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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNF]R BUN,DER DEI,CARATIoN
<br />I hcrchy aflttn undcr tcnslrr,)r p.rJury rhnr I tun cxcmll lionr rhc On Rcttrr t-,..nsc l,aw lor rhc f(nk,sir1! rcrnr 's"7rni5
<br />Ru\ine\s rRl Pn)fssrn,n Crtc) Any Ciry or O,utrr! shich r.quirc( I lcnnir to .onntucr, rlrcr. in{mrc. d.nnr'di '{ rq[ir Jtr]
<br />{rucrurc. oflor ro iis issunncc. aho r.qunc\ Ih. rnpli..nr lirr nr.h nc.mir kr filc I siSncd { ctrEnr lhd hcor dr h licctrql Pur\uillr
<br />i) rh. pmlnnnN frh. co.imclois Liccnscd l-r* ich{rcr 9. cotrnemin8 *ih sccri( 7(xx) oI oivhi{n.] ofrhc nn\in.s rnl
<br />Pn)lis\n,nsCodc)orrhultE or.hc is crcnrrr rh$cfron rnd rhc brsh li)r rh. rllc8cd crcmplion ADyviohrbndfSc.rirtrT0:rl5 hvany
<br />nmlic! nr rpcrmit suhjc.r\ rhc rpplic.nl r{, (.iviltctrrhy.l or rorc rhan ive hundrcd dollrs rS5LUr'
<br />l. rs oNncr ol lhc lml(nt. or my c'nployccs wirh woscs as lhcir $1. .om,rnsir ion. sill do lhc s{trk ,xl Ilf srrucrE i\ nor
<br />inrendci or o0crcd fn sic {so 7()44. Busincs and Prcfcsions Codc Thc cont0cl{tr\ I -iccn* ltrw doc( nor apllv ro m ow.cr of
<br />rhc pmrrn, wk) huilds or impmvc\ rhcmrn. r'ld wtr dfts sRh so* hinNcllor h.^clfo. rl'rou8h hn or h.r owncmploJtcs.
<br />IoviJedihtrrruch i'npmvcnr sarc nor inlendcd or olLri lbr srlc.li la$cvcr. rhc hurlding or imPrntmnr h $k lirhinonc )Er
<br />oi coq'lcl ion. rhc O*ncr BuiHd will hnrc rh. h cnoltovinglhd hcor\I[did mr build or nq'm!. rh.In,Fnv for lhc N'In{ oI
<br />-l.r\o{rcrofrhclroNnr_,amcxclNirclyc.nlracringtrirhli.cn{dconlmcnnt,con{rucrrttlnjccllscc
<br />7{}& Bu(trcss
<br />i,rl Pn)fssiotr C(xtc fhcConrrs.tr'sLi.cnsc l-rw docs tror {pplynr xno*hd ollr.lc yq'ho huildsor inrrmvc\ rhcrc.n.
<br />lni sho cdntrh l.(, \uch pmjccrs wirh a (i'ntrcron e licrn{d lunmnr ro lhc Conrrcktr s l-i.cfsc kw)
<br />I JmercmDr dNkr s(hotr .B &PC.rorrhFrca\cn
<br />Dale O*mr
<br />UOBSEIIS:.CAIIIINIAf:IAN
<br />I'ICI,AIAIION
<br />I hcrcby alttnrundcr pcMlryoipcrjnryoncor'hc rolloRins dcctullions:
<br />I h.v. dnd will rminlair ! Ccn ificaic of Coh\cd n, Sclf.lnsurc lhr solkc^ omptnsrtion. as pnvidcd fix hy Setiotr 37lD of lh.
<br />Lnbor G c, r.r rhe lclfoirmrc of ltc worl ror whnhrh.,dnrn k issrcd
<br />LhAuaniw'll ,nrdinsorlcr cnn'Fnsrlion 'nsurJnce.
