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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER B('I!-DI:R Di]l,CARATION
<br />I hcrhy rlltm uid.r pc ry r)f pcrlu,y lhir I aN cxctrrt lioDthcC(n rfldon l-iccnsc L'w fitr rhc folk,wi.8 rc0wn (Scc 70ll5
<br />BuriNsr rnd Proiessirr Codc) Any Cir, or Coutrly *hich .cquircs r prmir h .on{flcr. rl'c.. inl!)mvc- .tmlish or rFn rny
<br />nrudurc. nriorlo ns issuamc, dso rc{lutu\ rhd trlplicur r(trsu(hpcmir hlilcrsigrcd sldcnrnl lhal heor \hc h li..n$d purs!$r
<br />h rh. F)viqnrns orrh. Contrn lols Liccnscd Liw (Chaocr 9. Cor.rcncins wirh sccrioh 70fi) or Divisnnr I of lhc Aurincs and
<br />Pmlc$ions Codc)orlhrl hcorshc n dcmll rhcrclrom.od rhc hNn lor rlfnll.g.'lcxcmprio. AnyvtnolionolSccli{,n70ll5byrny
<br />{plicatrr t{, a pcnir sul'J..r\ rh. dtpli.anr k, a.ivrlp.nnkyorn.r nxtrc rhnD lire hund.cd nolh6 (S5(D)
<br />_1.tr\o*ncrollhcp'o|*nt.(trtrrrci\pk,yc.\wirhwac$r(rhcn$b.o.Dcn$ri.n.$illdolhcsork d rhc {fl.hm is Nn
<br />inrcfrtcJ orofltrcd for $lc lss T(114. lnrirrcs md ltdt(iotrs C{tc,'l hc Conkr(r'\ t.iccns trw d.cs nor lnplyh ]n o*tur of
<br />rhcpmlrny *ho huilds or inDn,vB rh.tun. irxlqtu docs nrch ryoA hnnscll or hrr\.llor rhtuugh hh or hcr owtr enrPloyces-
<br />D..vidcd rhal (h inll,oremnh m mr inr.ndcJ or olIcrcJ rbr slc Il t(rv.vd. rh. hnklin8 or irrlr.ovc'Enr is $ld sirhh onc )trtr
<br />olrnnrlcri,n. rh. o*mr Bu,lh wiu h,vc lhc n{rdo oilmi.g (hjr h. or sh. dil mr liild or imtimlc rhc ptuFny for tu Nqnc ol
<br />I..\otrtrcr.frhclx)J)tny.lnrcrclusivcly.o rncring*irhliccnscdcotrtrctrski.utr{fl.irh-protdlscc7(84.B!.i"rs
<br />mJ Ptrrb$ion Codc -t hc C{,nrrttr s t-i..n\c Liq docs nor Jptly l. m owncr ol pDt^-dy *ho hoi[h or i'n[.vcs rhcrc.n.
