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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DER DEI-CARA lON
<br />I hcrchy aftlnn urdcr pctrilry of p..jury rhar I rn excmir tft,nr rhc Contr.d('^ l-iccn{ l,trw tur
<br />'hc
<br />fink,trin8 rca\on (ftc7).115
<br />ansims rfrl Profcsnrn Cd€): Aly Ciry or Cou.ry *hrh rL\luircs r P..inil lo conio.r. allcr, impi(,vc. dcnxnnh 'tr Rnrn rny
<br />^slruclurc. Iri$b ns i\rurtr... rlo rcquircs rhc trpflhrtrr lor \uch Frm[ b filcx si8trcd snrcnrlll lh0r hco. shc is li(ci*L] tu^urtr!
<br />ru rhc tovisn,r .l llE Contracttr\ LicM*d ljw (Ch pr.r 9, Comnrnci.s *irh Sccrin 7fiD or Divhiui 3 .1rhc Bu\n$s nnd
<br />Pmtl\sions (idc) or lhlI hc or rhL i\.x.nlll rhcrciotnrM rhc tu\is lor lhc olkgcd cx.npr.r Any vrlaliorofSc.li,n T0.l l S hy rtry
<br />Iprlicorrn, apcnnir subjd.N rhc atfli.0nt lo !civilpcnalryoi.or B,crhr nlc hutrdrcd dollrs (S5tr0)
<br />l. $ o*ncr of rhc pr.Fdr. or nry . rdoyNs wth wi8.s N rhcrr $lc cotr,pctr\rroi, wlll do rM *nrk ud lhc der!to n ior
<br />i' cddl or ollcrcd ror srlc ( sN 704,1. Busircss ,nd Pmlcssions Crnl. l hc C.trLack, 1 Liccn\c L,w dEs nor apply b u owrcr ol'
<br />rhcnn,Eny sho huilds or inl'rxt\ rhcd,n, dd wlt, d€s \u.h n'fk hnnscll or hcrclt or rhn ghhis or hcr owtr c.{t'ycc\
<br />p(,vidcd rhrr such nuhvcnrnh ur. mr inrcndc! l or o1fcrcd lor \ah ll h)qcvcr, rhc htrildirla or nllt'ovcrrnr i\ $kl wirhid .r( ltrr
<br />of.otrurhlion. rlFo*n.r Boikhr sillhivc r bunlctr of poviq tl hcor\hcJid rt tuiln or ir1llm{ dc I'mFny nr rh. purlx){ of
<br />l.u\o*mr.frhclm,!.ny.arcr.lLNivcl,.otrrrlcri'lSsirhli.ci\cd.o tr.ror h .onnru.r rtr IxrFd ( Sc. l(,l"l. Bu\inc\r
<br />d RDlssir Codc lhc (i,nrrkn s t-i.cns. Lr* do$ not rpflyio !nowncrofp()pc'rywho huildso! inrPrcvcs rhcrcoi.
<br />rrd *ho mntrcrs fo \u.h lroFlts gilh ! Conrochn \) li.cnscdlur\urtrr r,rhc(ir racr,tr s l,iLcn\c Lj$)
<br />Ia t.xc rrr undd SNion-- B &P.C fdrrhis!.!sn
<br />Dalc Orncr:
<br />il()RKr'rc', ( :(rru'FMsa no[
<br />DECLAA{IIAN
<br />I h.rb, rfn'n und.r FDrllyol lcoury om oirhc lollo*ir8 d&hrxriotr\
<br />lhlvcrRl willnn,i' ri'rrCcnilt0lcoiCoDrnrroScltln\uRlitr{r cs'..mltn\[ior- !\ P'olid.df bySc.lion]7([otrhc
<br />I:hn O)dr,n,r rh. tcrt nMrrc.llhc work l'or *hich lhc pcrmir is i\\ucd.
<br />lhrvc rnd willtruinrain *orkcrico rlf,trqrnr ir$rrn.c. rs rcquitcd hySc.rnrn l7(x)olrhc liborCodr. forrhcN atrMtrccol
<br />rhc w.rk tu *'hichrhk Dcrnrit is tsucd My workcF- .otrr!.nsrrion in{mnccc,ricrn' Flicy Nnrhcr .
<br />Iccnilyih in lhc pcnbr@ncc ol rh. work tu qhich rhis p.fl r is i$ut{|,I shrll mr cnrlloy {ny Ier$n i" rtrv nuomr
<br />so os ro hcconf, \uhj.cl t, rh. worksl $nrFnsxrion h*\ of Crlinmh. nd ll3rccrhlr ilI should b..oft subis rorh.
<br />*orkctr comFn\arn,n ri,'visions olSccri{,n 17(X)oirhc l-a}in (txlc,l shrll- lhnh*irh.ohplt \i!h tlx)t nnvhi{nr\
<br />WARNIN(; Irailurc b sc.urc wo*crs conrE.salior corrEgc is xnl3vtu|. dd nNll \u$i.r u cn{loycr kJ dininal Porh;s tr'rl
<br />ciril lin.\ tp b onc hundrcd rhous.nd dolla^ ($llx).(x ). in tddiri, ro rhc cosr ol comp.n\dn . drtrugcs x\ pr.virl(l r'r rh'
<br />SccrnD:1076ofrhc t-ahtr C'odc, irlcrc{ ond artffcy s fcc\
<br />D6r.: ApFllcrnr:
<br />I ICFNSFh CONITACT(IR
<br />IIEII,AAAIION
<br />I hcrcbyrifinn undcr pcnxlly orr.rjury rhd I 0m lien$d undcr Proei\i.n orCh{lcr 9 (commNing lnh s(lkn ?OOD o,l)ilkion l
<br />or rh. ausm$ !.d hofcsion\ Codc, ind nty li.cn* t ir lull foEc {n cfid-.l
<br />C!}N5:IA!]EIIONITNIINI'.ECENII
<br />, lrrhy dltn undcr |Erllryofpcluryrhr hcrc is r con{rucrioo lcnding trsctr.y fttr rl[ n nnrnun . ofrhc q-ork f.r whi.h rhis lcnnir i\
<br />tsuc lSL\ :1097. ( iv ( )
<br />ISILICANLDIIIIBAII9N
<br />I lrnby dlrtrr urdcr lrctrilry ofpcrlury odc ofrhc rolloeirS dcchnri(nrs:
<br />Dcnmlirion Pcrnrirs sb({or Norili.arion ljcdcrrlRqrhrion\ alirlc 40. Pan6r
<br />R.qun.d hncr ot Norilicdi,,tr
<br />l( rilylhal rlr l.(l.rxL'rguL, n)i\,.!nklirs r{lx*o! r.fn)vrlr. nor nl)l,h.r[]. r, ihi\ lr.i..r
<br />l..n fy rl,rr I hxr..crd rhtr itfln_1rilr, r kl{r.1hx1rh. rh,\. J,ntrL r,rtr..nd.r I ..mnrysirhallciryr dcouNy
<br />!.\ olllri! ( 1ry r rl connrvt) r r.r rJr!i rh(
<br />ih.rr nrnliord pr(,Fny tur
<br />,\pplimtrl or /lEenl Signulu
<br />huil,linEc.r{tu.ri(n,. r hrRb!dur
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Framinq
<br />ln s u latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />,A
<br />FINAL l- b -.Y"W.tti\
<br />Certilicate of Occupancv
<br />Notes, Remarks, Etc
<br />t .dcfs Addrcss:
<br />-
<br />l'.rn lr nnnrc(prnrl):
<br />^* t9 $:ZQlo
<br />Shear Wall
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