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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNI:R BUO,I}}]R OELCAI(AI'ION
<br />I h.rcby ifim uider n.i r,dln riury rhar I merempr i!)m (he Gn(nd.6 Liccnv lr* rr, rh. nnlnrr8 r..q)i (5..70115
<br />,lusin.s nntl Pn)f.$ii,tr Cod.): Any Ciry or Coumy rhich rcqutr.s i t€irnn n) on(rud. .Iet. imptuv., d.mlnh.r r.nn,
<br />^nydtoduft. tIkr(, irs icsurnc.. rho r.qurc h. o,rtlrrmr i,i {ichr.rmir t, fil.a ri[nal n cm rharh€or sh. n rc.n{d Nrrmrh rhc 0mvhi)n! of r (r.nrm.ior's I.{.is.d l-a* tChiflcr 9, Conrn.ncjis wirh S.dirrn 7(XX) olDivnion:l ofrh. Bu\in.s and
<br />Pn)f.ssi0nrcod.)or$arh.or\h.i\.r.flrh.rei.o,nifrlrh.ha\nnrrh.ilLs.d.l.mjlbn.Any!nnrri)iofs..ti'n7r):ll5hyany
<br />lpirlicanr i,trr,l.imir subFdrrh. anllicanthacivilp.flIy.lnor nir.rhii lrvc hundrc ddllaF($51I))
<br />_1, rs o--n.r orrh. ,'n)lcny..r my.'n,'roycc\ wirh ui8.s rs rhcn !,F conrn n\di!)n, *iltdo ih. woA md rh. r*1m n ni
<br />id.ftlcd o.oflr.d ntrsrk rS(7r),14. Busi..sand Pn)fesi..s (ilr., Th. Clr rrc(oa\ Lic.nk I rwd..snor applybrnown.roI
<br />rh. r'mFf,y who hurlds.r 'm|F!.s rh.Bri-.fllwhr do.s \sh $rrk him\clror h.rsclror thmush hk orh.rorn.mthr..s,
<br />provided rh such iqr.r.Bnh tu nnr im.id.d or oftEn nn {h If. h)w.ver. rh. h{iuin3 or i.Iin'umn. ir $ld $iiin on. yls
<br />of $frtLrirn. rlt O*kr Builb will hiE E lnidc.ofnhvin-e r)trr lk orsh€ ilnor IDiIl or impruv.lne pm!.ny fn th. lurllx. oI
<br />L a\owner.frlE |nrtidy.0nc(.lusir.ly.onra.rinN si(h licens.d conrachF rr.on{rud rlI Imi.clS( 7(x,l, Buin.s
<br />rnd lh)Gs.n Gnl.:1lr Conrrrd.ls Li..n\.1-n* doe\ nor rpply r, rn ownd of prop.ny $h. huild\or impmkr rh.r.oa,
<br />and *,Y)..nrnr\ntrsu.hlolc.rsw(haConhcbd\)li..nkJlurumrroih.Contrador'\l.i.ns.l-a*)
<br />I Jnclcrhf'r und6 Secin)
<br />hlt: O*ns.
<br />woRxr, Ri' r'(ntnNs,rfi oN
<br />DICLAX.AIA!
<br />! hdrehy i{fir rn cr p.nJry ot prriur- ok of rh. (rl,N ing (rectinrioNl
<br />Ihrvernnuillurlnt n.Cldifr!(.ofC.n\cdn)S.lfli\urcnnrork.^ (nn[rn ion,rsnn)vid.dnnhySe.rionlTlx)ofrhr
<br />Llhrc,xl.,iinrhen rfo.runcei,f $.worknr$hichrhcn fl.ir (i{tr.d
<br />ffi* "*'",rr..r.* **t.rr ro ,r.n\ ion innmnce. i\ ftqukd hy s{, rn :i7(x) orh. r-,hor cM. ,{n rh. ncrromnce or
<br />rn r.rk i,r whi.hrhn p.rhir h isu.rl. My *ork.r'com,r.n\di,'n instrm'...xr'.rmdpoti.ynunrh.rar.
