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BUILDING- INSPECTOR RECORD
<br />SITE.WORK PATE ID/SIG.COMM.ENTS OWNER BtrlLDF:R DH,( AR,tT -l(rN
<br />I hcrchy allnm udcr ncnrrry {, rcrrury rhtrr I ro cre'npr rnnn rl[ coitd.t(t{ Liccnsc lju tur lhc n,llosiiE .ct\i;.(Scc 79ll t
<br />Bu\incss rnd Prolts\ion Cod.): ny Cily or Counry whKh rcquncs r ,(mil h Nn(rucr. rlrcr, inrln,vc, dcDolish ,{ rclJn rry
<br />ifl.(urc. prid t, irs ir{u.ncc. rlso rcquircs th. lnlrli.nnr lrtr suchlf,nniri' fiLr riSicJ n.r.'ftnr rhd bcor\hc i\ li.cn\cd Pt]hikir
<br />t, tlr fr)viri{trN of rh. (btrtrr.r.fs Liccnscd Low (Ch!l't.r rr- Comrmncing {irh Srcrnnr 7mO of Divhion I of rhc Btrsnrss rM
<br />Pnftssn,ns Codc)or rhrr hcorshc iscrcnDt rh.r.lionlirJ rhr hLnr n)jthcnllcgcdcrcDpli,)n Anyvi,rbrnDolScciiotrT(l.ll5hyary
<br />imlicr iur rpcnnirruhjccrs rhc dt]Dlicdnl Io !civilpcnilryolnornDrclhr. fiv. hu d'cddolhrs($5011)
<br />-1.
<br />us o*ncr ol llE F'!cn!. or my .'nrk'rcc\ wnh wdscs ^ rlrn $h .onrFnslrion- will do lhc r'.rt lnd t& iturm i\ tut
<br />idr.DdLrl oroficrcd lor elc (Sm 7tX4, Burin.ss rnd PmLssions Codc: 1.llc Contactn\ Licnsc b* dcs nor opdy ro !oosner oI
<br />rnc pmFry who bullds or imp.eres ihcmr rnd wk, des seh xr)* hinsclfor hc6cllor rhmugh hn or h.r own cmPloyccs-
<br />trcvidcd rhar su.h inpn'vcnEnh arc rcr i colgl or orlcd nv $h It l$*c!s, rhc huildiry or inDmrcnEni h sU rnhin onc )td
<br />ot conDkrirn. rhc Owns Buikl.r will hnvc rrx ttud.n of I'vine dr tE or shc {lt mr tuiU o, nqrovc rh. ttuIrny for [r puqrs ol
<br />-1.
<br />!sowncr of rhc pmp.ny. r cr.lusivctycu.trrcrnE wirh liccnsd contuct,^ ro .onntud rh. F,jccr (S(.7044. Bu\i"rs
<br />rnd Antssion Codc: Thc Conrncrols l-i.cnsc l-!w doc! noi nprly ro,n owncr olptoPcny sho $uild\.r nnPnrvcs rhercon.
<br />nnd $hi, .onka.rsrr!u.hpmjc.rsqilhrConlr0dons)liccn€d pusurnl t,rhcCoit!.roa\ Li.ctr* L1*)
<br />I rni.xc rp! und$SNrid I &l]( nirrl,i\r.r\tr'
<br />]lQBtrEtsSll:lJll&l|LriuloN
<br />IIECIASA-IIO!
