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BUILDING. INSPECTOR RECORD
<br />COMMENTSID/SIG.SITE-WORK
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venl/lnsulation
<br />Roof Sheathin
<br />Shear Wall
<br />Framin
<br />allD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n
<br />Pool Fence
<br />T-Bar
<br />Handic Re
<br />Final Re ortDeU
<br />En ineer Final Re rt
<br />Flood Zone Cenif.
<br />FINAL ,
<br />Certificate ol Occu nc
<br />Notes Bemarks Etc.
<br />{)\t Nt.]l lll ILI)tI{ !)l).(,\R \ ll()N
<br />I hnvcud will tr i' xtrr $orkcrr.onlc'rsarn iiNurancc. !\ (qrnL'd hySc.(i($ l?(r0oirhc l rhor Codc- fuihc pcnbanucdol
<br />workcs conrp.n\dnr iNU.rrEu ca i.r nlpolicyndmb.tdc
<br />:::: ll[:Idi'
<br />Wlurcto"lea ,,\,,tc\
<br />Ic.nifyIhrrirrheErfonDr{colrhcw.rkntrwhi.hlhisPcrnri(n{cilshrllnurcnIlovrnyl'Noninanynanct
<br /><, nro t'ccmr *tjccio r* *ork.r\ comp.trerion ltrws orCrlirrmia. nnd lgtoc rhd ifl slmuld hc('x subjl{r ro rhe
<br />N.lkcr comp.n\.rbn ,rovi\ion\ olS..ri()o 1?Ol, ol rhc ljh.r (iric.l sl[ll ronhsirh.on{lt $irh rh'E pmvisions
<br />wrrnxnc t'oitu," u, *"r. "ortcr' co,npenun r covcngc is rtrhq{ul. d \hall *uhlccr r c'nllo)q ro qininal JEmlti'\ mI
<br />.1vil fin$ up ro onc hunnrcd rholqid dollan ($l(x).fix). in addiri.n k, rhc..s ol comP'nernnr' damrg'r 's lrovided ntr rhc
<br />s.cr.n iu76or rh- LrLr r'mlc. rhlrr. ,d. roirr) . f,-.
<br />,,,", q C.,W Appridnr: '(?-',lt*ffir,,,NtrBdo8 __
<br />IhcrchylffiinUndcrNn0llyofnc.jurylhdllNlicctrk-d0iltclprovisioDofchulcl9lconnncmi[B$ilhs..lir7tx)o)nfDivki.tr]
<br />or rhc Busincss, Pmf.ision(Codc, xl nry li.ctrsc h ir, tulltur.c ind cllccr
<br />G.06,2q
<br />q.o.16 to.'(.".'-.
<br />CONSTRTJCTI(}N LENDIN(; A(iT'NCI
<br />lhcrchylmrmUndcrP.nlllyo',.!urylhlllh.rcka..nsd.lio.lcndingi8ercyl,o'lhcI,.lfofm0nceoflh.torklorwhi.hlhisltntrilis
<br />isNcd rscc llo97. Civ. C.r
<br />l-.idcr'\ Ad r.ss
<br />APPLIC^NT DTCLAR I-I(IN
<br />I larhynlllonnrdcr pcdalry ol t)crjury.nc ol lhc tullownr8 dcchrdids
<br />l).fnntidr Pcflnirs Ashcn.s Noriii.tri, [rdc'rl RcgDl{li.trs lTirlc'{}. P n6r
<br />Rcquircd lJncr ol Noriic.rhn
<br />--Lrd.ly rh rhc lc,l.1,l'rguhr,nn.rgrd'nP a.h.{ . rcrm\J
<br />{.-nri '*' ,t'.,-o,n^ dmtrartr'1rid ircrhauh.Jh'!r d
<br />ordinrrccs alld Sl!!c tf,ws rcli iu ro huild,n8 .oo(ruclion- aJxi h.r.h
<br />m not oDl,licabh t, rhis pmjccl
<br />lornurion ii.orel I lFe rocomtlysnh a CnvrndConnrv
