Cuir '
<br />PoricrNumrE:: c12o O A1"L Lrlro'nr.p,.. r f-Z
<br />,/(JI,d,f' thd inrh. FL'lrruc. lrh( q.rl lor uh{hrhsp.rm r 6su.d. r sh.lln.! mpLr i.r rEm. 'n
<br />lnr mun(I'$ f,rt, th m. suhl4r r' ,h. q nrls rnmFreirln |,tr s of Califomio, ud agr rhlt if I should IE od. srbjrr ti rh.
<br />*o*n'.omp6$li)nrhvisiodofsdionlT0oofih.tnborC.d..lJtrll.fodn*nhcomplywirhrh)srorieio.s
<br />WARNING F!'lurc ro s@ $o 6 onFsarirn covdn8c 6 unlarful. d lrBll tuhJ.cr u @rlolr r. nmiml FEh6 ,nd
<br />.6,1 li.d up ro om hudn d rho@nrl rt Ua ll l (xr.o(xrl. i. lddirFn ro rhc cor ot .ddaE6i ion. d,msd a Fo\ d.d lor !h.
<br />S.cl6n !076 ofrh. lltv (od.. inls.r.nd dlonE! ! r..l
<br />DECIAEAIIO!
<br />I hd.6r rrm undd FMI'y or Fjury !h, I D li.6cl und6 FrBioi oa ch,Fa e (on.ftrn* $ nh Sdbn 7(xlrl of Di\ E$tr :r
<br />of rh. llulre rnd Pr.fBioN Cod., ar, m, lk.* i in tull fora !d.rl.tr
<br />({f<l
<br />Id"
<br />AZAGZ
<br />triso l( r-r^o- 7<)
<br />CONS']RU''TION LFNDIN(: A(:f N('Y
<br />I H!.mm m& rE h! of Fjurylh,llE a.odtudb. kfitrS.gtrt lor llE FfM. of llE Krt hr utlih rhi Fh. u
<br />is!.d (s( 1097. ( iv c)
<br />APPI ICANT DE('I- XATION
<br />I hcrt'y lrmn undd p.irhy of pqjury oN ol1fi. following dclr.t io.r
<br />tlmlilion PmneAlb6los Notilic.'ion F.d.6l R.guhioG (Thlc 40. Pd6)
<br />flqRcqutr d ti!6 or|1di6di,n
<br />l{q I c.nily rhar rh. Ld6.l r.sulario Es!'dins 6b6los rmvd rc n{r 'peliclbk lo rhir prcj.d
<br />t0,-i&,t,,t '. -a,l!.pplidir. ftl rdcrhi $.rborr iotondir. i cor.d I .eE ro omdy *nh rll ( riy &d ( ounrr'
<br />o.dine6 !d Sid. t s FhiB
<br />'o
<br />tlildrig .otuiotr tn hftb! dhoriz EF6drir6 6f lhit any ad Coonl' to o s upn llE
<br />rlFr.ffinon d p$pdr ror
<br />Appridnr or Atenl shnrlu.c:X
<br />r"*ir* n.."rp;n,r, )(o .Loq
<br />lzdzoa
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing t
<br />Shear Wall )/I i\1rll?")
<br />Framin s I
<br />ln s u la tio n/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL B tt ln ,/aqffi
<br />Certificate of Occu Ipancy
<br />Notes Remarks, Etc.
<br />)
<br />I
<br />Pool Fence
<br />I
<br />Flood Zone Certif.
<br />I
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