<br />rtrd qho con rcr s rd such I'nicrs wirh u Conr6.t,r1\) lircnscd rurs!,ir tu rhc Coftndoi s Liccns h$ )
<br />Imcrc dunn.rScrtron .B &PC lorthnrD"'i
<br />Dole: O*m.:
<br />woR(Itld(' colril NsATl(|N
<br />D[!:I.A.BAIION
<br />I hcrcby rflirn undcr pcnalry ol pc.jury one oflhc iolk,sin3 dslururio.\:
<br />I h!\r and will tuinr{innCcniarcrlcolColscnt loSclf lnsurcIq $ork.ri c.nrp.trsdi,,n. is Providcd lbt hy S(rion l70O ofrhc
<br />I-rhtr Cnlc. r{n rhu l.rr.rmn.c ol rhc wort hr *hich th. ncmit ir isstrcd
<br />-r halr &d $ill man rin +ort$s .onrri-n\rrn,n nrurrmc. rcqundhtsc.rionlT(x)oirhcljhorCodt,torrhcr.rrurnDn.col
<br />rhc wort aor which rhis rcnlit is irsucrl My qork.* .onipcisdn nNUrM.c.lnicr and Jinicy nu'nh.r rc:
<br />Rnicy Ntrrhcr:-
<br />_lccnili rhri h Ihc ncrtui,tur.c.lrhc \ork ld *
<br />v, !( kr bc.onf, rubi..r ro rhc $o r kcr( co nrEnsn' ion
<br />s.rkcF ..nrNns idr pmvisi,)ns of Sccri :l7mol'
<br />WARNIN(i: Firilurc r, {.urc w.rkcF conv'.nslt()
<br />(Nil lir.\ ut l. otrc hundrcd Ihousrnd dolhrs isl(
<br />[ich rhi{J{nnir ir is{'cd.l n,rll
<br />h*\ ol Cxlili,anr. r rltr rlrr
<br />lhc I rhtrCotlc.l \hxll. ndhsirh
<br />n.onrr8. '\ unlr$lul. r d nfl
<br />x).(x)l)). in i,ltliri,[ 1o rhc.oi ,
<br />0orcmPk,ya.y t r$tr ir 0try n nncr
<br />ifl sk)uld t{rotrE suhi.r t, rh(
<br />comply virh lho\c pmvni{,ns
<br />I {bic.r 0n cmnblrr ro oini'rrlIr ,lri. rid
<br />mtrtr\rrnnr. ,lxn g.\ r\ tnvnlc(l li! rhr
<br />Sccriotr:1076 ol rhc trh, C(,,. ffrrfttrr c. inrcrc( a.d lrlomy \ lce\
<br />6 oron-,., (
<br />Ihcrcby rlliirn utucr r^_n0lr, olI]crjuy rh l sh liccn{ar u d., nrovi\ion ol Ch{rcr 9 (.nnrmncin8 wirh Ssr bi 70fl)) of Divniotr :l
<br />ot rhc ausiM\\ md Porc$ions Odc. ai my liccns is ir lull hrcc ud cfr.cr
<br />,*-*"(,
<br />IAN R.UCI,IONI.ENI),I iENq
<br />I hcrcby rlimrundcr |ctr.ltyolpcrjuryrharrhcrc n r con{tucri{'n !tulin! rsrtr.t ln thc lcrlonumcc olrhc *ork ror $hf,h rhn lxflnil is
<br />hsurd rscc 1097. Ci! C )
<br />I-cfldcls Nanrr
<br />-arfucANrlrlltrl&Lua!
<br />I htoby nmm undd l.mlr, ol t{rjLtry onc olrh. n]lk,*nrB dc.laftri,,ns
<br />DgnDliri,r |cmir\ A\h.(osNorin..riotr frdcral Rc8ulrridr\lTirl. 10. 1'an6)
<br />Rc!uircd lxrrrr of Norifi cdi,rr
<br />_l ccnilirhnr I la'vc rcxd rhi\.ppli.rrotr flxl {rrcrhdrhcnhrvc iohnnrri,)n iscotrccr I alttr lv wirh illClrlr nl(\nn \
<br />ordinamc\ lnd Slnrc tiss rclnring h buildint (.Nru.riotr. dkl hcrchy lurhrrizc rcnrc Ciry ard Counly ro.nlcr upon rhc
<br />rhr( n( !iultr,,lur\ l,i nri]lrlr,' Dtr'D!\.\
<br />,\trlicr orAEolSiqnnlun,:\
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall ^DFraminq014/A-,W gtr {4
<br />lns u lation/E n erq y lzr C
<br />Drywall 6"A"lX ptwg)
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />/4,
<br />FINAL 7-75-lg x-V{-\tS
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />a,d'ic,
<br />I cndoi\ (idk\s
<br />I.cnrfr_rhrt rh.lidcrrlrcEUlrtiotr\ EgIdinE r\h.{.\rrftnrlrrr norx|flr.rhlc tu lhn pnil.tr
<br />Arry-'PlG
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