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BUILDING. INSPECTOR BECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUILDER DET,CARATION
<br />I hcrchy sfinn undcr r llry or p.rjury rhar I m.rcmpt lm'n lhc ConrBcron l-kcn* Lrw rd th. lolloriu sson (Scc 70:ll 5
<br />Busincss uBl Profc$n,i Codc) Any Ciry or County shich rcqnncs o lcnnir xr ..nnru.L ahc.. improvc. dcmlnh r tnst rny
<br />id.rurc, In.rro ns hsu,ncc, sl$ rcquircs lhc 0pplicanl for such [Ermir h fiha \ittrcd $.rcmnl that hco! \h. n liccn.cd PuAutr.t
<br />lo rhc [ovhbns ol lhc Conl6croas l-iccnrd lrs lchnrr.r 9, Commcncirs silh Sdioi 7ffx) of Divnion ] of ltc B!\in.$ $d
<br />Pmfcsn,nsCodc)ortharhorshciscrcnDrth.reircmlndthchrsi\tulh.alhs.d.x.mpti.n.Anyvi.larionotSario.T0ll5byrny
<br />!ppli.0 ntrrpcmit \ubjcc.rhc trptli.dn[o dciviln.nrrryorn.r nucrh!. fivc hundrcddollusl$500)
<br />-l-
<br />rr .$mr of ihc l)lolf,d y. or ny cmllo]rcs wilh wa-lcs !s rhcn v'h conlp.Nirion, will do lhc wort ind llf dnnurc h nor
<br />n .fthn or orlcr.d ld s0l. (SE'70.14. B!sin$\ und Prcltsions Code Th. (i'nta.kt \ Li.cn$ bw docs nor lpply b atr owrcrof
<br />rhc l,Dpcny $ho tuildro! iqre\e. rltmn. md who der crh w& hnnscllor hcr\clfor lhmueh hh or hci own cnDloyccs.
<br />nr.vidcd rhar skh irymEftnk N ml i, cndcd orollcrcd for$h ll howcvci rhc hnikling orinDbvc'nd he0*ilhinoncrlu
<br />ofconllLrirn, rtf,Ownf Bnihcr willhlr rhc budc, of l)()virr3 rhor hc nr shc did mr tiild or ir{rorc rhc pnrr.nr aor rhc PurF)*.f
<br />l. r{ow cr olrhc proncny. Btncxclusivcly conrracrnrr wnh liccrscd.onlru.lors ro.!n!ltocr rhc proJ.cr (scc. ?044. auw$
<br />and tnrtF\irn Cod.: l hc Co.rktr's Li.cnsc Lrw docs n.rdt)ply lo.trowner ol lolrny who hlllds.r imJtrovcs rhcteon,
<br />,nd who.otrrd.kro!suchrmictswirh!Conirado(s)li.cnscdrrr\uMrn,rhccn.r,.loisl-iccnscLrw).