<br />! olrhr Clry lnd Cou ryl..nr.ruJ! rlx
<br />1,4 *,t-
<br />oh,rc 'mnrioncd Uopcn y ror in\p.clior
<br />ADplicanl orAgml Slgmloe:
<br />P.mile n.me lprtnl):
<br />-", +J lg
<br />DATE
<br />lnsu lation/E ne rqv
<br />)t\f<
<br />I h..chy ifi n undcr l.ndlry ol rcrjuty lhlr Lm cxc lpl iom rh. Conlra.loF l-iccnsc trs lor lic fi'llowinB rco$n ls" 70ll 5
<br />Busircss aM Pmfcr\i{,n code): Any Ciry or coutrr, shich rcqut s I IEiInir k, conqd.r. lllct. imtrovc dcmli*h or rcI'lir !tr,
<br />{rudurc- l)'irb ns hsulnce. !l$ rcquics lhc applicanr fd such rcrmir b filcr siSncd (ur.tunr thd hcor\h' is lianscd ,xrcrinr
<br />to rhc J'mvisions of rh. G)nrrscxtr s l,i..i\.d rjs lch4rc. 9- Commncing qirh Scction Tl)O0 of Divkion l of rh' Busi'rcs rnd
<br />Profc\sn,nscodc)ollhalhcorqlEiscxcnrpllhcrcfton,ndlhcbosisforlh.,lhscd€icnlflbn'Anyviolali.nofs(lion7()]l5bynny
<br />,pplicr for a pcmir subFcrs thc arrlicsm ro , civil Fnrlry of n r ,mrc rhan filc hundrud dollan ( !5m)
<br />-1.
<br />rs ownd oflhc [r.pcnr. or mycnrtnoyces sirh wiecs.s rhct slc conrFnslrinr. *ill ilo rhc *!rk aJd rh' slruclurc is 'srirtnd.d oroltcrcd t; eh (ac. ?Oi4. B!\ircsand Pmlcssion\ Cod.: ThcConlruciofs l-i.cnsct *docs'orappl,b'noBn"'r
<br />rhcpmpcny who buildr or in{'rob rh.Nn. fl{ wh) dms smh n hirsclf.rhcacllorlirorghhhorhcro*ncmtlovccs
<br />p",'it,r rl,rr -.t' n |rr(rvc Enls uc ftn ilncMcd or ond d ior vlc ll hotrcrcr. rlE bxildiry nr in{'mrnr hhll*irhinr{c)tJr
<br />;r.o Dlcriotr. lhc Own;r Bxildc. will hovc inc blrdcn oi l,olins lhd hc or shc did nor huild or inPmvc rhc rniFnv for rhc Nrlnsc oi
<br />I.isosncroirhcpoP.ar.rmcx.lusilcly.onlroclinsNirhli.cn*dcoorrr. h .on( ruc l r hc Pnrjsr (Scc 7o{'r' 3 usin's
<br />rn<l ADr.xion Codcr j h; Codraclols L,iccn\c t-a* dd\ nor lplly b "i owncr ollroP.rlt sh(' build\ or imfrorcs rh'rft''
<br />rnd who cdntrch for such pn,l.{ts lirh 0 Coniractn(s) lic.tr*d plrsu.r brhc CoDlmci{n\ Lkcnsc L!*)
<br />I amcrcmpi xndcr Serion-- B &P.C.fttrrh r. \on
<br />Dule O$nrr
<br />w()RI(ELS! COllPr,NS Tl{}N
<br />I hcrcby rflirmundcr p.n,hy ol1",1u,y nu" nr,* rotu-i,gffiP
<br />Ihrvcmduiuaui' rinaCcnilicarcofcon{ lo sclf-ltrsurc ftt wo.kcr' coul.nsarion. 0s ptr)vidcd lirr bvSecrt lT(x}ofrh'
<br />Latxn Cod.. rr, th. |xrformdne of thc work ior whi.h rho pcrmn ir i$t.d
<br />IrM.r's N.mc:
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