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I BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE rq
<br />Set Backs
<br />Forms/Steel/Holdowns J-4-t1
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall -z x+
<br />Framing "R I
<br />ln s ulation/E nerg y
<br />D rylva ll /\
<br />Ext./lnt. Lath )n^)-t6- t1
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />\
<br />FINAL
<br />Certificate of Occu pancy
<br />Notes, Remarks, Elc A\ltl L- 11'/t 1-*9*Bt)ttu0)
<br />L C..ll | \-./
<br />U\J
<br />\
<br />OWNER AUI'^DAI DEII'ARATION
<br />I ha.tr .,Im urld Frty of Fir.y lhi I i danF tD6 dE Codr.clm lx.e l,r for 'lr follo*itB l6n (5<.7011 J .
<br />Buine! ..d Prol*io. Cod.) Ao, Ciry or ( ounty which rcqut6 a psni ro enstuc1. !h6. inprcvc drrclth or lt'ai io,
<br />5lrud@ Fsro tu iw.,.&or.qoi6dE.lplidfor*hFnih6krr,8,Ed$dErrllrlloriEali.!a.dpu$!r,
<br />b tlE Fo6io6 ol E ConlGld r Lrc6!.d t u ((t ,(6 9. Comftins vnh Scrbn 7000 oa Drvi!i.. 1 6f E B6illd ild .
<br />Prof*ion! Cod.) trrh hc or rt. n .xmpl llE 6.m $d rhc b..ir aor th. .lk!.d .xaFkin Aiyviolltionolsdion?0115 by&y .,
<br />!Cpl'.dr for r Ft n ubjdl! rh. 4plicsr ro r.ivil Fuhi. ormt mE rhe fiy. hurH &llus (1500)
<br />-1,
<br />6 ow of lhc p.op.ny, or Ey .nploys wilh wia6 d lh.ir $k conqE$l tu.. qill (h llE eort ,rl th. nnd4 a er
<br />i did.d ordffaar lor sl (s( 70a4. Bo!i6 &d Elr*ioB ( od. TIl(odnddrlideLi*dBd+pl,tomo$Gof
<br />th.FFry $h hri&l or ltrmE tlE@ r'd wlE &E Eh w.t hirelf or lE*lt or rlEou3h hB or lE os! 611016,
<br />Fovid.d rhd .uch inF.!6a6 m mr i ai.d u otnet &r slc l[ ho$or, llt hrildi.s or imFolqcn B $Ll *ihi. oE ]6
<br />oaoreldnr rh.(\E Builds *'iU h.w rlE hd6 of Flvil{ dli h. m dE dA Di Eiild or irFlE tlt FnFi, 6r ltE F,pc of
<br />l. 6 Nffi ofrh. FFry, o aduntb .oflGri.g $nh ltned cotu .ror ro Ntu rE FtrF tse. 7014. Brffi
<br />rn hiilsni Co&, Ttc conrtuiM r l-E@. Uw dc mr .rrly ro u o*-F .t proFn) s ho buildr or imF6!6 rhdo(
<br />md who ontEdr lor !!.h Fnl.d! wnn . Co Gro(, licda.d t)@ud to ih. ( ontn.ror'! Li..M L.*).
<br />I d.rmF 'ixld Sdbn_, I &PC t'i'hire.
<br />l).r. ()*nr
<br />1!l2Ar$f,5:(Du[rrA[4.]IIi(Li!&Uq!
<br />I hccnt aii' trnds lsilrvol lrjuR onc olrh( finhl tr[ (t di,trs:
<br />-l
<br />hrlrsdsitl r .in . (-.nrfE!r. of Consr ro S.lalBs. for ssk(r comr.nrr,on, s ForiLd forh S<lbn.r7q)oarh.
