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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII-I)I]R Dt]LCARATION
<br />I hcrchy a,nrm hderycnalry .r Frjuly lh.l I anr cx.mpl riun rhc C ra.r.n l-iccnsc t{w lor lhe dlowin+ rcnqn' (Sc.70rr s
<br />Itu\ine$ and Pr.fc\s.n Cnlc) Any Cily or Colnry shth r.quncs a ,rrmn ro condocr. Jrr. impr.v.. dem'li\h nr qa'n rny
<br />nrucrurc. p.br ro irs ilsurncc. dln, r.qutcs rhc 0fplicrfl hrsuch pcrmil ro,ik s sign d n orcnt lhai hcor sh. ii liccn*d l]Unud
<br />ro rhc pmvnioN orrhc Conkaclols Liccnsed Lnw {Ch!!lcr 9. Commcn.nr8 wirh Scclim Tlxxr or Divkion I of lhc Blsines rndr
<br />I'nna\rion\ Codc) or lh lRorshci\cicmlrrhtnfromMdrh.brsisforrhclllc8cdcrcmprion Anyvn'blionotSerk,nT0.ll5hy.ny
<br />appliconr lo! a pcrnrir sobjen rh. ippli.a.r brcivilp.nallyolno' 'nordh.tr nrc hund,cddolla,s (55( )
<br />Lrsoqncrolrhcpnipcny.ori'yclPlo)t.ssirhwiBcsrsrhcnsobcorp.n\rirnr.qilld.llEadkurlih.nfldunisnor
<br />inlcfllsl or ofitrcd r{tr $L l sc 70{4. Busincs ind Proti$t'n\ C{xlc Th. contdtr\ Liccn{ ljs dtu! nor aldy ro 0n .\.cr oi
<br />rhc|nJF_dy $h. hrilds or ir.lBws rlrR'n. ilslFddssuchso*hiflscllarhcrr.lforrhr.trshhNorhcro$n.mPk,rccs.
<br />pmvidcd rharskh inf,tuvcnrcnls ftc Dor idcndoloroltcrRllirr {h Il hNcvcr. rhc hniBmg or i,nProltntnr iq$kl snhmorc )ur
<br />ol'conphrioi, rhc Otrmr Bniklct nillh!rc rhc hurlcn olpmvi.C rl_,n l'. or shc dil nol huiklor in{'mr rhc Imll)cny ftr rhc turyn{.1
<br />l, trsowndr ofrhc propcny. !m crclNnrly conkd in! *irh l&nsc{lco mdorloc. (ru.r rh.ttojccr(SLt.7044. B6inr\\
<br />! Pn !\{roc( c: ThcContNrr'\ Liccnsc Lns does nor npplyt, trrownci.{ nrcpcnywho builds or impilrrcs rlucon.
<br />,nd sho.omru.F,orsuchroJc.k*irhrCota(trG)li.cn\cdpuGulntr.rhcCotrl6ckr'sl-i.ctr*t-ru)
<br />I icx. rt, uMcrSccrio
<br />TABtrIiBI].CAUIINSAIIONDlillAx.urc!
