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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS ()1\ tl.R t II I)t k Ir:1,( ,\t,\ I l()\
<br />I lErr$y nftn nndcr !.nally ol pcrjLry rhd I u cxcnfr lmnr rltc Conlracror' LiLrNc Lrw fir rhe f.lloqin8 rcn$n (Sm 7l.tl 5
<br />Dus rcs md Proicssn,tr Codc) try Cn, or Coutrry $hth rcqoiics a Frmir t, .otrslrucr. rli.'. inPovc. dcnFlnh or Rllr unv
<br />nruclurc. prhrro irs ksurtrcc. ako rcqlircs rhc.llh..rr lnr srch!$nirb fiI:. si3trcd dd. ttrl thd heot \h' A li'ctrrd nur\urnr
<br />k, rhc lovi\ion\ of rla Contrcnn s l-iccnrd trw (Chrprcr 9. Co'n'mki'r8 wirh Scction TUXr oI Oivhion .l ofrh' Busi'rs and
<br />Itorc\sbns c.dc) or rhrr hc or\hc ncxctrU rhctcfro'nmd rhchsrs for lhc lllcscJcxcnplion AnvviddionofSarbn?0ll5bvonv
<br />rptlicrnrtr0llcrmilsuhjrchrhclpPlicanlhrciv l)cnrxroinornucrhanlivchu red doll&\ (S5(xD.
<br />-1.!\o*nfiofrltrlnoJlcny.(trnry.rlloitc(wirh${Sc\!\rhcnv,h.onIEtrsurion.
<br />ll do ll€ work {vl llt srMhrc k R
<br />inrc'xlcd or oflcrcd lni {le (sN 7(}44. Busincs a.d holtsi('n\ codc: l lt Contrntr'\ I iccnsc t-rw d$ nor lpllv t) in owncr or
<br />rhc fDncny who buildso. imProrcs rh.n4 rkl sho ims s'ch wod( hinsclf or ltr{lf or rhoulh his or hcro$ncn{hy'cs'
<br />pR,vidLal rhnr such imIrot'ft* m .ol inrcDdcd .r .,Ictn for vlc lr- hucvcr, rtE hu i[in! or i'nPmEnEnr i\ sU sirhi'r onc )ur
<br />;lconplcrion. Ihc owtrcr Buinlcr willhir tlf lurd.n of pmving rh{ ht or shc dil r buitd or iq,rorc rhc ln)pcnv |otrltrllrF){or
<br />l.$.sr.rolrhctr.t{rry.ror.r.!usi\c1trcnt..ri'r!$ir[1i..tr\tdr..nn\hconnfldnEPr+'r(S"71]'lJ'lltrlnc\\
<br />ntul slD rofrru.r\lo \u.hjnoiccr\*irhr (in .r.r({) li.crr\cd [)Ur\trrrkirhc (.nrrrc(, \ Liccnt lrq)
<br />lr cr.Drln un,l.r Sc.r( ll .! P( ntrrl' r rcr!, )
<br />(hlner
<br />\yoRKFRS', C()ItlPFNS,r',r'l()N
<br />Dl:cra&tll0!
<br />I hcrchy fltmu,rdci pcnrlrrof|jclur! otrc oilhc followin! dNldnriotrs:
<br />I h!vc rftlwill nHnnrir.Ccnificalc ofCo.\ctrrr. Scll1,,{rc litr eorkd\' .onrlr.n\dnn. rs lrovidcd ntr byScclion l'(Xrofrhc
<br />L htrC(xlc.litrlhc pcllorinrNcofrhc*o!k ttr whi.h rhc Nnnil is is\ud
<br />tlulcsnd$illn[inriirrorkcricomPcisnri(ri,rtrrro.c.nsrcqund[vS.crion:]7(x)ollhcL]horCdtc.litlhcPcn'rnnrol
<br />rhc work lnrehichrhis Nlnril is issudl Mywor*c( conll}cnsrlion n$ur.N.citrhr mtl Flicvnumh'rdc
<br />,.,.-, fon r..-<,--c< J Eo\^sW
<br />,"*,n,,^, t^r!-19111 85!- 1,.* ? lrS l l8
<br />I.cdriy rh.r in lhc p.rtonnrn.c oirhc work lnr slri.h rhit rtrmil i\ t\ucd. I drll nol cmtl()y rtry Nron in rny
<br />'nrtrDcr\i m ro hcBnm \uhjtd h lttr workcri .onf.n\ar ion hws ol Calilfftrir' tnd {rcc rirr ir I rrur ld hccom subjc'l t' llrc
<br />soltcs mnrpcd\nrtun ptuvti(,n\ ofsccr r r?00.irhc uhorCodt.I d(ll. i.n h*irh .oifly * ilh rh){ Pnili(tuns
<br />WARNING: Fnilurc ro rcurc sorkcn .onDcnsarion c.vcrrlc i\ unhrlirl. rNi shil! subj(l r. rnrpk,yd lo lrimifxll. rhts rnn
<br />h oN hun(lrcd ihou\and dollrrs (Sl{xl.(x)Or. i'r Uirir rrr rhc.o( .l.onln.nsrriotr. daNrscs r\ Pflrvidc tur rhc
<br />S..rn,n 11076 ufrl* tit\tr Co{lc. i'rcrcn rM NonE} s lirs
<br />blrr lrs
<br />fnr^(nrnl(l |,.r9r(n Dttr.trUsirhSr.htrTtxxr).1l)nni,,,lI h.rhyrlllrnrrftl.r prtrrlry.rt{tjry rhxr lrtrt lnttr{d u
<br />.I rhc llLr(ricssrDJ t'mfc\!o,n Culc. xl n,y lic.tr{ n tulllhr.c Jalcllc.r
<br />B, cr
<br />-l-icen\c
<br />Nrnrt{r:
<br />-
<br />r-ls rl3
<br />ulrrl 1$CS(E- Co r,J ,1
<br />lnNlirBucu!]tr.Lli}iDlNli-tlcltll:x
<br />issucd(Sc. llyi)7, Civ. C )
<br />APPLICAN I)l(]I ARATIoN
<br />I llr$yrllinnu .rpc rlrtol P.rjwyoncol rh. followirgdccl3rarnntr
<br />D.nrrni(itr Pcnnirs A\hcst,s Norificiri,,n Fcntrrl RtStrhrnrn\ (Iillc 10. Pd6)
<br />R.quircd l.crrcr ot Nori,nxririr
<br />I e.nillrhir rfu fcdcrnltEUltri,,n\ rcenftt'tr*trsbc{,,{rcrn,vrlrrc nor rtr0li.rhlc b thn tlxrjc.r
<br />1[r .*',rlr'.r r r'." ,".a ,r.* ,p1r
<br />t:idi'un!.\ x J\r. cL1trr,(1, tr'rr.
<br />rtx,vc nrnri{nrcd nn,lcny for inst^-_r
<br />i. ri()traDdsl{rcrhxr rhcnh,!c rnhrtrx(ion is.orc.r I rSrccn)ro v*irhrllCirr"rtrd (inrrr_
<br />nid hcrcliy rnrlm'i/c 'ct,tcscnlJrivc\
<br />ol
<br />ADpli(nnl or l,$nt Si,tnrltre \J.<}a^
<br />,."' u'iiri"il.'
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq z-At /t a Gnttrl /o-
<br />Shear Wall I
<br />Framinq
<br />ln s u lation/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL z,Lw lt Q .O,ytort / rz-
<br />Notes, Remarks, Etc.
<br />h dci( Addrcss
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