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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DET-CARATION I hscbv rlfm uadd panty of Fiury thr I d qa4t nlB rlE Coffi6 tile liv for tlE lolr,*ing ra]n (S< 70]l t aNin6s od Prcf*ion aod.lr Any Cily or County whth r.quic ! pdet ro coruM. 8nq. inFoc ddmlih or lE.i oy fld4 Eir ro ir! i*lGq rlo rqui6 rh. e,ltor for $ch p6En io nl. i ii8nrd nnffir rh, lE or $. ir licaB.d pu$!r to rh. FovlioN of tt Co.rfftdt Ltcr!.d tlw (CtlBq 9, CoI]ffiins *nh SdD. 7000 6t Divbio. I of th. BGilB md Pmf6b Codc) mrhll h. orshc is s6pl th6.frod &d$. b6ir fort& nklcd ddption. Anyviohbnofsdrion 70ll.t br Dy .!pli..r fo,rFnn$bjd3tt rpglttd ro !.ival p.utyotmr mEtha fivG hurd.rd dolld (tt00). L 6 0*16 oflh. FoFry. or my cmptqE wrlh sss6 6 th.n ,E @npordiol! wiX & d. *dr !d dr rrrrE i! ml [roxLd or ofrqld for r.L (Sd.?01.1, BGiIB.ad PDf6tod (-6& TIE Cor.r-ld ! LEoe t5'&€ &l @9ly io x o*ta of !h. prwdiy el[ b!il& or ulpm!6 tlEBtr &d who dG eal str hi@laor half or 'hml3h hn q lE ou.tplolt-. ForiLd rhd *h rrForqr6 E @l rrcd.d -olH 6r *.l( how,llE h'ldru or urpr.!frrl i! $E wnhii oi. t@ of@mplriorl rh.OrG Buil& vill b.t.rh. hrdoofFovir{ thr lE tE dd br hild or irFlE tlt FoFry 6. $. F,!o!.of - - L c ourn oflh. Fopdry. e 6.1u,!.ly .o.rdins siih li.oBal co.lra{loa ro rcdrud tlE F.j.d {56. 7or]l. &!16 !n PlD,3ih Co& Tn. Co dois Li.N t w rb6 ml !p?ly lo e o*nd orFoFly vho b ld! ot impEva $q@n lnd who coDtr!.13 for 3ucn prDjd! wnh . Coir6clo(5) lta!.d Fr6oi to rh. Cos.ld r LiG Le) -l m.x@F u!d. Seli,n- loxtrE85:.QllfElrArla! DIiCIA8AIIO! I ho.h! amrn undd pa{lry of pdjury o.. o f rh. fdlhsin8 dEhrdioB: ,_l h.E nd *iu milr.nr. Cdift.rc of CoM:l ro S.lf-l@ fd mrtd otrFlrbtr s ForiLd tor bt Sdrioi l70O of Oc L.bor Codc aor rnc ,qfotlrmc of rh. wrt for which fi. p6,Erl b s.!.d I h,v. rnd will m.rnr.in *0116 comFBalion itMuq B tqun.d by S.dion l?00 6atlE L$or Co&. for tlr Ffi)trrrc ol E "ort fM *hrh rnir Fmn i isr.d My worl6 o6p6'!iio. idlltft. c.ro d Fli., nuba a.: -I.dl'rylh i io th. pqfo.rjs. of lh. srl for *nich rhit Fnn i! is.4 I rh.ll ml dpby my Fsn in ily @F $ Erobcorcrubjd!orh.m 6'comF srion hE olcdifornu. &d e@ Dd ial {buld beo@ $bjEl to th. $brl6' compdE li.n Fnvi5io6 olsdior I700 olllE tdor Cod.. I 3hdl. fonh$ti 6mply * nh iho* FovnioE. WARNINC: F.ilurc ro sw work6' conpats.liotr cova.Cc a mLwtuL .,n rh.ll $bj€l e dploF lo ditud FEri. &d cr 6tr6 !p ro oE lMdr.d rhou{nd dotls! {tl00.m)), in .ddhbn b rh. co, of onp.elioll. d&n.s6 a provil.d for th. SErior 1076 of rlE llbor Cod., inldcr.nd dbrEy s f6. Applor: ucElsl[CaNuacraB DSJJAAIIOT I hGb, .Irtrn uidd Fndty of pcjury lhd I m li.a!.d ultdd FDlnio. of chtpid 9 (coMing wnb selion 7qr0) ol DirBEr l ot th. BslB..d Prcfdioc Co&. r,n hy lic* n in tull forc. a .fl..1. cqxElB!(flglludllNclofd(I I horby.llm 6d6 F.dt, ofFjur,thd lhqcis. @ndruclion L ins tsdy for lh. pofo,rre. of tb. mrt for rttth lhL Fnl it isn d (se.loe?. Cit. C ). Ldds 3 N6c: - AIET(ANLDECIJsAIIOB I ho*y dl-r urdd Fdy of Fjury oa of th. followirg deldioa: Dmolirion PmiteAst6to! Notilicdion l-.ds!l R(guLrioa (Til..l0. P.n6) R.qut d ldrd of Nolifcai,n I cdriry rhn lh. fnidil r.g hrio6 rqrdr{ ab6tor lqm\de nor 4?lr.bl. lo rha poJai I .airy ftn I h.E raj fii +plkdion md !r . lhn $. lbow infoddio. B 6r.tr I .!G ro onply *nh !U Cny .rd Co6ty ordio46 !d Srr€ l.w r&uB to boildiq @orrurio( lrt lE ty .dl'orn E .e,ric of rhir Cny !d Coury lo o16 upoo 0. .!o!.6rio..d FDpqiy tu iNp<rioD pEF6 Applicur or,\ur siBnrrnr( PtrmnR n{mr (!rinl ): Set Backs Forms/Steel/Holdowns 3,/8 -U Lze 2n Erection Pads UFER Ground SLAB Floor Subf loor/VenVlnsulation Roof Sheathing Shear Wall Framinq lnsulation/Energy Drywall Ext./lnl. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif 2--, =.V /s ^a #ez qlJ I #gl}^e-->\). ,rr c-b FINAL 3-27-21 12 4c,vt4s Y2t7 Certificate of Occupancy Notes, Remarks, Etc.