<br />a! rcqutcd t,ySdi,nr:1700 orthc L,hor Codc.Ior rh p&roantrn.ctf
<br />rhc work au*hthrhh p.mir is hsucd. Mywolk6 compcns,rion in$mncc curicr ud Pli.y nnmh.r ffc:lrul-
<br />n"rty Nurru: l,ren
<br />-lccnifyrhrr
<br />ii rh. |xrLnnrrcc of rhc *or[ I{n shi.h rhi\ tcnni i\ i\Ne,l.l.hi]lnnrcnrtk,rrny!.6on in i, trtrncr
<br />$ asro hcmm 6jccr ro rhc *orkds con1F,trs{rion h$ s ol ( nlinmir. iid r!rc htr ial slu,ld h.co'tu subjccr hrh.
<br />*.ltsr.onrp.nsnn,trpmvnn,nsofSccrio.lTlrOolrhclrtirCixl.,lshrll.lonhrihco'nllysirhrho*PnvhnnN
<br />WARNIN(;: Ir.rlure ro secure workc^ .onlf,hattrnr .orcriSc is unhNtul, rnd {hrll subjcct rn cmtl(,)$ h onninil t.nalrh\ rnl
<br />.rvil nrcs trf rn orc hunnrcd rhou\rnd dollr\ (ll(l().tXx)). n trlrri,n,. dr'mgcs r\ nrtriJr(l tur rhc
<br />S.rrnD 1076 ollh.ltrhr Oxtc. i'nor.{ dd
<br />+'(-DEOASAIION
<br />Ihcftbyrfinnundcr lxtr.llyoitcrjryrhxr I n li.cn{rl uMcr Pmvhion ol Chrprcr I (commncins wirhSccri Trl0l)).rl}ivhi.n I
<br />,\(1n1. r'kl flrvlircn\. n i', fulltur.r rkl.lli.r
<br />'UtzJt
<br />1"4-
<br />!;aSEIIICUONuiNDIdIIiACENq
<br />I hcrcby.mirnnndcr pcnalryorp.auryrh.rrl'.rcisrcon(ruction lcndinsagcNy i{,lhc Pcrf.nron.t drrhc!o lnr *hichrhn ltmir is
<br />i\\hd (Scc 1097. Civ C.).
<br />AITLICANLDEII,AAA.IION
<br />t lrrcby ffiinn uftcr l).nnlr, oitcrjury onc ofrhc ftnhwi 8 dcclrlri{tr$:
<br />Dcrdirn Pc.nir!Ashcnos Norincdn rF.dcrnl Rc8ut{tionrI1ilc,10. Pan6l
<br />Rcquircd t rlcrolN.iilicarirr
<br />I.cdilyrhrrrhc fcdcral reguhtions r.Erdnre $h.iosrcnmv.l{rc Ni lpPlicah[ ro rhn rmrccr
<br />I c.'rilrrlnr Il rlr lrl,i\ l,t)lnnr rrtrd rhu i'!Irmrridr a.orc.l l 0Ar\- b cotrldy silh rll Cily !n,l Coun(y
<br />nr.\ rn,lSrJrr I x*\ r.l i'i! ro htrrldrg rcby auihtrizc rcfrc{nrniiE\ ofrhi\ Cnt Md Counryt,.nr.t tlxl rh.
<br />rtivc nrDtiorcd Dmpcny ntr inrFcr
<br />'\Dplirflnl or ,\r.nl Silnnlu
<br />I
<br />*,",$y'ru
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Rool Sheathing
<br />Framinq rN)*b ,/\tuDtk 16
<br />lnsu lation/Enerqy
<br />Drywall t \l 4il4 ,hrrfutl a
<br />Ext./lnl. Lath
<br />Brown Coat
<br />I\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Esqineer Final Report
<br />. Flood Zone Certil.
<br />^1t^I
<br />FINAL //5//s7o rail%4 2'bb
<br />certif icate ol occupincyT'
<br />Notes, Remarks, Etc
<br />Shear Wall
<br />*"r'-
<br />L. d$\ Addrcs
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