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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNEN EUILDER DIiL(ARATION
<br />I hd.b, rmm undd Frlhy of pqjury rhn I m .r.oDr Iion rh. Co raro6 l-k.M llw for rh. folhwnB l@n (Sc.701 1.5
<br />Busin6! lrd Prcfdion Cod.): Any Ciry or Coudy *hkh r.quir6 r Fnil lo .ondrucl. dts. inptuvc. ddnolnh or iqEt uI
<br />nodue pmr ro nr is!e., atro EqliE lh. pplir for !u.h Fnn to filc. ta*n.d n'ldo! rha lE o. tlE i! lic@!a! pqaa
<br />ro th. FDrEioB of ll. Conr.hr'r Li.a!.d lr* (Cn4ld 9. Cdmtrin8 wnh Sa1bn 7m0 ol Divilhn ! of lh. IruiB rn
<br />PtD(<bNCodc)d$!rlEddEkqorpihd.tomeil[.t-irlortlEllk3.ddqqrid,{nyviold.nofsd.nT0llSbym}
<br />rrplkd for . pdni !br68 tlE .rpli.or ro . .ivil FEhy orml mr lh& liy. hui<tcd d,llt! (t50o)
<br />L s ov6 of rh! proFny, or ny mployG virh wa!6 6 rh.n $b omFMlion. willd. ttr mrt &d llt *ure h ml
<br />nnord.d .. oils.d aor !.1. (Se 7044. Burind Md Pmfdio6 aod.: 11. Co'n,.dor'r Lr.e ll* do6 Nl .pply to d oMd of
<br />ih. FDFI} e ls tliLl.r inFr6 lhaoE rti wlF &E sn sd hielt or h*lror ihEugr' hn or rE o*n mployc,
<br />FovrLd rh.r sh mFoEE s e tDi irsi.d d otutd fc nlc l[ ho$i6, tlr h('lt!E r n+.offi i bld winin m )aof.mpldE [E O$E Bu]& wiu h.rt llt hib ofFotr8 dd lE or tr dit rel blild rqrE dE FFry 6r tlE FlIr ot
<br />L som6oarh.lroFny. h.xclsiv.lyconrlcrins wirh licoa.d cont@oB kJ codtud llE Fojd (s6 7044, B6hs
<br />ed tYorsin Cod.: Th. Conrmtoas Li..N.l-aw do6.ot dpply to u own6 ofprop.ny who build! or 0110!61h66..
<br />md who onrr..rs aor luch p.!j6t! {irt ! aonrtrro(s) licGB.{ pu6@n tolhc Coirodoli Lkru t *)
<br />I dn .r.mF und.. SRli'n .B &P( f(n tn6 rd)n
<br />,.k692-4.{@. o",.,
<br />laatr[EglaltfElsara!Dlig tralla!
<br />I hs.t'y aflim und6 Frlit of Fjury ok ol rh. nnlr)wins &rlad hni
<br />-l
<br />hrr. dd *ill in.n . cciifi.n. of coEn lo sdf-l.l@ f sort6 onFsirc B Fovi,.d 6, b, sdioi 1700 onlE
<br />trSor ( od.. lor th. Ffffi of tu Nn ld sirah ll& pcnir i! is.d
<br />!=tf&.od will ftliil.ii workd .onp.N!(ion iNuffi.. E r.qui'ql by Sd ion ]TOO or lhc Lrbor Cod., ftrr th. pcfomu.. of
<br />rh. mrt for whth fii! Finn ir isr.d" My *orld @npds.lion iNuftc @ia &d FlE, d@bd t.l,* ftl\'- Qlv'z-
<br />,r*,n,,0-.fL4:9o!&Q:!xr l *,* ..QL!t l94D
<br />I .cnify rn in th. pafomlnc. oalh€ worl lor which lhir F.rhil i! it!u.rt, I sh.ll nol mlploy tny p6on in !.y non6
<br />s 6 xr tE otu $bj6t ro rh. rort6 ..f,Fudion l$! of C.lifamir Md lgG lhrl if I ltruld h..od. tubi.tl ro th. .-
<br />wnrl6'ooFelanForirio6ofs.dio.lTmofrh.l$orc.d4ltdlfslhsthcooplywilhltFsprllnioB
<br />waRNIrG r ur. to su. *ort6' conFdir ovq.s. 6 uiL$tuL dld {ull {bis 6 onpLF ro sinird Frrit id
<br />.nil 6G up ro ok ho,r&.d rlErsard &,114! (1100.000). in ddrlE. ro lh.Vry:sdrb.1076 of$. ttE cGL. inlsd.d dlorrEr's fc
<br />I L-3-\1 V A,>cuiaaiiF E Niii^ctuR-7
<br />D!filaatro!
<br />I hdl,, .lhD u,(b Fity oa Fjlry thc I e li.6.d E ta Fviion 6loqrq 9 (@nffiiE *th Scrb. 7m0) of Dn titn I
<br />of rlE BaiB ald n!ft..ioB Cod.. ri m, lt.e i! h tull loE !d cfEl.
<br />b q 3c,1-
<br />12 2-t1 ,"",-,,s-€
<br />A8IUTANLIESJAAIq!
<br />I hoit y allnn undd toalr, of rajury o..oalhc aollowin8 d..lediotr!:
<br />Dqturlirion Pdir-A3b6r6 Noifi.arion t.ddal R.8!h{ioN ITnb 40, P.n6)
<br />R.quncr kitd oaltr'6<in6
<br />I .drt rhd lh! LJ6.l EsuldioN rcsrdrn[ BtElos mou] e. mr qpla.bl. b rhii F.j.d
<br />l.ctiiyrhd I hav.r.adrhirrppliclliorMd3t.rcrhd rh.Ebov. infonndlnr ir.on.<t I !!rR lo mnply wnh lll Ciry atul Counly
<br />odie6 md s'.1. tls. ELtinS to hildmX .odru.liotr ad dir6 o t this ('it! Md ( ouly lo 6ls urEn llE
<br />.bo\ . .6lFEd Fopcny for ND.di6n
<br />Applic.nr or ,r86n Si*.rtrF c-
<br />,<-
<br />/z-<,f
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framrng
<br />lnsu lation/Energ y
<br />Drylvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />1l <Ln -L w.d,*1 t-/? -/1 iLc 217
<br />-4-1
<br />FINAL /?e-/,/c c,. , .'-gb) (Z'7 / )
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />I horby lllm @d6 !<rxy ot parury $d rhr. ir . otr{N.lion lqdD, .sdy for tL Florl]rec ol0E Ert 6r *rich Ui! Fnn i!
<br />i$u.d (Sc 1097,Civ. C ).lndd r N0.:
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