<br />I hcrcby nffi.nundcr pcmlryorpdjury.nc ol rhc lnln)r'irs d(hnlnna
<br />I have lxl w ill ruinrlin a C.dificdrc .r con*d k, Sclf ltrrtrc rhr *nrkcrr to rF.iarion. trs fmlnbd tu bt sc.rnr 17(x) ol rhc
<br />Lrhr (ndc. f.r tlE l)crfonnocc o{lhc Nork fr which lh. pcnnil is isucd
<br />-lhi\clndqillNrinrrrn{orkc^.onrNisari,!riNnrnNc.r\rcqutcJhtScdirir7(xrolrhcl.rhorOic.f(trrh.Ntunrr.colir s isnEd My*ortqr' c.n,Fnsrrion in\lrrtrr..ini.t ind nol 7ou(aa,lI
<br />o
<br />l.crrilirh t ir rh. n nhou'n.cofrh. tr.rk f( whichrlris Frnrir i\ i$ucd.l \hrllnot cnr oyany P.r$l nrrny r trcr
<br />{, !s r{i b.c.nf, suhi.r b rhc workn comnctrllllon hss orcrlirornia. Md ngrcc rhir ii I should hc..N nrhid ro rhc
<br />workrr.orp.trurionprcvtions.lScclion:17(X)oIrh.l-rknG)d..1\l ll. lonhq irh .onrdy wirh rh$ ,'r ovnions
<br />WARNINC: I'dlurc b \ccurc *orkc^ co rp{fl\ n,n.ovcri8c is trfbwn'|, a d drll s'hjcd arr cnrPloycr t' ai i'rl Ftrrhic\ ind
<br />civil nncs un ro onc h!ft1rcd rl$!$nd
<br />Sdrnr 1076 ol'thc Lihar Cflle. inrcrcn
<br />^,Gb51iffi
<br />iloln'\ r\11{) lrx) , !J,lri,,'confrcnsorion. drroe.q.s provilcd for llE
<br />DICI.dSAITAN
<br />I hcrcl'y llttn oDdcr p. rlryolt)crj'try lh(t l0m lieasd udcr Pdviri.n orChnl]lcr 9(con,nrn.inB wi'h scclion 7O((, or lxnid' r
<br />.f r[causircs.ndPnntsn,nsCodc. d n1yli..trs n ir lull lorcc a'x]clr.crg (c,9322- I
<br />Glz514-6 ,"^** 6n"n. t- 2L ^*^,.-to -
<br />CoNSTNTI(:T(}N LENOIN(i CI'NCY
<br />I h.rhy.flnm uMc! Flohyolpcrjury'har rhm is r..6Ndcrion lcndirs rsci.y rd rhc,xrfom.ne ofrh. sorr ror shth thn P(rnri n
<br />i\sucdlSec .l{197, Civ. C.)
<br />AIILICANLDEQANAIDN
<br />I ltalry ln]nn x.d.r p.nrlry olpcrruryonc olihc tollowine d..ldmri.ns:
<br />t)€nmlirn,tr Pcflnira Aslr$os Norificarion Fcdcrul Resuhn,ns(Tirl.40. Prn6)
<br />_Rcquncd Ir(ci of Norilicolion
<br />l.cnilythrllhclcdcrrlrcslhrn,nsr€gdir!nsb.nosrtrnraliran.rltPflicblcrollN[l()l$r
<br />I.dlilyrhd l luvcrcdrl,i\!t!li.rri( and(ntcrhdihellrNr in&nurion n.om.l llSteloco'nPlysirhrllCirvlndCouniv
<br />.Aimnccsatul Slrrc ljwsrl inSrohuiunr8con$rudnnr.uxjhcrchrrtrht,zcrqrrc\cnlariv$ofrhkCnyrndCounrvhcntc.rri)irh.
<br />xh.rc nrnrioNd I'arpcny li)r i'rl.c(nnr
<br />Aoj)li(atrl o. /\A6t SiSMh'R.
<br />n"*u*-.",rn*r, 1!
<br />. ^efu5fuolu(^, t'fa4o.
<br />16
<br />Set Backs
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Rool Sheathinq L z-8lo ,<,laqd kpl,.9 *aol olll- at*a.
<br />Shear Wall l4 ^<- slg-|.tu. *l^o
<br />Framing "ol-ql>v aolt r,JL i,
<br />lnsulation/Energy *.,1^! k' b ro.r^hlt',,-.
<br />Drywall
<br />Ext./lnt. Lath
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Reporl
<br />Flood Zone Certif .
<br />FINAL 5L<.6
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />Forms/Steel/Holdowns
<br />Brown Coat
<br />f/lA /lq
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