<br />c**, arrql-V t Loav,\ AJy;Ll1w lllll?-e?-D
<br />lc.nilyrh inrh. |trformnceof rh. sork frn shich rhi\ n.rmir i\ nsu.d,I \hrllnor.mpl,'yanyp.^on inrnynrnner
<br />n) Abi.mmshr.dbrlkwo s(c.mp.n* ntorr.f(hhn)n'.,itotigdrrt rrtsh,utdtEo *rubj.dhrlr
<br />B.rk.^ cotrilEnqrit'nln,visionrofS.cr nl7(x)ofrh.L1htr(ix]..1\lrll.fonhsirhcomtlrrnhrhokpmvnion\
<br />wARNING: ,i.ilLtr. h rcu.e wtrl.r'.omp.ni ion co\.ras. i\ unhwfu| md \hrll {'hl..r rn cryloyd r' aimiii Fmhi.\ aid
<br />.'r'l flnes uD (, oi. hundr.d rhiuimd,lollffs ($lur,Ux)). in rddii,,n h, rh. ..{ ofc.mr'.ns rroges r\ pnrvid.d l.r Ih.
<br />:""- i i
<br />!lrh( Irhtr{n(1.. ni{.n 1rhtr'n) \1!-
<br />tq | z..rLo
<br />^,,,,,,,,,,,,.
<br />I hreh,"xrftuur(ld rrilryolt.r tr'yrh.r ln, l(tr\.dtrfd.rnn,vl\rn of('hifl.r 9l.oNrrncinE sirl, Scdi.n 7(xx)) ofDnnion:1
<br />or (l'r 80!nr$ rnd P'.,i$ilrN I n' rtLr.r trr.frl.r
<br />cto ,e.i\.Ntrtr$.r:_ afrM
<br />Vtv\nf ,<>la|(LI| * lz.,:z-P,,,,,, ^", ",
<br />IQNSI!,USTON.LIIJING.EGIACI
<br />I h.cby aifiirn uids p.nrhyoap.rjuryrhd rh.rc k rco.{tudion k inga!.nc) f(n rh. p.rfnmance ofrh.work nn *hth (hk Frmir is
<br />is\o.d tsec lln7,Civ ( )
<br />AfIlllANLl2[qr$ IQX
<br />I)ikhyrfiirmund.rp.nrkyof prrjuryokof rh.fdl,)v redeclirifu,i\
<br />D.nrlirhn fermn\ Ashr{.s Nori6cr. n r?{t13rR.3uldi,)ns rTirld .10, l,mr6)
<br />-R.qurdl
<br />l!(.rilN.!i.dhn
<br />l..nifyrhr((h.f.d.mlrcEul.rion\EtMliiEish.no\r.n,vrlirenorrppli..hkrorhnlln,tcr
<br />\Lt{ry,r,. r r,*.,""4,r,i{ dprrrarj,,i m rar.rhdrh. x r,gr€nrcomprywirharci,andcounry
<br />ni,l'nrre\ .ft1 SIa(. Ltss rel.riip t,
<br />$ok mnrioned nr.ntny ntr in\rcr
<br />Applicanror A8enl Signclum
<br />orrhn Cty xtrd (routrry h.rr.r uNnrhc
<br />,,^,n* *"*ron*rt p4 a "* llftlz-t-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulatron/Energy
<br />Drywall
<br />Brown Coat
<br />Itilaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handi cap Req
<br />Deputy Final Report
<br />tngineer Final Reporl
<br />Flood Zone Certif
<br />/t
<br />FINAL )R ilw &Ldat*
<br />Certiticate 6(dcitparrcv
<br />Notes Remarks Etc
<br />I:l(lv 08-0;' 2t) l5
<br />Ext./lnt. Lath
<br />Grd.r'\A Jr.(
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