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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNf, R A!ILDl]N DEL('ARATION
<br />I @ !,IEm undd Fi!h, of Frury rhd I m .ronpr nDm rh. (-onrdoE l-irft.lis for th.lollowi,rs rd$. {Sc ?0:11.5
<br />Dcin6s afilProldion Cod.I Ant Ch or Counr) shth r.qun6. Fmi k' oldrucr. 1116. 6Forr, d.inol8h d. Enr My
<br />3'tuc'8.. rffto r'. i$uoc., d!, Bqun< rh. lppli.er fs su(h Fnit 'o
<br />fih..i8Ed ,rmt rh. lr or CE ii lica!.d FN.il
<br />ro rh. Fo\nKB of rlE Conrftdor! Lic6r.n h{ (Cnirrd s. CoFmcn ins r,irn S<tio. 7000 of Divisirn ! of ftc ltBind !d
<br />Pmrsiod (-o&) c th,l IE ft ih. a d@F tffioh &d rh. b6n ro, rhc rll.*.d .rnF$n Ary viobliof,ofs..ti.n 70!l t bDy
<br />tffi ;;;'c*ffi;',il,****fr*****.*" ",rn. pn,Frt *,h. ttrild! or irymt€ rlE-n. id *tr &6 kh *ri( h Mlf or lErlf .r thmu8h hir o. h6 o$r orph)6,
<br />F irtdlhiiud imp.o\ffi! & mt id.dol..oll6.d for sl. l l ho\ 6s. lh. hiuds or nryrovaFr ! Dld wnhin on. !d
<br />of.qnpkn rlE(xG auildd $ill hAi E hrda olFDlilE lht lE d dr dn d toiti q ir4.r\!rh.FFry ft'rlh.p{4xeof
<br />L d o$ffi of rlr F Fr. s.rlutr.t .odrerB N ilh licmr.d onrmcroB ro on!ru.l rL Fojc(l (sd 704-r. ttEm6
<br />ltd thfsionCo&:1h. Co.trocroas l.icru.lrv &,6 tur rpply ro &o$6.f |roFn, *lF boilds or inFo\6lhGon.
<br />,id ul$ od*r! f $(h ,rol.<1r *ih r conrdo(!,Ii.!@d puRM' rorh.aonrrcl.is LtdE lrs)
<br />Iinr.\. rtn u ld \r.rnr,/ to -:tq - t1 "-,X
<br />![c!aaaua!
<br />I ha.hv lmm und.r FMny of rEju',- oE of rlE tullou ry dalE.taB
<br />I h.\.rn\rll m'nrlin rCdiitrd.orconF' kr Scl osurc tur sorrd conp.nsion, a Fovid.d aor b, Serhn 17(x) of tlE
<br />kbor (-od., for 't FfolM.olilE$ort ttr {tr(fi tlE Fnn t su.d.
<br />I hs\ . !fl1 s rll m.rnilrn r ort6 co6rE s.l ion iBuranc.. $ r.quir.d by scl ion 1700 of rh. l,&r co&. for th. Faollffi. of
<br />llE sd I fn s hich rht pannil it is!.d Vr r ori6' mmrqEaFn 'rsuru. E&nd !d lbliy nlmbd e.:
<br />Poll.yNumb6: Erpt6-fr^:Sdi6 rhr' inrh. Ffornffi..arh.rort aor qfiEh rhitFmi is isu.n., rfi.llrct oploy!.yF{n inanyoena
<br />e N lo bc.oru lubjd to rh. uortsr' mnFEnnn hss of Cllifomi., rnd eG rh.l il I .thuld lt oE otir' io rh
<br />*0116 omp.ndion,m\ tioN of Sdtur l70O ot lh. lihor ( ode I till. fonh* nh codply sih rlss F.tirioB
<br />wARnlNG FriluE io Fc $orld'6mFdio. or-rs. ! unl,sfil. md rhrll subjdl an dploF lo siminal F!fti! &d
<br />.iril nnB up lo on. hu tal lhorqd d.Um (tlm.0ml i. .ddnion ro rh..€ of .omrEslior darreB a rro\id.rl for lhc
<br />s(rnn lui6 ofrh€ l..bor (nJc. nrs6r atr
<br />,.X.LO-:-!-!L::-L1:
<br />^wo
<br />DICIASAI]O!
<br />I hd.b, dtftrm undd Frk, ol Fju, rhd I m li..Gal un& Ftrr iri6n ot (lEAa I (6nl,lRi.s tr nh Sdnn 7000) of Dtr "o l
<br />.a rh. IlGrhd.nd PmlBn'B ('o&. ai m! lk.M n in tull lora dn.fidt
<br />c9{iraucrqB.'l{8DllcacrN(I
<br />I H,r lrm unda Fllly of Frjury lhd lh6c i ! @druc1ior Lldnrs isa.y aor ih. pq{orl1@. 6lrh. {orl fo. shkh rhir Fni i!
<br />ilscd (Sc 109r, Ci! C )
<br />AtzuGttLl)l;(LtEiIlI,!
<br />lhEdr aflimundc' po,ah) ollujury o . olrh.lnlhsm* d(lrdtunr
<br />lkDoh()i Psm[r'AslEnx N.rifi.arnrn llddal Rqul,rk]nr (lil€ll). Irrn6)
<br />R.1tutr.d Lcrrsof Notndan
<br />-
<br />I cd'6 rhr rh. fatd.l Etsuld nB E8din3 6tEs'd rm\ !l m m! lr,plubl.
<br />'a 'tir FDjd.
<br />ffi-,r,,n,,*'.,*,n6!9 c,lFn dJ srar. rhd rh. !h.rc in fonndn, i! cor.(. I .gc ro @nlpt snh .u ('nr. couit
<br />l.l6.R'6ddsr.l^,dr4rohuildiqcnlgru.1pll'rnh6tt,lu'hodaEpr6a'div6otrhi.CiryedCouryroo16uF,rlE
<br />!&)r. m6ln,h.d prcpdt for iNpdtn Vro- t4 ' 79l)tl+ '.\ppli(rnr or ,rtor Shn.,rx
<br />RA t@ tr4o+.rifftr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Dry\ivall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Deputy Final Report
<br />Engineer Final Report
<br />n\\
<br />FINAL 5+V20 I
<br />Certificate of Occu nc
<br />Notes, Remarks, Elc
<br />2
<br />Subf loor/VenUl nsulation
<br />T-Bar
<br />Handicap Req.
<br />Flood Zone Certif.
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