<br />I hcrchvn11nnruMcr r'ctrrllyolDcriury.rrolrhclollo\irs.lcchrxrn,n\
<br />I hrvc .id will .D,nraitr a (tn ifEulc ot Conrnl n' SclI l nsurc tu sor kc* co'nrcnsrrmn.$ fmvidcd for byS.dn,n l70O.rdtr
<br />titxn C.dc. ror rhc p.rrormftc or rhc work for ahth lh. l)cnnii k issucd
<br />la-
<br />Ivly$.rlrri mn,rrlsrri(m \Drrtrcc.dri$ M,l plicy truDhcr irc
<br />u.hbc-:1-t- 17c17N)
<br />-lccnilylherinrhc
<br />pcrforhd.c..frhc work ntrNhi.hihi\ I).iln is nslcd- I shlll n l cnlnlor rny ptre,n nr dny nEntrcr
<br />$ *t,h..dnr sxhJc.r h lhcaorkus conrynsdnr hBs of Crlil'oaria. r d rgre rh ifI sh ld bccoN suhjcd rorlt
<br />wo*.jJ conDcns0r ion porkn,ns of Scd ion 3?(x) of rhc libor C(dc. I sh,ll. nflhwirh cotrPly P ilh lhoe Pr)vi\ions
<br />WARNNG r3ilurc h s-!!c nrk ri.omFnsrrion.ovch!. i\ unlaqtul. and !h(ll \uhjccr rn I'nplntcr ro rimiml Pcnihics lnd
<br />civil fitrcs up t, otrc hu.dr.d ttrusind dollrs (!ltXr.(XX)). ir iddilion ro rhc.od.fco'nP.n\arion. donmacs os Providcd in lhc
<br />-u-tz ,rpplionr: L 4[e,q
<br />UCENIEI}.!:ANII^I:IAB
<br />DECI.dAAUON
<br />I hcrutytrtfirnufrldr p.ndlry.r l,.rjurr rhd I anr lic.nscd ud.r provision olChrnrs 9lconrnm.inB wiih scdion 70(x))o,Dilhion.l
<br />oi lhc Businc$ and Pmfcsio.s Codc. dd fryliccn* n in rull ror.c anl rlTcct.
<br />- t4'b Ot0 Tqsq
<br />c 4S-tg a.,,.,",..,)<.
<br />l(lNlralJcll0lLlrNDllc-acDll.:I
<br />I hcrcbyalfinn! dorcidxy.rpruryrhar rlrrc isrconstrucrion L ins asc'ry fn rh. Frrontu..c of lhc *o* nx shich rhh p&nir i\
<br />nsucd (Scc 1097.Ci!. C )
<br />lxrdci. {dJr"$
<br />-
<br />AITLICAXLDICIASAIIIIN
<br />I hox*,y llllm und.r r.ndt, or Fqury oN of lhc followln8 dcclr bns
<br />Drnniiu Pc.nrih Actiskx Norinc.rion F'cdcml RcSul.rions frnb40. P!n6)
<br />-RcrtuiEd
<br />l-crrcr of Norilicario.
<br />l.cnilirhd thc Ldcra I rcsu l0r ions rcB.rding nshcnos rcnNvalrrc nor nfnli.ablc b rl'is fhjcct
<br />oftlinrNcsrnn Srrrc lissrcllrin8 rohildi',8 con hcr.hy iurhori^ rcprcsctrliljv.s olthi\ Ciry and Coutrry to cntd qry th.
<br />.Lh,\c n,r fo rJ t,otr,r) ktr trNttr.rr
<br />^rr,,.,r "r,,r-r a,*urr.. I
<br />,"-,U* --'.,r.t,,, K k 9ih<
<br />..11261V
<br />Set Backs /o/orl16 Trtrrtll lrv
<br />Forms/Steel/Holdowns i{a/iln 4vurxrn -ft\t -,v '.' '
<br />UFER Ground t0lilllr ry1nMtA 'ilD-,-
<br />SLAB Floor l/
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Heport
<br />Flood Zone Cefiif .
<br />l-tr - t?,./*Sol1.azP
<br />Certificate ol Occu nc
<br />Notes Remarks
<br />tz-
<br />-..t
<br />Erection Pads
<br />Pool Fence
<br />FINAL
<br />EtC.2d ///l7z{LAb
<br />.(>zL' r'f:i)
<br />t ndc''i Nam
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