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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcl,y rrfirnr tr c! pcnalry oa ptrj ry rhar I anr crenpr irorn rnc Conrrd.ror' l-ien* ljw lnr rhc rolLwingicr$n (sc.70rl5
<br />Busincss r.d Prolcssion Codc) ny City or Counry which rcqut s r |)(Jnir ro .on{tu t. 0ltcr. im[ovc. dcmlish r. rcl]an ny
<br />slrudurc. prior to irs issuancc. aho requncs rhc,frlicatrt for suchlcnnil ro ljlca st.cn ltatcmnl rh,l hcorshc i\ liccnscd ltr$lnl
<br />ro thc F)visiotrs or E conhdcror's Liccfrcd Lrw (Ch,fl.r 9. &)nrmn.rng wnh Sc.rion 70(x) ol Dilision 3 ollhc Dusirc$.!d
<br />Prcrusrn'ns Codc) or lhlr hcnrshc iscicnpr rhcrclnlnund ltu blst lorrhc!llcEcdcicrlprion Anylidario..rS..rhn?0rl5by,ry
<br />arpli.int for. p.nnir suhjahrhc appli.nm rozcivilr.irhy.fnor motorhin fivc hundr.ddoll.r (S50O).
<br />-1.0\
<br />oqrc!ollhcpropcny.(rnryenr oyccs virh wi8cs rs rhcn sb.ompcnsorion, sill{lo rh. s.rk md rh drM& is ftn
<br />i'rc krl oroIL..dfors,l.(S(?0,14.Bu\inesanilPn,fesbnrCodc:Th.Cnnkn.ttrsLic.ns.L,sdocsnornppl]to!tr.qmrof
<br />rhcpmFdy Nho hlilds or irlllnors IlIB)n.0rn lho dts su.h wtrk himscllor hcrell.r rhrough [is or hcr ow..mpk,ycc\.
<br />Imvnlc(l rhlr su.h i'npoEnrtrhmmr idcndcd or ollarcd f.r srL ll hotrrvcr. rhchil,li'rBor i,nFtuvcmnr h$ld wihirrtrc tqr
<br />or(nqrlcrio.- rh Osmr Buillcr *ill havc rh. budcn of proviry rhor hc or \hc dil nor hild or impn)vc $d pn,Fny rd rlr puilr,{ur
<br />Lr\o*mr.frhcpnpcny.rrcx.h\ivrltcontacri',g$irhlicctrlcdcoDkrctht,con!tudr}[tn,ic((Sc.7U1,l.BtrfN\\
<br />rnl hrttssior (
<br />'nlc lhcCotrticro.\ l-iccn:c Liu (l()cs iorrttllb rnrsno.ffr.ncrry*ho huillr or imp'ovc\ rh.'con
<br />rntl trho conkrc{\for n,rhlx,jccr\silhr o,ntu.ninn li.."rd nunrrDrk)rlrcofr,r.ttr'\ l-'.cr\c h*)
<br />lrmcxcnpr und$S{rio
<br />]!}BtrEBS:IOUENSAIIAN
<br />DECI.AAAIIIN
<br />I lrcrcby dlllnn undcr p.nrlrr.fpcrlury onc.frh. folbwirg deldarbn\
<br />lhivcru will hnrrir rCcnfi.rrc ofcoNcni t) Srlf-ldluro nr q.rk(rr.oDrcnr i( .as f,vtlcd thyScciiot ]7lx)oIlho
<br />LnhtrCi o, nr rhc NrlornLnrc oIrhc sork lar (hich rhc lennir i\ is\ucd
<br />_l tarc rnd Bill nrantrair worlcs conrcns.rion insumkc. rs r.quid hy Sd ion -l7lx, of lhc Llhor Codc. ,.r rh. Frtunuft. .r
<br />t\ctrorIl.rtrh(hrhi\nc(n(r.r.uCMy*nrlcFmrnncn\lrnnrn.u,!(.caaic,Jndnol'cynumtnrc
<br />elA-4-.2-
<br />P"txyNunb.t:---44A-L €-t7
<br />(ao I ooYIo 7
<br />-(t- v
<br />IANEIAI]CIIaN.LENDING.AGENqX
<br />I herby nilirmundcr Fnally ol rcrjur! lh,t rh6c is a.otrsrucrion hMir8 08cNy for lhc p€rlomrme oIrh. *nrk fttr whi.h IhG p.rmir i\
<br />issu.d (s(.1097, civ c.).
<br />AITLICANfDES.A.EAII!)!
<br />I lrrcby.llinund$ FDalry.ipcrjury oDc ol rhc IolkJwir! dcclmridis
<br />Dc rrliriUn Pcrnrir\ sh.no\ Norin.arirnt l:.dcral Rc!uhrnrnr (lirlc J0, Pd6r
<br />Ii.quncd Lcrtf .lNoriicrri.tr
<br />l.cdifyrhrrihc l.drrrl r+uhri,,tr\ ruEtrln,I r\h(o\ r.ntrrlrrr norntrt)li.rhlc n) rlrtr !r.j.(r
<br />IccnilyrharIhovcrc rhkrmlic iotrflnlstarcth lnc.bove itrlorm iotr isconccr IasrerosnnpltoirhrllCnyaMCuunty
<br />ordin!rccs md Stirc ljwsrcldinS robuiklirgconnrucri.n. fllrl hcrcny rhorir rcrrrcscnrurivcs oirhis Cn, and Counryr. circi rronrtr
<br />-r*l,c
<br />,^,.,"/01,"
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />Sublloor/Vent/l nsulation
<br />Bgol Sheathing
<br />Shear Wall
<br />Frami ng
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL l9a,Y,eo
<br />Certificate of Occupancy I
<br />I t
<br />Notes, Remarks, Etc
<br />UFER Ground
<br />SLAB Floor
<br />Brown Coat
<br />dlolN 1 f.?.))
<br />J
<br />l.!nifyrhar in rhe Fnnobtuo of rhe work rorshichlhis ncnnir is issmd,I sh,llnor.nplo, lny lc(on ir ony munncr
<br />$ r\ h bccom suhj.cl ro th. wo.kds on[.ns,tion l.!s olc,linnnia. nnd a8rcc thd ifl should ti<.om subjd rorhe
<br />worlss c.nrrcnsarionpmvniotrsofScclio.lT0Oofrhcrjh Codc. l siall. lonhwirh comrly silt rhor pnvisionr
<br />WARNING: Frilure b s.uft *ork *'con:pe.\ n,n .ovc'ag. is urLwtil rnd shrll sublc.r ar cm,,lo)€r ro aimin0l!.mXics !r,S
<br />.iril finc1up b onc hundrcd rhousrnd dollrs ($lm.Uxr). ii rddirio. t. th. co( olconrpcns{liotr. daN8cs as pn'vidcd l'or rhc
<br />Slaron rrr,6oi rhc tibor CoJ.. mrcrcn ahl anorm) s l(q a'l-->,
<br />D,,e: 7:\KaY-,rr,,*,,b'47\--
<br />I llrtq\Ep eoN I R,\c'tuR- dE(t ARAnrrN
<br />I hcrcl,y lffirmundcr pcnaltyolrcrjury Ihol I m liccnsd unlcr tnvision oaChoprq 9lcommrcitra {irh Sc.ri.n 7000) or Division l
<br />ol rlrc Busircs 0M Pror'csions Codc, md my liccnsc is ir tul| lnrcc aril cricct.
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