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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.. COMMENTS OWNER BUILDER DELCARATION I hdcb, srm uftla ,ci.lry of pdjury rhd I m .rmnl filn lh. Coilrtclo6 l-t.e l!$ fot lh. following t.&n (s< 70ll 5 BBind nn Prorahn C.d.) An, Cnt.. Cd'rr *hrh r.qur6 . Fn. k' Nldrud. .!d. !4rore damlilh or l4.t xr smrtuq F$r ro n. iwq lho r.gund 0. Qdtul lor.ci Fm to fiL i.i8..d riu6t lhr lE or ilE i! li.sE d F,tr., lo rhc Fnvirions of rh. G.ftuoa! Li.ord Llw (Ch.pl6 9, Cor6dci.s {nh S.clion 7ffX, of Diviiion I ollh. Burnra sd Prcldnrtu cod.) or lhd h. or rh. ir .(mpl lhs.non sd lh. b6is fot th. .lk{.d dmFho An, ri]hhn oasElbn 70: I 5 by dy .pf'lkur for . Fnh qticr. th. +pli.or ro r cilil FEftt of mt mn. rhe nR hotd,td &lLB (tJ00) I. .r n*n6 ofrh. pmp.ny. or ny mplorG snh ugB d th.n $L onpqE lion, wjll dr lh. ro* !d ! nrude i! @l inldrdal or ofiqcd tor !.J. (s( ?o44. Bui,6 ud Pr.fdioB Cod. 'n. Conrdna! Lictr Ue &B iol +9lr lo.i oMd ol rh.FrF ty $'lF hrill d rFn\6 tlEa rn Fno dE $h \ul trulr or lE-lf or rlrcuah hit u lE or, dph)6. Frvilcl rhd kh mForlrdr md hEn d dor@d 6. sl. lL tntr6s. rlE t!'ld!B d dgDraid i o! *nt6 d '6orconrldio( ln. ()*nd Brilda qill hlr€ tlr tu&! ofpmrus ltd L or.h dn d tlild or iqmw th. Foluty 6r E l[rlreof I.sonEofrh.Fopdy,mcr.hn.L_rd r&m!$ h licor'l coir-r.x b odtud rE FoF (s( Tolr' ItB G !d thti$r.(-od. Ih.Conkrclo.s l,icor l.!tr do6 mr.f/oltti Mo$nd ofpr('IEny*hn buildtor impro!6lhscrn. dnd sho conrreri tu such I,d.ft wilh . ( onlmdo(r) lic.n*d puBu r lo rh. (bnrador! l-i..M k*) I m.i.md uD:lc S6lnn// .t3-Lcl DICIASAIIA! I h6.ny .fim u.d.. pd.ny or Fjrry oR or rh. folh{ in8 d..Lrdrd I h.\. !,vi sill 'Einl!i. a Cdin..l. ol (i)Mr io sclf- lNut. for rortd Nrnr..s io.. s FoviLd for hy selidn 17(D of rh. r,bor ( o&. f rlrFtffi.of rhcudr f6r$hihrh.pdmn it i$.d I hav. rnd s ill niinrdin s.116' conp.rlihon !Nu.iN., s r.qun.n ht SeN. 17(Xl oa lh. I lhor (nd., lo. rh. ndfolM. of rtl. \orr hr *hi.h rhit p.flnil i! is.d My u orkd' comFs.rion irenmc. csFir ad policy numb.r ec I en'6 rhd i. rh. Fa(llM. oa rlE uorl Ior *han lha Fmi ir u$.d I JEll ml odor ar" FiIn i. ut mdE $ d ro tEorc $b.n ro rr. qlrld 6ml.dio. hvr of Cllifomi^ d rsc rhd if I dDuld tdom. rubjrl lo rlE s0116r'.o,npsBnrtr'nDmvistr,ns.lS&ridrtr(X)ofrh.l.ilN('od..l\halLn!lh*ih.oml]lr W nNIN(; F.ih . ro kur. *rr!6'.omFrdtun cov@*. E Ml.$ful, ed shru dnplolr ro diminil rtr[irs e'., .ril lih6 up ro oE hufrnal rh,uerd {hllG (!,00 S<rn 1076 .lrh.l,l.tr aeL. inrdcr dd nhrEr I h*by.m.m und6 Fshyofrdiury rhd I dn licqtsaj lndd pm!itnn{tchtpla 9 (.om,ndcin! snh S.nno ?000) olDivision:! of rh. Busins sd P'oleiod ( od., dd my lic.M ir m full forc. al.aI<l I r.ft. Nnmlq. COIISTRU("IION I trNDING AGFNCT I h*b, lllm u.dcr Fflahy o f Fjury ihd rha. ic t .odrudi.n Lndins a!fty lor rhc pdnrlru.. of Ih. u ork ft,r *hi(h rhi. pdhir it ir$.{ (s( 1097.(n ( ) artugBr.DriglEtruqli Iho*n.llirnundd r.nrllyolro|[yon.olrhcfollowinsd(l.rarn)ns: Ddfr)l [n Pmir3.Aib.srG Noriliclrrn li.dsll R+uhr$nr (lil.,1rr. Pan6) i.quiEd tdrs of Ndifrcris - I .diry dld lh. H.6l Eguht 6 Egrdins abdor rmvtl c mi +pli<!bk lo lhir ,6F lcdritilrllrv.,udlhirrgtlhdio.nnrd.lhddEdio\!inroririon!oEc,.SEroonplywirldlCny.,iCooly o' 'linan.rs trkl Stuc lissr.lnrn! h hor nB..n{6ddn6 olrh$ ( iry and c.u.D i, nr6 upon rh. nh\€ nBrn,n.d prcr.ny fir //-/3'^Lq Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation , Roof Sheathinq .d{tu lllzrh frfr Shear Wall Framing ln su lation/E ne rgy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif. Aa r-Y FINAL 7f/)rz)arba /t&6\ Certificate of Occupancy I a *.4:1319__ Notes, Remarks, Etc.