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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE oWNFJR BUII,DER DIILCARATION
<br />I hcruhy rfird undd p.mxy or p.rjury rhal I a .rcnDr rh) lhc (tnlrlcnnr License lrw l'or lh. trk,*int r.av,n (s..70.115
<br />BLrinc$ Md Pn,f.sn,n Cod.) Afly Cily or Q)utriy which equncs i Fruil lo con{tocr. rllcr. inrrr.\t. dcmlhh or rclrt any
<br />sfl.lurc. prn ro its isqmNc, lho rcqutcs lhc ulnlic. ntr $ch pcrnrilr{r filc a \igncd {trrc tnr rhar hcor shc h liccnsd I'lFUnnr
<br />b rlr F,!i\i.ns olhc C.nt,.ror's Li.e.s.d tla (Chlt)rd 9. Co'hnrri,r! with Scclion 71xx) ol Dilhn,n I oi lhc Burn'c* itrd
<br />Pn,fc\sn,nsC.d.)orrhd h.or shc k cx.nDl lhcrcfrom mrl rhcbash lor rhcullcscdcxcmprion. Anyvi(narion.tSc.riotr 7011.5 hyony
<br />rnplicrnrfor fl pcrnrir sun]cclslhc !!pliclnr ro uci!ilncnalryo{..1nmrc rhtrtr liv. hollllr.d dolln*(15u))
<br />L as o{nfiorrh. fl,Fny. or nry cnpnry(s *i'h E08.s.s rhcn h[ comprnsulnrn. willdo rhc {{,k ntolrhc {trrurc ( mr
<br />i, c cn or oltircd lor Mk rS.! ?01-4, Busincss lnd Pnntsio.s Codc 'I hc Conh.ttr ( t-ic.n{ hw d.cr tror lPlly to !n owlEr of
<br />rh. |m)rEdy *lrl lnril& or i'nnrovcs rhcNn. ehodcs\udhsrkhtn\cllortu clforrhrorghhi\orhcro*ncnld }!cs.
<br />Iolidcdrhrr\Kh impnrdinh d n inkndcd oror.rud fitrsih Il howcvcr thc ttrildin8 o! inDmvcmnr i\ $kl wirhin nctrrr
<br />oi con[lcl ion. lhc oqrEr Bui]dcr wilLh0vc lhc budcn ofpmviry that hc or shc did n.r huild or i'nprovc ttu pn,Fny lor rhc puqr{ oi
<br />_l. x\owocroirlEpm|Edt, a'ncrclo\iv.lr.onrracrins sirh licctrscd co r .!(rstucoNrnrr th. [.Jccr (Sec '70,$. Dusincs\
<br />ihl th)fc\r Cod.: IhcCotrt.dors Liccnr Lrs do.r nor l,plyto.n.n.d ollropeny*ho l'lildror imtrcv.\ rhcirotr,
<br />and who conrach lor such Fojccls with ! Conrra.rorl9 liccn*d 0!6umr ro rhc Contrirtr\ Li..nsc tiN).
<br />lrr.x. rp! un(lcrSccr
<br />]v!BNl&5:.CoufENS fl)N
<br />![cl.a8Auox
<br />I hcrchyrrlnru crp(nnllyol,)crjuryoncolrhclUL,qnrsdccl {ri{nn:
<br />IhNcmdwillnrn ain o (tn iltatc ol Con{ lo Scll ln$rc 4.. * orkcr' .omFnerion, pn'vid.dforbySc.liotrl7(Dolrhc
<br />titxtr Gldc. Lr rh. ,nfoiiMn.c of rhc vork for wh i.h rhc Fnnir ( issucd
<br />|*i,nir is isnini I!1y *orkcr' .rnnpcn\xri{nr i'i{trnrr.uiilcr rd |hlic} trunhcrrc
<br />t
<br />\05l to- tL. ta
<br />I crnily rh3r in rhc pcrturmicc ofrh. slrk ntr trhi.h rln\ Fnnir is tr{rcd. I \hrll ool cnrl,,y orry
<br />'trrvr
<br />in rtry nrrtrn.r
<br />s) Nk,l{( rE sunjc.l io llE sor kcr' conrF$\rli(D lnr$ ol Cnlilonri. rnr xs'cc rhxr iII dx)ulilh.r. t {hjccr rorh.
<br />trorkds.ornpctrsalnr|xisi\i,,trrolS$lion37(x) lrhc l-trtxtr C.dc. r 1hrl!. krrlrwirh.omtll sirhrhosc tovhions.
<br />$,\RNIN(;: |x'lurr t, \rLxt \ro'krr( .!NNi\rrr{ .o\en!. r! r nfkry.r r' ftimirrlrfilri.\ rtr(l
<br />,n, dn kgcs rs F)!i(lc(l t{ th..lvil fims np b otrc hundrci lhotrsrnd dollirs islm.uD). ir odd
<br />sc.rnrr:1076.trh. trfttr (i c.iricrc( d{r-18
<br />^
<br />Ihcrcnyratunru cr Enrllv ol rriurv rhll I '!licctrrdtndcrnroviiinorChrlrcr91.. nmmitr8 wirhSc.lion xIn) olDivi\i()i l
<br />or rhc Burnrssrnd I']rofc$i.rx Codc. and myli.cnsc ir ir tulliorcc 0r cttcr
<br />b ?b?.14
<br />f-/t/'/8 w
<br />*nulrS.. loq7. (-ir ( l
<br />AfIIIIANLI2EI;LABAIJTN
<br />ln.rbydlnmundq pcnolly oilcrjury one ollhc lblk,winE dcclarr'ions
<br />D.ndirbnPc nirs Ash.sosNoriri.ationFcdcr(l RcAuln.ln"N(litlc.l.(J, lnn6)
<br />R.qun.d Lc(ri of Mrifi.nror
<br />I c.nilirlr.r rhc lanerrl r.gtrhtnrs REa'JinEr$.{o\r.nnnrluc nor rffluht n,rhi\ l]n)j.cr
<br />rli c nrI i,rri\.frr.r I r!rc. n, cotrrt,]! \ hnllC[]_i (ntrfrr_
<br />hcrchrinlhorncr.nrcs. rrivc\{)lihi\Ciryr dCotrlltynl
<br />llrditr rld Il$rturlrl '.n{,ln.,Ir,n. irl
<br />,tr,I'tr' tr,. , trI\r. rlr(\'.1.i""n trlnmI,,.r
<br />Jh{r n,s ntrq n. n."y r,",,rr',", v'trI,r,,1.
<br />,rr,*r*^*rr,*rrr"/ \M!
<br />t'"^,lt"" ,,^" tp;"t, ,y'/ |otxlt4 n&f 't\ "b
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Roof Sheathincl
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<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 />Engineer Final Report
<br />-:-)7/26//i '.1rut '.9/
<br />1Certiticate ol Occu pancy
<br />Notes, Remarks, Etc
<br />ID/SIG.COMMENTS
<br />Sublloor/VenVl nsulation
<br />Flood Zone Certil.
<br />FINAL
<br />Ixtrdc.i ddr.(
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