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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AU!LDER DELCARATION
<br />I hcrcby dlrtrm undcr lEnally of Frjury rhlI I m crc rpt trom llt Conrrtrlon l-tcnc lr* tot rh. r,rllo*ing Erstr ( Se ?0.1 1.5
<br />Businc$ ad Profcs\ion Cod.) Any Cil, or Counry *hih rcqond 6 Fmir ro d'niR1. rlld, imPmE, iLnnnh .r qrn .ny
<br />(rudm, Irii. ro iis iss!m., ako rcquiEs rh. ir,plEunr for such Fflir io fib r rign d natEnr rhrr h. o, nE i! liNnqd furudd
<br />to rhc rrevnions of rlE Conr,mbr'r Ltcnsn L.* (Cnlprcr o. CommftinS *irh scclhn ?Lm or Division I or rlE auriErt ind
<br />Pmt $id.s CorL) oi thd tr or rh. il .r.mpr rrmrri'm and rh. hr.6 ror rlr ulhBcd cr.nprion AnyviohrnnolSdi,nT0:ll5hrEny
<br />.ppli€mt lor r F.rt sublch th. applicrnr to . civil FMlty of ml frrt ih@ fivc hu.dErr dolkrs (isfl,
<br />-1.
<br />s owEr of llE FoFny, c my cntloy..s wilh wry3 !r llEt elc @n{inslbr. sill & E*,trnll1llldmB b'
<br />it'r.tuted o, ot@d lor $l. {Sd 7(}14. auiEr dd Pbrcsi,^r C.d.: Th. C6.rBr,\ Lj..N L., &B mr {'plr l. ( owd Dl
<br />rhc polEry eln trir,k o, irqftB rlE6a lld *tn &-r uh Hrlt hin*lt o. h..sl, or lrmuAh hr m trr o*n .rpbF...
<br />provid.d lhal rEh !trFownl! e d id.r'iLd m off.,rd for {L. lr. inkq, l,E tlildin8 or it!.ftmd n sE wnhin.r Fi
<br />of6n l1i,trrtrO*BrAudrwiutbEllEtn|rofFUvin*$rtE6rilEdndhillGqmE[.poFr,brlh.ti(fEor
<br />-L
<br />s owrcr otrh. Fotdy. mcrctusircly..turrina *nh ft.rn.onrxron ro o.{.d rlr Frd (se 7ol., BurEs
<br />rd lM<in Cod.: TIE Coftror'r Lkcnr Lv dG3 mr .pply ro u ouF of FoF.ry *ho boild. or inrphtr thdFtr
<br />.!n who o rrrs for trh pror.re eirh r codrrto(r, li.rnin pled k' rll G,tu.' tr{N Lrw,
<br />I an.xcnlPt undcr S(li{'n
<br />lllBf!8ti:gutai$I1laIECIJXIII{A
<br />I h.E!y.rrm u ti Fnolly of FI,ry oE of tlE folkr*ol &tlr.rDnr
<br />-l
<br />lEE.,n vi[ Binrrin r CdrifE.l. of Colgr ro S.U-!N@ rq wrt6' onF !.rb.. E FoviLd for b, S..rirn ]?m ol rll
<br />Lrbs Cod.. ror rlE Flm ol trE wt f- *tah rrE Fd ir is:d
<br />l1l lt6r.rd *iU minl,in *",16 6r+.8{ir inffiq.r Equ-d by sdr$n lroo oltlr L,l'or Co<b. ror dE Flffi ol
<br />My wrt6 or{Endir. in.urm csio.rd Fniy nlniris c
<br />P,.t"!N,"r*, Q 2 b1? q 0' 21 \-Y -'L2
<br />-l
<br />ccniry ttlr i! lh. FraolmN oa rlE eorl fq *h.h rhtr Ff,n n i$.n. I rh:ll m'.nphr..y Frcn i. dy turr
<br />o c ro bcoE sbF lo ilE *trt6 orp.Mbn L$of Crlifomir.,n.*r rt l if I nDlU b.iim.ubF to rlE
<br />mrt6' on'FMio. prevnioB of S.dbn l?mof rlE L.lu clde I rlull. fonieirh oopl, silh
<br />'ho- FDvaaB
<br />WARIiINCT F.ih]E to ru rqt B'o,Fns.lbn oy.nr. i unb*r![ dd rll {bF a dlt,lotlr lo cinwl FE!6.!d
<br />civi! ar.r up to orc hudtld thousld dolbr (tlm,om,. in rddnaon io ilE ..r or onp.nsrion, durt.t Lr Fmvil.d for llE'
<br />SNrhn 1016 .f rrE Latv Code. inlcrcv and
<br />ill.K**eu- "€ sr",@
<br />I tt]ljr.,sln ( lmTral|l0r{ v
<br />-?_
<br />DECIASAIIO]T
<br />I hdrby .rtm un&r p..dry oI Frny rhd I m liere.d unlcr Ftrviiion ot Cn flq 9 I Nnftft rng wirh sdhtr 7(uD or Drnbn l
<br />6f th€ Busift:s tuld Pmf..rir.r Cod.. rrn ny ltcnE ir in tull loN .ri cllal.
<br />.'**..r*, C^ 3e{,.,,.n\.Ntr,rxr tOG LorSr-
<br />yl)tt*tttL-<- z \
<br />!AISIBUqu!JNI.EdDI!GIG!!I;I
<br />I hcEby afftrmund.r rEnaltyofFrjuryrhur rhd n ! oi ru.ri,.lcndin8 r3.fry lbr lh. JErlirMcc of lhcwk for $hi.i rhn Fmi n
<br />irsu.d (S.c.309?, Civ. C.).
<br />AIIIICANI.IES,AAATO!
<br />I h.rtly lfm undcr pcnalry ol Frrury onc of lhc ltllo*inr dKhruri(,.s.
<br />DcB,lirio. Pcrnirr AsLroi Norill.ario. F.d.rrl R.luhrions (Tirlc.lO, Pd6)
<br />_Rcquircd tr(.r of Norif.arDtr
<br />I cdiftrhd fic rcd$al rcBUhtirns rcBeding astElk]\ rcnDal !'c nn,pPlitrhlc t, rhir rn,F.l
<br />I.difrrhnr I rBw ad rhis +t,lkarion d,r, arc rhlr trE rtov. rtrlormrion ! !orc.' I .BrE nr comd, ei'h rll Ciry.nd Cou.ry
<br />odiMft.s .d sral. k*s Ehii,8 to boildinS coGrMioc rn lEEhy .ufi,ria rcIilrnllrir.! o, rhk Ciry jd Cou.ry ro .nrd urbn rlr
<br />rtr,vc mnrion.d pofeny fd insr..r n puq$us
<br />.\rpli$ l or AH.nl Si*nntu
<br />0s ur gsnLL(?C -z-zt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />rr
<br />Roof Sheathino L(t.llz\>wy 7
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />I
<br />FINAL
<br />Certificate of Occu anc
<br />Notes, Remarks, Etc.
<br />UFER Ground
<br />Subf loor/VenUl nsulation
<br />Ext./lnt. Lath
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