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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCAT",\TION
<br />I hcrchy afltN ufr,er Ntrrlry oi pcrlury rhd I dn di.npr from rhc A,nImcnN l-iccnsc L{s (tr rhc rblb{in8 rcasn (Sc.70ll 5
<br />ausirr.\! rnd P0fcsion C.xlcJ Any Cily ar Ctunry whi.h rcqxn.\ r lf,nnir r. Nnntu.r, rlrdr, im,,ro!c- dcmlish or rcnlir any
<br />nru.tuE. priorro irs isiu,ncc. als ftqunc! rh€ 3pplic r nn su.h pclnri ro nle I siBmd narcm rh0r 1.. or shr ir licc.sd punuair
<br />to thc tovr\i.n{ of rhc Conrtucttr\ l.iccn{d Law (Chapicr 9. Comrrcn.inS sirh Sc.iion 7fln of Dilki.n I nf rhc Brsincss and
<br />PFlc$ions Codc ) or r lmt hcorshc iscxctrrp' rh.rcrronand rhc hasn ld thcllL8cdcx.qnnnr. Anyviot ionofSccrinrr0lt 5 b),ny
<br />applicanl fo. ! lcrnrir subJcch thc Etlicant '. acivilFnalryorftn nrcrnrn rivc hundrqj d.lltrr (!5(]O).
<br />-1,
<br />,\ owNr of rhc popcny. (tr my cmpk,yces wirh waBcs rs rhci $lc otrIf,nrrliotr, will do rh. sork ml rtr ndm tr mr
<br />inlcndcd or olt rcd for {l.lsN.7().l]l. Burin.ss lnd Professions Codc:1h€ Contr0dois l-i.cnsc kw (n)N nor aDIy to nn osnn ol
<br />rhcrmlEny who huikh.r i,ll(,vB rtrmn. snd sho d@\ sNh w.* hinNclror hfs.lfor rhbo8h his or hcr oonemplotcc\.
<br />pn,vidcJ rhar slch inrl'ov.ngh m mr i cfried or ofladl for sL ll howcrr, rtr btrilliry or i,W'o$mnr is sld wirhin onc yts
<br />oroq,hri,n. rl.c(rmr aDi crwillhirclh.bnftlcnorpn,vingrhathcorshcdilnolhuildorin{'mrcthc,'mFrtyforthct'uqr$oI
<br />l. rsowncrollhcIin)Nny. rncxchr\ivclyco ra(ing wirh liccn\c,l contr.xns xi.onirucr rhc pnlccr (Scc.70,+1. Businc$
<br />nM H$li:!\irnCo,lc'llrc(\nrrn'cnnsliccnrcl-iwdocsnoll|)t)ltninnown$or|nofcdywhohuildso.impov.srhcrcotr.
<br />rn $ho conrrrls l.r srh tn(rl$rs*irhnCotrt .knG) licc'r\crl ttrFuotri l rlrC{ r!.Irtr \ t,i.ctrsc Lr$)
<br />-l
<br />rnrcrctrr ntrlcr Sc.lio
<br />lonxDBs:tllalfENlialloN
<br />DI'q,AN{IlaN
<br />I hctohy rllnm unicr p.Mlryoltqtuyom olrhc lalkrqii:e d..hrrnrn\
<br />_l h!rc and vill mi"rutu ! Ccnirrorc or con*nr b sclr lnsu.c fq work.s conlPcn\lr iofl. 3\ pmvidcn lor by Ssrion l7(xj ol rhc
<br />hlnr Conc. tu r hc p.rf.nukc .r rhc w.rk r(r snicn r he pcnnit k hrucd
<br />I haElnd will nuinhir *orkcrs' conrr.trsrrion iNunn.- r\ rcqutcdhvs.cri,u.lTrrolrhcLntxtrCodc.lhrlhc!.rlorm0nc.o,
<br />rhc Norl i{ whi.h rhis ,Eirnii n it compcn\arion iNurrnc. crricr an l Ix)li.y numlEr irc:
<br />x,9-/3- zo/(
<br />I..nil!(hrr inrh.tcrlonnNColrlt*o'If{,whichrIi\ncrmir \i\wl.l\lrltr.r.nrnhyrry|Er.firrryNatrncr
<br />$ xr h hcoN {rlr]!.r ri rh. wrrk.n .o Ntr\rrnnr h*\ olCrlifin,ir. rnd +'o. thxr if I slnnili h..tr,c suhjccr l. rc+
<br />.N1l lnjc\ ut1 k, rtrr htrntlrd r|r!\xnd d.ll r\ t$tO(r.{xr0r. ir rlirirrr b rh.nsarntr. da Ucs trs provldcd for ihc
<br />s Sc(riotr rU76.frhr ljhtrC'iic.
<br />l,*, or-u- tg
<br />irncrc{ rnd rnotrry \ f.cs
<br />I hcrc$yarlnm und.r p{n,lry ofrcrjury rh,r I rd li.rtra{ ondcr pmvi\t'! orCh{rcr 9(.omnEn(ins with Sc.rion 7O(D) ofDivtion l
<br />af thc Bunnc$nnd Ptufc$i,rnsC.d.. aixi nrli.cn{ n in lull l.r€ ind ctlicl
<br />!5!tzsi>**"-./.o". -r'zr - 14lE CBLI
<br />CONSI&gqUONIEN2INC.AIjINCI
<br />I hcrchy uifirm undcr lEnrliyoipcrjDry rhal rhcrc h a con(fl.rion Lnding re.n.t ror rh. FrrornDn.c olrh. work for which rhn Fnnil ia
<br />i$ued (Scc 3097.Civ. C )
<br /> .ITUCANIDET],IINAI&Ii
<br />I hcn$yrnn ruid.r rrnrht orl,.rjrry onc ofrhc fint,Ning d.claririons
<br />Dc k,l(tui Pcnnir\ A\hc{o\ Norifi.rrion Fcdcrul RcEDhrions Ilirlcitr). Pin6r
<br />RrqunrJ krr.rol Norifi.rri,m
<br />l.cnily rhd rhc l.d$rl rcgulrri,trN rc8rrding rshc(o\ rcnm\,!lrr. for )tpli.rhl. n, rhi\ In)1..r
<br />I ccnify lhar I hrrc rcod thn !p,)lior ion and satc rhar rhc dtxJvc inrd,r.r id n .omr I r8i r ro .oqry unh all cnt aM counry
<br />ordinatucs lnd Srarc LrNs rchrin8 ro huildin8 construcrion. tun hcrcby iuihorizc Elrc{nrdiv.\ .l ihk Ciry rnd Coxnryro cmcr upon rrr
<br />$ mnrioNd prorny inr iisjL-rion
<br />ADDlirotrl or acnl SiBntrlurr
<br />C t'rr'a l-
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq Kltr tYt TlltNrt l6'v'
<br />Shear Wall
<br />Framin s
<br />lnsu lation/E nerg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N/aso n r Y
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.\
<br />Leputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL )AUrft>lE)-
<br />Certiticate of Occupancy
<br />Notes Remarks Elc.lubfrD .24t-,n,/z . /
<br />-^ f );-6r-'TE/-74-7/-e--
<br />Forms/Steel/Holdowns
<br />Sublloor/VenVl nsulation
<br />Flood Zone Certif .
<br />tln h9
<br />LrDd.r'( AdJ.$
<br />r"r" O..f'Z l-4?P
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