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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS O\T'NEX BUILDEN DEL( ARATION I h6.tr srm und( n nih, of rrjury thal I m .rmd tun lh. Colllrf,lo6' liro L.r for 0!. rolo*i.s lan (Sc ro:l I 5 BulrlB ,!il foldbn C.d.l: Anr Cily or Cs'r) *iah r.qund r Fni lo srdrud. .lls. itrrF.ve tlamlirh or tq.n nv lttudue Firr ro itr isu... dlo r.quir6 rh. @plKdl for luch Fmit lo fiL r sisn d naddr rhlt lE n JE i! ltd!.d pd$!I ro rt FovilioB of |lr C.drxrd'! Li..nsd Lls (clrfla 9. CoMi.g *in Sdion ?OOO or Divi.ioo ! of th. Br'ilB Dd Phfdirs (-.d.) r rhtr lE tr rlE i ddit, rffiom &n lh. blt lor tlE .lkscd ddplioi An, vioLrionofs..lioo?0115 bylny ap?lic! ror!pcmnsubj.fltrlE.pplkr.lrotcivilp. hyof rcl mclh& ljv.ltund,.d dollds (lJ@). l. s oma ofrh. F.Fny. or my .nplor6 wnh wts6 s th.t d. mnFsrion. sill &, ll! *qt !n 'lE rndr i! (n idaxlcd d ofia.d f(r rb (sd.7ol4. &6iE !d PmfsioB Cod. TIE Cotr6.loc! Li.4 Lry do6 ml Pglt lo 6 o"â‚¬ oa rh. FF! uho tiil& M imFo!6lts&( sd s ho &6 uch E* hin..lf or h.trlf or lhoush ht or hd om .nploy6. FoviLil thi trh mFrsfficmr -rdHdofir.d 6t d.lL tnw,llE tlildill or in+oeqd it 5ld *ihh w )* olcorDt bq 0! O*c BliltE sill hlw LIE hido of Frvins lhd l'E ot !h. dd tul build d niDott th. DrDFty tr tlE F pc.r I. B o$nd ofrh. Ftrpdy, m dchlirry.oiddr.a trirh li.6!.d codd6 ro ('dM rrt Fojet (sa 7()41. &and .d hDisir Co& Thc Clnrrrors Lic6. Llw d6 ml rrply lo e .66 of I'krpdy {ho buildr or inprovd lhqon ud eho odd3for sch FqGt *irh. coffio(3) lkded FrEd lo th.Coir-loai l-k@ r*). Ln.rcmp! uid6 s(rxrn A & FC for lh6 rda'n Drrc oin6 ulal(E!5:(auflirsallQ!ul(ldaarla! I b6cr^ stfirm unds pqul') of FJrr!.R orrh. nnh!i,3 dcl[llNN I h.\c rn $ill md,in i cdifkd. of (-()lgl b Sdf-lNE lq uortd onFE io.. B Povii.d lor by sclion 1700 of rhc l,tor Code forlhc psfomec. ofth. m for fiicn rlE Fnil ii NU.tl I hrv. an,t $ill mrinr.in sorld cohpc6irton i6ur!m.. e r.rtriEn L' Sat ion l7m or lnl Llbor Cod., lor llE Fr()lrfu. of rlE $nl lor [hkhrhir Fnil i'in d My*ort6 onFdirn iM..ai, sn F lt) n@bd & ..,- * NtrvAv orn 2-r,rPtch *,"rn,.'-, -- WC btr9 UO t3 ,*-,' o-]uo Ll n I cd'ar rhn r rtE Fao'Il1*. of lh. *ork fo. I hih lhi. FDn n s{.n l sbll ml strpk'} &t F$n h &y nIffi s sro b..oE.ub6r ro $. wrd (o"qEE rio. L*: of (.lifomi.. ud lsr lhd if I tlbuld haom. tubjd lo th. m*d' comF!.lior prbviEN oasâ‚¬rh. l?m oarlE L!&r Cod.. I JdL foni$ nt omply wnh rho- F$ir.6 UARNINC Filu. lo sE. wrld' onpdltion .ovdte. U ohwtul. Md dl tubjd e anlloF to sinintl tcuhd od cnil fin6 up ro on. tundr.d rno!.ed 116116 (llm.ooo). 'n .ddnion b rlE .on of .omFdion. daE36 B Forilcd fo. tlE scrhn i076 of lhc lrhr (ii<. rnr6.r ei diorEv 3 occ (] . DECLdAAIIA! I hdby llIm undd p.n.lr, ol pdjury lhd I u l(qs.d uids provirirn ol (-i!PtG I (snffiins rnh Sdi.n 70m) ol Dn irnn 1 or rh. BNitB rrd PmiBio6 Cork. .n my lr6E i b frrll lore tn .lId Li@c,.s- -c-u-)D6oL4 1''r19(o g))e4f- cqlilaucrxtd rEdDllc-&c[lcr I lErby .md undq p.ruly of pqjory lhd lh6. ir ! otrnruclbn Lndi.s aBd.y aor rh. Ffome. of rh. rdl i,. *hkh rhir Fna i! is.d (Se 109r, Civ C I Ladd r Nm. AffU(AtrL!!CIASAIIA! I hEir,rJfm undd dahy of tEjury oE of lh.fouo*itrB&{le io : Dmoliiirn PmnlAltdr.! Nori6..'io. r.d6.l Rqlldrn! ll nb{o. Pdl6) Rcqurcd l dr6 of tlrn'frrkrn I .dr 't rhd rh. f.d6.! r.sulirioN rcssdina ab6ro! rno\ r! d. Rn !pdk!hl. lo lhu p.oJer I rsrd to conpl, *nh all cn, tnd Colnry ql4r t', I .61ify rllal I harc @d thB.rpli..rion and e.r.lhal rh. ih)v. i;i';7F; Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor SubfloorA/enUlnsulation Roof Sheathino Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif FINAL tl?-lot..]-ot *?lk" Certificate of Occupancy Notes, Remarks, Etc -,- \OltztSll4