<br />t hn Code for th. Faofru.. of th. so for whi.h th. F6n ir i!!.d
<br />I h$. rRi * 'll lnrmta'n Forkfr co,np.Mnon rBurrnc.. s rdptr.d h\ S(hon r 7(x) of rh. I :txn ( ild.. i(y rh. Fi{rndc. oI
<br />rh. Ndrk i(tr sh'.h tlns l.nnir s L*u.d Mv rorltrs' co ,lmqrion iNuranc. umfr dd pol'r] nun$d tn(
<br />K;*,^n Tacxt t S t'l ( ( € I
<br />-e,pa,
<br />lZ-t- ll
<br />-l
<br />c.nirythal inlh.rEfomreof lh.eort forwnthlhnp6mit L! lsurd.I shlll nol flpLy uy Frsr r dy mmni
<br />s a 16 bcn@ eliri ro rlE *ort6 onFlrhn h*! olc.lilohi!, a"d .sE fii if I rrblld bdom 3ubir lo llE
<br />hrlo' 6mp@.re. FovirioB oas<lb. 1700 olrn lrtDr Co.L l Cdl, fodn*i.h 6mply rirh tlror FlririoE
<br />WARNINC F.ilur. lo cuc world' comrqsdion sr.Eg. n unhrtul, .!d rhdl tubj.n u dltloF lo 6inin l pouh6 {d
<br />civil fUE up lo oE hund.d llEurrd dolLB {ll00.((lo). i, ddilior lo lh. @, ol conpaExioi. d.nusa B Fovidal aor tlE
<br />Sclioo 1076 oltlE libo( Cod4 irigcn !d fidr.y .lB
<br />\.," (-ir-(q n..,-. -X Aq..zt-A' ' t rcrtsrn coN rn^(fri--
<br />DICI.AIAIIAN
<br />I h6.by 6ftrm ond6 Ful, of Fjury rhn I dn [.dEal !id.r Flvirion of ( hrFa 0 ( coffiing wnh Salbn ?000) of DivBion r
<br />of iE auir &d ttof6b6 Co&. .t n, ltoe a q tull rora !d.lld
<br />(*.
<br />\e'.,
<br />cr-, B Li"*NuDhq + tzs G1
<br />(-3(r(t J&A.27q
<br />CONSTRUC ION I rNNIN(: AGtsN('Y
<br />I hF.!y ,Ifrm ud6 FElt) ol Dqjury rh.d lhs. ir ! on!ru.lior lq'dirs t*try for rh. Florr1lm. ol rh. $.d ntr *tth rhis Fnd n
<br />is!.d {s6 $r7, cn c)
<br />AfIUgArfLDfglaAII{l!
<br />I hddr rtrm un& F iq oa FJUrI orc or th. follo* us delsd{tu:
<br />D.flolirnrn PmirlArh.nos Norificdioi F.d.r.l RG8uUln'B (Tirl.40. P!n6)
<br />-Rcqut.d
<br />1116 of Noriftibn
<br />I cdi[ rhd rh€ f.ds.] rctsuldioG r.3id'.lt 6tdG rmr.l e N aflrltabL h lh6 proj.{r
<br />l .diiy rhd I hav. rqd thn lp?licdion dd 3lr'. $d lh. .b.v. inLlfuio. i! coEd I .3rc ro omply * nh .ll Cny ud ( ounry
<br />odin4B !i std. t,g,.lli,'. io hildlB co.fudio( in 6.t, dhrt rcF6dniv6 of tl s Cny rd Cout{y ro ar6 l4o! tlr
<br />,bov.6ran d FoFn, lo. d+drio. F p6d.
<br />lppll.rnl or ,trdl sirnrl.r.o.,. l2-l-li
<br />(smr'emm(eritr')l
<br />Je 4 o./q
<br />( S rfo;(v1(
<br />)F,WSltll
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<br />D COMMENTS
<br />Y.WJLI
<br />/zr\
<br />\*Z-t1
<br />.t-v{Irll
<br />Brown Coat q-tK-n
<br />5-2-11
<br />Eue/ c qt
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