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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE lo/stG.COMMENTS OWNER BUILDER DEITARATION
<br />I hd.by .IIsm u.da FrXy ofFrur- lhr I e qap( 6!n . Co nd6 Lt.* L.r, ror rlE tolkr*Es l6,n (S€ 70ll 5
<br />Bcin6. drn Profdior Cod.): Aly (ny or aody shth rqui6 . Fmi 'o .odM, .ld, inFove dgbli or EFn &y
<br />ntu.r6., rin lo trr isueq 8to 'q!iE rh. lppticdr aor $ch Fmil lo fi1. ! sis..d rndd rhl lE or Jr a lica&d Ftu!.
<br />lo llE FlvirioB of dE Contrlq! LEn d t w (Ct4l6 9, Com@in8 wnh Scrion 7000 of Divilion J of lh. Buind &d
<br />PEldioG Cod.) or lh.r h. d dE i ddfl rh.6o6 rd rh. bci! for rlE .lle.d qdFhn. An, virhre. of Sd6! 7011 5 b, ey
<br />aPplicMl for a pqmil tlbiat rb. +plic&r ro r civil p.n lry of ml mrc rhd .fr. huidqj doll4 (ltm)
<br />-1.
<br />a o*c otlh. FrFly. G my ddo)d $nh w.{6 s rlEn $h mmpssrrcn, will & tlE v(t !d llE ilntl@ i! br
<br />iirad.d or olf6.d for $L (Se 7o&, tlsilB ed ftol6.bc ('o&' TrE Codr.dd r Li@ t r &'6 d lpdy lo e o*E or
<br />rh. FlFq who h!il& or iDFt'E ltroBr ed wno 66 wch &* hidcll o. h*llor thmu$ hn or h6 om arph)6.
<br />Folit drhd trh idq.orElEae d ndi.n moft..d 6r sl.Il. fio*6E, rlEhildirB or itr'pmrsE a sld withii ot. y.d
<br />otconlpldirl! tlE O*c &,ildd *i[ tlrr dE hrda olrvi,{ ,'r lE d tE dd
<br />'Dr
<br />hdd d ntrorr 0!. FDfdty tur E F Frof
<br />_1. s 0*6 oltlE FrFt. @ d(haiv.l, 6ddi.g $irn h.N.d .oddc ki adM tlr Fqcl (56. 71x4, &!d6
<br />dd Fotosnn Codc: t hc Conr.dd l,ic.M Llw d6 mr {ply lo e owE of Fopdr} wlo b{il& or imForq rns6n.
<br />ud wh6..ffi!forsEnFDJet3wih.Co.rd.(rlkd!.dp{aullrorh.Conlrrclor'!Li.eL5w).
<br />_l m .r@fl uoda S6tion_, B & P ( lor di r66n
<br />D.r.: o.tr6
<br />woR(ensicontPE s^'rrcN
<br />DECIAAATO!
<br />I h6chr lltrrm und6 p.mhr orp6rsr) orc ortlE folhtr mE d.cladbB
<br />-l
<br />h.vc rd will ruinr.in . C6rifrlt. olconsr ro Sclf-lBurc for rc*d onodarioi, s Fovij.d fo, by S(rio. :!700 of th.
<br />rrir Codq for th. Ff.ltl'E! olllE sut for *6ih tlE lann ! ecd
<br />0a.'."*.r..,." *"rl.a .oEFN,on Eutr.. E r.quftd b, sarbD r?lrcot rh. trhor ('o{k
<br />y'h. $qr tu wlth rh! Fnd ! sld My rsta' mmF(bn 'Nffic c!rc od pohcy numbs N',*'/lt{lqe&ca)'u)c O -3 I
<br />_l Giit rh in ltE Ffolrrffic of rh. *orl for wh'ch rht Fnir ir 6rucd, I shall nor dploy my p.6.n in uy Iurs
<br />e 6lo tcom sbd b tlE trsrtd'ohFdion L*! of c.lifomi lld .sr thr irt druu baom Nbrdl $ tlE
<br />*0116!' otrrFsalion FovnioE ofs.cl ion 1r 700 of th. L.!o. Codc I !Ell. tonhs nll orlplv *dh lt $ FlrsioB\v^l lNC Fliluc !o sE sorl6 NmFldion sroBc n un!.$ful. d lndl rubjdi M onplolq lo simin l FE!i. &d
<br />.ivil aG up to oE hund.d rlFu.Dd 6116 (t100,000). in rh. cd of .om!.@rion. dn5*6 a !rcvd.d for lhc
<br />IEOIAAIIO!
<br />I iq!r,)'ollm unda Frty or Fiury lhd I h lic6.d undq Fovtion of CiIFE 9 lcomidcrs wnh S..rirn 7000) oa Divilion I
<br />of 0E BuiB rri PDfcirB Code id ny lk* ir h tull fore ri .lTE!
<br />(adsrBucrr0lLEtl)tdli-AcEB(I
<br />I h-.hy lrru udq FBlty o I Fiurr rh, tlEc n r odrudnn lqrlbs .sft! lor ill Frolrl@. .f th. \ nt fo. $nEh rhis IEh( n
<br />6sud (S(.:\LxJ?. Civ C,
<br />L.rd.r'r AddE. _
<br />AITIICANI.IECIdIAIIO!
<br />I hdd,y .rfth u.di p6!iy of Fjury @ of rlE &lbwing &(lan ioot
<br />Dqtulnio. P6En+Albd6 Norif(dbn f.ddrl R.glhioN lTtl..l0. Pdr6)
<br />_R.quind t 6ofNorlfi.a6
<br />.
<br />-
<br />I d i6 rhd rh. fqldl quLt 06 ard,B 6bdd I6s\.1G hl +9l..hL b th! FDF
<br />TL
<br />P1t.or't rt'. t r^. 'oa,h! eptrdE. rn d.rhdrh.'t v. i.rom.tion b cotrEr. I uE ro rcrply {hh ill ciry,rd cou.r'adilM6 .rd Srd. l,s EhrB ro h'ldes mreur@ td hdcbr .dnoriE rw&riic 6f rhn Ch, sd Co',r, ro 616 upo. $c
<br />.bovc nm'ional pr.pdy f.r iBpdbn
<br />,rplUoor or lrrar Skorurq /
<br />,*,,- -..,rn*r,,K ga*L^3b
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL 6/<Lz -.W1/1 1
<br />Certificate of Occupancy /, /.-t-
<br />-
<br />Brown Coat
<br />Flood Zone Certif.
<br />Notes, Remarks, Etc.
<br />,,,,,,,-.,,,,X
<br />,7q
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