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BUILDING- INSPECTOR RECORD J
<br />SITE.WORK ID/SIG.COMMENTS
<br />Set Backs t4
<br />Forms/Steel/Holdowns
<br />Erection Pads x1
<br />UFER Ground ,xr:1 I
<br />SLAB Floor *1lr,lltp
<br />I
<br />Roof Sheathing ,4o1"
<br />Shear Wall tiYflT'
<br />Framinq 1UT Z ))
<br />lnsulation/Energy lif "
<br />allD h)
<br />lnt. Lath ufl I.x ,/
<br />rown Coat ((
<br />It/asonry u./
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil
<br />xu4o{1{tak-ltt (a{-/9)
<br />I
<br />t U
<br />FINAL o I Ixotez"/t '91)
<br />Certificate of Occupancv UI \/
<br />Notes, Remarks, Etc
<br />/tr
<br />orvNER BI'II,DF:R D}',i,CARA.lI(}N
<br />I hcrchy rflnm uMcr l).n0h! oi rcrjury rhal I am cxcnr lmfl rhc (onl.rcron' t,iccn\e La$ ntr
<br />'hc
<br />n I'win8 rcns ls(t.Irll5
<br />tlusiNs and Proltsi.n Cole) Any Cir) o, Counl! whkh rcquncs r Frhir kr .onntu.r. rll$. inprovc. &mli\h or EPln atry
<br />Ntucrorc. pri{,ro irs nrnicc. also r.quid\ rhc,,'dicmr l{n su.hFflnir to lil.a \i8ncd (ltcnEnl rh hcornr i\ li..n\.d fuhunn
<br />t, rhc [ovhnnx ol lhc Co.hcrofs LiceDrd LJw (ChrDrcr 9. Connncmin! *irh sccrim 7un or Divnion ] ol rhc Busine\l and
<br />Pr)lesi,'n\ Codctor rhsrh.orshc i\crcnrpr rh.rciioma' rlrbNsforrhcrllc8cdcxcnTrion. Anyvi.hrn,nolSc.ri, 70:ll5hyrny
<br />,mli.rnrrd|rnirsubj(rrhc.p!licrtrrroacililpcDrlryolmlmorclhlnrivchurdRddolla6(15(x,
<br />-1.
<br />!\ owncr orlhe I'n,pcdr.,tr DrcDrPk,yNs wiih w rcr $ rhcn $k..nr|ENarior. s'irl do lhc *ork iid rtu {tuctrm i\ tur
<br />inrctulcJ.iof.rcdfotulc(Sa7(}!,Busircs\atrdPn,lcsio[Codclhc(innrmntrsl.iccnscl-twdetnolaptlyr)mosmrol
<br />rhc pnlrd, sln) toikh or i'rit(JrLr rh.rsn. rn(l wlrJ des sEh $on inn\.llor hcr\clfor rhftUh his or hcr tsn cnPkDr.s.
<br />providcd thor such inrpn^cmn6 arc mr inr. r1] or oficrcd lff \rL ll hoscvcr. rhtr hu ill]in8 or inlPl or$rnr i\ *)ld sirhn o.c ttrr
<br />ol.onlllcrion, rhcOstrs Burldd qill lurc lh! tatrdcn ol foving rhalhr or shc dit mrhuikl.r i'r{tuvcrhc pmFny l'or lhc |uqrsc ol
<br />L.sowncroflhcnrllrcny.0mcxclusiv.lyconrrrcriruNirhlircnscd.ontrckNir..r{nrrrhcpmjccl(Scc?(},1.r.Bu.i"c\\
<br />and ftrfl\\iJi Codc: Th. Conractr\ Li.cnsc Lr\v docs nor aprlylo a.o*ncr otp.opcrry $ho builds or i'npiov.s rhcrc.n.
<br />.nd q,ho contuch ior such pmjccis wirh r (nnhcro(, liccnscd rru6ulnr h rhc A rndui\ Li.cn*^ tiw)
<br />I snrcxc rl, uid.r Sc.riotr .3 &PC forrhn.cison
<br />Dol. Orner
<br />wtrunn.s ctlrltpem,trrol
<br />DICLABAIIO!
<br />I hcrchy{flnmundc,n n!llrol'pcrjuryoncoirhclalh*inEdccl nrion\:
<br />-lhlvcoftlwillnmiolai,aCcnificarcolConrnrrosclilnsurcr(nworkc(.onf.trstuon.as
<br />nmvidcd ttrhysccndn:]700orrhc
<br />tf,ho, C.dc. ror lh. pcrioa,trnce oflh. qort for which Ihc Firnir is nsucd.