<br />-l
<br />rcxcnrpr unJcr S(l
<br />Ddc OPn r:
<br />woRKEis c(NiPnis^noN
<br />DIgUAAIION
<br />I hcEby llrrn undcr Fnnltyofpcrjury.ic of$. rnlbwint dd.ld,rion!:
<br />Ihrvcond*illrMinrdin0Ccniri.olcolconsenttrScltlnnrcri, ork. .o Pcns,'iotr.as Pmvirlcd l'or hy Stln,n l7m .r Ihc
<br />ljtin Codc. f{, rhc lcrroroftc ol lhc wo* lor whicn lh( !.nDil i{ is\ucd
<br />-l
<br />hrr lnd willflrainroin sorkc^ .o rFnsrr ion in\u rftc. r\ rcqukcdbySsrion:l7l)0oirhcL*orcodc,forlhcp.rf moccot
<br />rh. suk tnrlhichlhi\ prmir i\ i\skl My*urkd{ co rtc \rrtr{ [!urin.c.rtricr ii]!Ix,li.ynu ,h.r rrc:
<br />of A**.,!ro et/C.^a .1t\P.1,,.l
<br />. 3- l-?olq
<br />t rcnity rh r i'r rh. tcrfornuNc.frhc uork fo (hrh rhis t.rnril is i$u.J. I \hrll nor cntby dtry |].rq).ln rnr_ nunmr
<br />s trrotcconE blcd r. rhcworkc^ compcnsrrion hs\ or Crlilnnrid. rtrd 4rerlN il l+oukt hccont \uhj..r torhc
<br />*orkcr( comtcnsnrion proli\ionrnfSccrn,n:lTO0ofrhc titxtr C,dc.l \htll. n)n[$iln.onrnl] sirh rl{,$ tmvhi(,ns
<br />\tARNlNc Frihtrc ro arure rork.^ conpcn\sr n.orrmlc is u h\lul. rnd lhill suhjccl {n ctrlnloycr b ri'nn'r! tunlr$ tr d
<br />civil linc\ n room huDdrcd rhou{nd dollnrs lSl(Xl.(XX)). in rddirn r)rhcco{comp€.s.rio.. damger as [ovidcd for lhc
<br />CVv/D
<br />s.Lri(ir 1076.r lh. rlt,(itr|. i'rcfc< rnd ikrDr! \ lir\((,,,", . E-l(r-\cl F
<br />I hctoht rilfln undrr p.mlryol r^-rjury rhat I rnr liccn*d und.t of chafl.r 9{..nnmrcinB *irh S(rion 7fix)).rDivnio. :1
<br />of rhc l,usircssond Profc\rions Codc. dd nryli..ns. is in tull Lrcc mdcriccr
<br />tol Z
<br />. fr-lb-\I conrmcro.E Ll)
<br />I hcrby aftiriondd Fnnlryorprrjuryrh.l rluc is n consr
<br />is$cn rS.. 1l)97 aiv C )
<br />:'g.tr.y k, rhctcnnnnifl.colr1[ $ork fir $hidrhisli,nril r\
<br />AIELICANIDECI,ASAIION
<br />I hs.tydif, u.dd p.nrlry of pcrjur! o.c oilhc iollowinS dcclarolions
<br />Dcmoliion Pcrmirs Asl,cios Norili.dnr F.d.hl RcSularions (Tirlc,10- Pana,
<br />_Rcqoircd tanordf Noriftr bn
<br />l .cnirr rh ll[ lcd$al rcsuhliotrs ressdins osbc$s lcnn'val rc n.r amli.$lc lo rhh Proicl
<br />AA ..niry rhar I h.vc ed rhis applicari.n ruxl slore rhol lhc uhovc inlhnd nn, is .oncd I 0ef,e ro omFry wilh orl cry ind county
<br />:r#Tj;,ilil,i,:f;vJf;Illl.:.:';'Htr'.J}I.* l"l'crch}lulhurm,.!rc\cnlalNcsnflhrc,dndc.Unly'ocnlgUFnltr
<br />ooo,**,*nr.^r,r **,*u4.fuJfilr"-,D . D.,.' efi:f1
<br />p.d,,*@n.,prin,,: rLlltfEf"X lh vellrrno ,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall dt-'/1 p sz-t,il/
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar qTr t//? f-zlz k4
<br />Handicap Req
<br />Deputy Final Beport
<br />Engineer Final Report
<br />FINAL ?./(22)J/.lrt {rr-,
<br />Certif icate of Occupancy
<br />' A/.A)
<br />-t
<br />UFER Ground
<br />Ext./lnl. Lath
<br />Flood Zone Certil.
<br />Noto5, Remarks- Etc. ^
<br />n.rr"yr.*.,' i.\ BFK{FD,-]8618 266 .,"*,
<br />t-n,t.--.
<br />^,ld
<br />r.\
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