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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVl nsulation
<br />Roof Sheathin
<br />Shear Wall
<br />Framin ilk r.E(JF.ntg<
<br />lnsulation/Ene
<br />allD //ls,'st lL7-#rrl
<br />Ext./lnt. Lath
<br />l\4ason
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />De Final ReU rt
<br />En ineer Final Re rt
<br />Flood Zone Certil
<br />n
<br />Noles Remarks EtC
<br />FINAL
<br />Certificate of Occu
<br />OWNER BUII-DER DEI,CARATION
<br />I hcrcby alnin u.d$ !.n,hy of pcrjury rhd I m cicnur fmm rh. conr(br' t,iccn\c rj* ror rh. tntn,Ninc ,cogr 1scc.?o.I 5
<br />llusincss dd Prctc\sion codc)r Any ciry or cou ry which rcqutcs ! f.flnir ro .o.jtucr. rtrcr, improvc, d.mtnh or sp.t iny(flcrurc- prior ro ils hsudtrcc. slso rcqtrn* rh. a]rolica lbr su.h pe ir h fitc a siEmd shlc rN rhnt heorshc k ti.cDsed px^r i-
<br />t, rhc pmvi!tuns oa r,E Crtrrr..rofs Li..n{d Li* (Chaprcr 9, Co,rmrcin! wirh s.dion 70(D ot Divhhn I orrh. r}o\nrc$ !.d
<br />Pn,rc\ions Cod.) or rhrr h. or shc h cxchpr rhcrcrnxn rftl $c hdri. for rhc altcscd cxcnrtrion. Any viotrri.nofsarionT0ll.5 hy aiy
<br />rypli.,nr ru ! D.nnn $rhj.ck rhc !p!ticrnr ro n.ivitpcn0ttyotnor,norrhan fivc hundrcddojtrntg5(D)
<br />-l.a\o*trnofrh.IroFny.ornrycnpk,rrcswirhwrscsasrhenv,bcotrrp(trsrriotr.silddrlhsorkarilrhcsltrrurc,r*rnn.kled.rollcrcdlorsh(SmTO44.BunmisaidprofcsionsCrdcTh.(irnrrocrol!Licc.*rrwdo.sn.llPptyroanowmror
<br />rhc pmpcnt who hlilds or iry)rc\$ rhcfrnr ud qho dod\ \uch wo* him\cttor h.n.tfor rh,ouSh hi{ or hcr own dmfk,yc$.
<br />pnrvidcd rh,r such irnptulcftnG rrc nor in cdcJ orolT.rcd tor stc. r h)$rls, rhc tlit.tiD8 .r ,nvn*c,mnr t $td wirhi,, onc )trtfco'rlhriotr- ltE Own.r Build.r *illhaE tlE hrd.n olpmvinS rh.rh.or\h1nil d nuit or inprolr rhc Irep.ny for rnc rurt s.r
<br />Daie: Opnu
<br />woruons, rrnrpcrsit.rtlr
<br />IIEII,AXAIION
<br />I hcrchy arfim undcr pemxy.rpcrjuryorc olrhc lbttowins d(tardioN
<br />I hdvc lndwill Einldr i CEnitk.tc of Conicm b Sctatnsur. ror wo si c.mpcnsoriotr. 0s providdd ror r,yS(ri.n tToo ofrhc
<br />tjtxtr Cdc. for th.IErromme ofth. wod f.r shkh rnc ptrnir i* k.x.d
<br />?AI hnve and will minr0ir worketr .onp.nsariotr iosur{k., ,s rcqlircd by s(l ion r?fi) of rh. Ijhor C.dc. ior rhc ,).rronruEe ot
<br />rhc work for ehkh rhir pcmit is issu.d. Mt wortcG comp.nsarion in\uucc caricr urd rsti.y rumbcr ec
<br />S}; k R;n.J
<br />o*, 5lloll6 .*,,*,".
<br />CONSTRUCTI(IN ! F'IITIN(; AGTNCY
<br />I h.Ehy atfirm und$ Fmlry of pcrjury rhal rhcE is a conslructio. Lnding agdn.y ror rhe I].rformn@ ol lh. Rtrk rr whi.h rhn [Ermn is
<br />i\\!cd (Scc 1097, Cir C ).
<br />APPI ICANT NF(:I At(ATloN
<br />I hcE$y arnn undcr pcn0lry orI'crju.y oft.f rhc followinB d..ta.rrions
<br />Dcnn'lirion Pcrnrirs Ail{stos Norincarnn Fcdcrrt Rcsuhrn,n\('In,c 40. p0n6)
<br />-Rcquncd
<br />btrrr oa Noriticarion
<br />lccd'fyrhJr rhcltdcfllrcAUhri('ns rSrnli[! ashc{.\runx]vrt
<br />'c norr!fti.lhtc r) rtri(pnic.r
<br />ll
<br />odinntucr and Slrtc L.w\ rchrinSr, huildingconnB.
<br />uh'!c mnlioncd |nrprny ror inspccridr!uqx,sr.
<br />Appli.ntrl or/tA.nlSi*ntr1trre ^,.,5ila/1fiZ,ri
<br />COMMENTS
<br />SLAB Floor
<br />Brown Coat
<br />_1. .s o*ncr oa rh. F)Fnt. rm cxclusiwly .onrncrihg wirh ticcns.d .onkNc'un ro onnrud I rf, pn,r.r (scc ?orrr, Businc$
<br />arrl Profssion Codc: The Conractois Liccns. trw docs nor q'tty r. d osncr of0rop.rlypho buitds or imrroves thcron.and sho mnlncls ior su.h pdjccrs wirh 0 Co.tm.ro(, tic.n$d pu$u,nr rorheConlloctor.sLi..nsc L,w)
<br />I dd.icr.!l rnd.r Sdi.n_. B &PC lorrhisrcs$n.
<br />stzL/lE
<br />I ccnityrholinrhc Frrlo unccolthcqorkforwhichlhist)cflnn irhsucd. t shalt ml cnrrtoy jny lc6on inanymonncr$ ns to b.com sobjct lorhcworkcs .on{*n\alion l.B\orcahln.nia_ and oSr hnr ifl srsutd rf,com subj.cr rolh.*.lte(' omp.n\inrn pmvhions ol sNrior :t7(xl oi rhc Larft c{njc. I shllt. fonhunh conpty wiih rtns pmvhions
<br />WARNINC: fiilurc b sc.ure sortcrs ompcis,rion covcrigc i$ untawlut, and shatt suhjd an cmptoycr rn siminlt pcmlrics 0nd.ivil llnci !p lo o.c hunddd thoustrd douaB (SI00_0m). i. addnion ro rhc con olcotrpcnsarn,n. dnnB8cs as pn,vijcd lor rh.
<br />sc'ion 10'76oi'h. Lnh, Codc. inlcrc$and anomy s tccs
<br />,,,", 5|to/13 App,rdtr,: a*-a-'W.ul)'
<br />LlcFNsElr|rE&ACT0R -DECI,ABAIDN
<br />I hcrchy nlfiir! unde. rcn,llyorp.rjxry rhrr I am ticcn$d und.r Fovision ofChnDicr 9t..mftnciic with S(rin 7ur0) orDilhion lol lhc Bu\inc\rand Prcfc$ion{ C.dc, and nry liccnsc h in frtllorcclndeller
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