<br />lh(vc {nd will monrllin workds coDDcnsrrn)n in\urancc. rs rcquncd bt Sc.ri( lTon ol rhc l-*,or C d.. rr ihc f,crturntdcc of
<br />Ihc work ntr $hichrhirrrnnii i\ i\sucd nry snrkcn c.nrpcnsrrn r rn\trri.c .rri.r . Fli.ynunrn !lrc
<br />c..i., ' 6vl ( Cr.^ os7-sE sl-T-r
<br />l.cdityrhnrinrhcpcrf.mnccofrlrcworkiorwhichlhirNrrniri\hsucd.Islrllioi.Dloyitrytf,Forinrnynrurcr
<br />si s lo bLcom shjcd t, lhc wor[cn conlnrnid i(,h lrw\ or Crlironri,. d 8nclh.l iiI should tEcom \rhFrt,ittr
<br />\ukcn conrlEneiion Inrvisn,is.fSd.ri{[ ]7lnofrh. tjhr Co'lc.I sh0lL. iinhwilh.omply wirh rho{ prcvilnrN.
<br />WARNIN(;: Flailurc h scurc workcn rorpc \riion covcagt ir uilnwtul, ,trd shdl subicct u cmiloycr ro di'ninrl Fnrhics d
<br />civil ,nB up ro om hundrcd rhousa .lollf,r\ (Sl{X).(iOo). h uddiri,rl t, rhc cosl ol compcnsalion. dlmrsc\ r\ Pn,vi.lcJ rd rhc
<br />o*",' oG
<br />itrcru r. klrnfl.\ \ 1..\[t,.n,',,.,,,)k- BUPTY \-f
<br />u!!!$:Dt!2NltrA(IQtr
<br />DECI,ASAIrcN
<br />I h.Ehy!finmundcrpcnnlryofp..j!ryrhul I !n lie.$d lndf aft,eik,r .r ch,Pr$ 9(coflnmmins *irh Sccrn,n70fi))orDivisi s
<br />or rhc Busiftss rd Pmic$ior$ Codc. ond my liccnsc is in tull txe a d .1Lrr.
<br />T)o
<br />,"," d(r [rg tlg cor.rro"\A ts"I-Ltot\e
<br />CONSTRI]C'IION I ['NDIN(; A(;FNCY
<br />I hcrct'y oltm undcr pcnslryofperjtryrhnrrh6. ilrconnflcti lcndir8(8cDcylorlhc|{rlonnrmc.fihtworklirrshEhrhhPcrmirh
<br />hsucd (S...:ltli)7. Civ. C )
<br />ATIIIQTNLIIqdAAIION
<br />I tr{hy,ttian undcr lknrllyol pcrjury onc oflhc nnlowirs dc.ludnn's
<br />D. x,lni.n P.rmiIs.A$cslor Norilicarion tjcdcrll RcEularions (Tirlc40, PrdO
<br />Rcquircd l.rrcr oi Norifi clrion
<br />-tccnilyrharlharrcadrhi\lppli.arn,iuxldrrerhdrhcrbvcinn,mhrn{isconDclligrerocomPly*irhallCiryindCou.lyordimr-^cs od Slllc Li*\ rcldin! b hdiklins.ond
<br />0$ovc mnrioncd propcnyntr inspccr ion pur|ors
<br />Applic.nlorAs€nisisnnture !l-
<br />ion. rid hcrcbyaurhoria rcrlcscnhlivcs orrhi\ Ciry atul Counry ro ctrl.r uF)n thc
<br />K $uF\(rl4 <--t -," oC[tat lt,
<br />Ililttr'rZlA
<br />EVYtlt
<br />DATE
<br />L1tr1.,'\ Nrtrr
<br />tf,ndcis Addrcs.: _
<br />I ccdifrrhl rhc li{lcrltuSuhrbtr\ rSud[E {hc\los rcnDul rrc mrnmli.xhl.t' rhi( |miccr
<br />l,d
<br />IY
<br />'a?
<br />Sublloor/VenVlnsulation
<br />*le7 I (
<br />tQfl,fl t3
<br />9lg-ll tg.,
<br />vY.il:o.Le.
<br />Altrlu lrfD..
<br />.f
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