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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />RoQf Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Ene rgy
<br />wallD
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4asonry
<br />Pool Fence
<br />T-Bar
<br />De puty Final Report
<br />Engineer Final Report
<br />I
<br />FINAL
<br />Certificate ol Occupancy I \-g
<br />Notes Remarks Etc.
<br />OWNDN AUILDIiR DTLCARATION
<br />I hcrcny llnnn u cr pcnrlly ol Frjury rtu I n.&mfl lnrn thc G,ntracxrs Liccnsc 1,0w for Ihc lhllowins EN)n (Ss.7011.5
<br />Bu\iics anl |}oltsion Codc): AnyCiiyor c.unry whlch rcquirc\ a nennit ro s,n\trucr. alre( improvc. dcmolth or rcprn iny
<br />nrucro,c. pritrro ils irsuarcc. nho i.qtrncs rh. lpt,licul r.r slch I]ennir ro filc a sisncd stdcmnr lhlr hc or rhc n lien\ed lu6urnr
<br />ro rhc pmvisidrs ofrhc Conkrcror'\ Liccnscd Luw (ChrDr.r 9. CDnDERinE qirh Sc.riotr 7lr0 ol Dirki l ofrl[ Btrsdc$ ,nd
<br />Prftsions Codc)otthai hcorshc is crcnur rhci.rr,m rnd rhc hlsn lhrrhc trllcscdercnrtion Anyliobrio.ofsccri{nr70.ll5hyrry
<br />.ntlicrnr ror r p.rnir subjc.k rhc appli.ur b!civilpcna[yolrcr nme rhnn rivc hundrcd dollrtr ($5u)).
<br />I. {\ o* crofrlf, pro|Erry- or mycar0loylrs *irh $adcs rl rkn y,h unlai\ nrn. silldo rh. $ork md rhc {h*rh tr,k{
<br />inrcfrlLi or ollcr.rl ror sft lse.7(!1. Arsin.ss rDd ltofc$t,r Code Thc (nnrn.rol\ Licc.r ti* doc( nor.Dply r' inorrcr oi
<br />rhc PR),rn, wh' huildsor inDrovcsrhcron. altl who des {rhw.lkhnnscllor hcrcl{orrlrnx8hhh rhcrownc Dl,)yccs.
<br />lmv cd dr6r {u.lr imprevcmnh¬ ir{c trtkd or oficr.d n,rslc lL howclcr. rhc tdildi',! nr impovcmfr is {nd *irhi',otrc )tnr
<br />ofconlnbln.rh.OwnsBuildcrwillhr\rrhcburdcnolpmvirSrh.lhcorshcdidfrrhoiuoririp$vrlhcpmiiatrlorllLpurtE$of
<br />l- 'sosDcroirhc nmpcny. rNcrclusl!cly.ofkr.ri'r! sirh lt n\cd.onrrctr\hcon('acrrh.pmjrcr(Scc 70.r.r, Btr$'s
<br />rnd ltolcssr Cod.: Thc Contkkr\ l-icctr{ l-,s docs nol r|tlyro rtro$ocroipr.pcrtywho hnilds or nnpmvcs tlrr..r.
<br />rnd sho cotrirrd s l0 sl.h ,!n)jc.rs wirh dconracbrl\) li..n\cd pur{unr ro rhe conk&roi s Liccnf l!sr
<br />I
<br />Ihrvc trd{illn[inrainrCcnifir]rcoICor\cnlroScll:lr{ncttrNUrkorconrDcN nrr.rs rrcrnhd i,r by Scdirr lTl)l} oi thc
<br />tlhtr Gxlc, ntrrhc!.rf{nNoc. ollh. trork ir}'hich rhc Dcnnir is isuLrl
<br />I l,xvc rnd *illnmiNiif workcrJ .omN n\nri,)n i',\rrrn... J\ rcquircd hySc.rn,n.r?(xrolrhc l.160r(inlc. for rhc pirlnnnrncc.I
<br />rhc qork lor whi.h lhG p.rinir is isucd. Mt* rkcr\' .ontln\rrtrr i'!nmm.utricrrd ['li.t mn,hcr arc:
<br />l',)licy Numh.r Erpnc\
<br />-l
<br />ccni! rhor iD rh. lcrr.nndNc orrhc *.'k r(, which rhh rcirnir is i$ucn,I shrll tror ctrfby nny |tr$n i. lny mrtrncr
<br />$ h b..om uhjccr ro thc workcH comf.ns i.n lawc of Crlilonria. and +toc rhd if l should tf,conr suhFr ro rh.
<br />sorkcr( s'mp.n\arn,n lrovhions oISccrio..17fi)ofrh.ljh, OJd..l\hrll, hnhwirh c.nrrly wirh rho{ pn,vili.ns
<br />WARNNG r{ibrc ro c.urc work.* .otr1p.tr{rn,n cotrrrsc i\ unhw{ul. rtrd \hall uhicr .n.nulo}e. ro qiininrl pcialrics md
<br />civil fincs up lo onc hundrcd lhonsrM dollr^ lilfir.Ou)). i', dir drnrgcs as povilcd fitr lhc
<br />:;|"*;:?wt;-
<br />IhcmbyafirduidcrFnrliyolf..jlryrharItrmliccnsdutrdcrnmvlsnr.lchioq9tconmncflrewirISccl
<br />of rhc Busincs\ md Prctsnnrs Codc. aM mylicctr* i\ i'r full for.e drl.fla.r
<br />CANSIruCIIONIEIDING.AIiINCI
<br />I lErchy afllrm und( Fnrhyorp.rjxry rhrr rhcB is n con{oction lcndina rscncy ior ihc pcrtomancc oflhc suk tr wl,ich rht pcn.il n
<br />hntcd (S( 1097, Civ. C.)
<br />LttllcatfDEcldnarloN
<br />I lEElry fiim xndcr r.nrlry orlf,rjury otu ofuh. firlowin8 d6-l{.rlions
<br />Dcnxririon Pcrhir\ shcdos Norificarion Ftdcml ReSulurion\ Irirh 40, Prna,
<br />R.qutcd l.crcr.rNorillcrhon
<br />_l.crriryrhnr rltr rldcrllr.BuhriotrsaSodnrgisb.ios rc trrnlrrDorlppl'crbkkrrhispn,jccr
<br />l.c iftrlBr I hJ\r r.rd rhnnntlicrri{nr klnicrhrlrh. xhiv.l r comr. I asre roomfly wirh rll Ciryand Coutrly
<br />rcrncsorllivcs oirhh Cilyuid Coutrly to cnrcr Dpon rhcordiMtr.csrftt srtrrc Inw\ r.l '{ir huildi'r3ro
<br />rlirr N Ii{)ncd pn)pcnyfor i',sp.dn,n
<br />/\DDlionl or \tml Siln lur.
<br />v
<br />*,", or/nt/&
<br />^.ra
<br />Erection Pads
<br />Handicap Req.
<br />Flood Zone Certil.
<br />I hcleby.inn undd |xnalry.rpcrjuryotrc ofrhr fi,lloNins ncchrdion\:
<br />L.nilcil A'lJc+
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