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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/VenUlnsulation
<br />Roof Sheathing ol3/t+ lD +rf\+ ,
<br />Shear Wall I
<br />Framing
<br />lnsulation/Energy
<br />Dryrvall
<br />Ext./lnt. Lath
<br />Brown Coat
<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 7//7 /l=l It//r/
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />tV.fN^ b.K
<br />OWNER BUILDER DEII'ARATION
<br />I lEdl rilm u.d6 pa[l.l) oa pdjotl thi I m .!mF tom rh. ('d.-6' Licoe L,u ror rh. rolr,trinB rfr. (S< r01l 5
<br />tluind drd Prof6irr Cod.) nr ( ny or Counlt nhih ,.qurd r Fni lo Ndtud. ahd, 'mtro\., d.mlih or qln ur.
<br />itunu., rrE lo ns Bua., .k ,r]U66 ih. +plkei lor r.h Fnnd ro 6k ! sr8..d rdffir rhd lE or tlE ir l'.oa.n ,nNrrd
<br />to rh. ForsnB of tlE Conkrro.! l,'c.B.d L!\ lclErid 9. ( ohEfr'ns snh S..ii6" 7000 ot Dtist. ! of rh. lrusins ond
<br />Prof*nrni Co'j.)or lhar lEor!h. n -ofl rhocftom and rh. hoss tu rh. ill.s.d.(otrio. AnyvnndionolsdirnT0ll 5brtnt
<br />aptli.! lor . rdnn suhjdk rh. arpli.rn! b.civilp.mlr!ofnoi m.r.rhd fi\. hrndr.ddollsr($500)
<br />l. Et o*fl6 oalh. prorEny. or my onnloyG q ilh va*6 as lhcn Fb $mp.Gdr ion. (ill rh
<br />'h.
<br />$dk ard rlE nru.luc ie ml
<br />ddrlqi or o,Lrd tor elc (sc 7(x1. BBin< md P,nlsi.B cod.: Ih.Gtu.do.s Lk.G tiq do6 nor q''1ly ro eo\nd.f
<br />rnc Fl'tn, s llr hrl& or nrF\6lhcotr s'd u lF &E sh N,l i'n*lr or hdrlf or rhtuqh hr. or hd .$ f, .nploys.
<br />t or,:tdrhdru.h dF.\ffis c ft, ddrldl.r olrd.d aor $L l( ho*6a. lhc tlild,r8 or n rllcFl irtldsihin"ft !6
<br />ofmq)llhc llE OrF B{rUd s l hlrc rli hnlor orFrins rh, lE d dk dd d hild o. np.o\. tlE ,rcI6! a rlE lu?G.or
<br />l. B on'G of rh. FoFU, @.!.lu$.lr.o r..riry *iih licaa.il..dranE ro coNrud llE For.(l lsa 7ol.l.lla,6
<br />lrl hlasih co& Ti. ('ortFor ! l,ic6* lrs' d.6 mt .rt'l! lo u or nd oaFop.dy *ho brildr o. impNs ri66n.
<br />trnd trho conrrk ntrru.h lror(h$iha (i,ntadoisl I'rdtrd Nr\uitrrr, rh.(.nradois I i.{r I
<br />Iitr,.\.n, tr er Sr.rnnr r, a r', 1,,,*,..,"*/-I i-,/JL-(bgxr {s t t,"rrrrsurun
<br />DECIAAAI]S!
<br />I rE .tit .rrm undcr FEX' otpEjury oe ofrh. folhu $s ddlo.t ioa
<br />I h.r. dn s ill roinrli. a Cdrf(!r. of ( oE6l r. S.lt'lNrc for rnl6 .orqEanion, d F.\ id.d fd tr Sdhn 1700 o f rh.
<br />h&, cod.. for rk Ffoirlm. of
<br />'h. "nt for $nih rlE Fmit a is<d
<br />I hi\. .nd tr iU mrinrrin s.itdi corp.Brtion iBuranc.. 6 r.q!tr.! h! s(l nn 17(xr oarh. tjt$r ( ixl.. for rh. psIomN. of
<br />rhc s .k for \rhirn this pdnil n !a!u.'j Mr, *orkm compglsrion inntrNc.n6 dd pol,.) ntrmlrdc
<br />Poli., NomiE
<br />I cdri lhd
<br />'n
<br />th. pcfolrrltr. of rlE $ort fr strich ltt Fn( 'r s.d, I .n. mr aPlo) ..) Fm. in tn! lME
<br />h 6 ro b<o@ -bi.tr b ilE tr rtd'omFMFr l,s: otc.l'fomia sd +r rhd if I druld b(om ub.( t. llE
<br />*ortd .onFdil. Fo\irh6 of sds. l7m of th. r,&r (_c,. l !tu|1, n(hsnh compb tr(h lrntI'r.rai'6
<br />ltARilN(; Iriilu.. to wu.c sorlG\'c. ,Il(rdion F\Fa!. 's rnhstul. ifrl \hal
<br />.'vrl fin6 up lo orc nun(H lli.uqnd &116 (1100.0(10l. in artiirn
<br />S(non r(176 ofrhc Lib.r Cod.. rirEerr ud rorrEr's rd
<br />DESJAAIIA!
<br />I H,y lrm und.r Fuh, of FruD rhr! I m liGEod urdd rm\iihn ol(-h,P6 e (omffiins *nh S.cinn 7(x)) olDnision l
<br />ol llE tlsilB rd Ptltsn]B Cod., nn ny lt@ i5 o tull to.a !d.rT.d
<br />(a! tru(I&xl.l,NuNi-a(ili!(I
<br />I hrcN amrm und( rEulryolpdjuryrhd lhc. i t $(rodio. kndin! 4dc, ao. th. Flomm. oIlh. sork ror rhi.h rhis lrnir i3
<br />isu.d(s( 10e7. Cir C).
<br />AITU(AtrLIIES.AMIUX
<br />I hort'y .rm undd Fnah' o f Fju.y oN of lh. lolkrx irs dc(1,.1ions
<br />D.molrril. Pmi.'Arb6r6 Nolincdio. r.is.l R+olations ( rnE,r0, Pirl6)
<br />R.rtun.d Inrd of Nori6cdion
<br />I.d'!-rhd rh. f.&r.l r.eubrn'N E3r'lin*st sosrdorald..or q,I]liobl. (, rhis trojd
<br />asratu.on,nl\ { trh all( \.nJ(i\'n6
<br />N6 ofrhtr (\r] sd ( {'uh( r. orc ulF. rh.
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