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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNIiR AUTLDER DELCARA'TloN
<br />I hcrchy iifinn undcr pcMlly of pciury lhal I im crcarpl fm'n rM (tnlrlclo6 t-icctrrc liw rbr Ihc hlloeing ENn, (Scc.?0.115.
<br />Utsinc$ and P.ofcsion Code): An, Cily o. Counry $hich rcqutc\ a pc.mir ro consrruct. alrcr. ihp!,v.. d.ndi\h.. Enrr r)
<br />{ru.rurc. prn h irs uin.c. \o rcquircs rh. +llicanr forsuchlcrmn ro fil.a si8trcd sr.mnr rhd hcor shc n liccn\cd nur\uJnrf
<br />tu rhc,r,,vi\ion\ ot rhr Cont,ctr'i t-icc.rd t,s* lChiprcr 9. Com,nercii8 wirh Sc.rn,n ?fiD or Divnion :l ofrhr Au\incss and
<br />I'ntcssionsCodc)orrhrih.orshchcxctrrBrhcdro rrtrd rhcha\is f{trthc rllcAcd cxcnrtriotr. Any viohion of Sarbn 70.1I 5hrrny
<br />ipflicitrlfor r pcanir$nlc.lslhc lPrlic0nr Io nciviltcnrlryofnorrmrcrh.o firc hundrcd dolh6 (S500)
<br />L as owncr of rh. lnIeny. or ry cnpk'$el sirh oa8c\ !\ rhct n,lc conFnsarion. will do rhc wi* ,fij rhc slmru. \ tror
<br />inrcndcJ or ontrcd fttr eh lsc.70a-4, Businc$ lnd Ptulcsi.ns CGlc Tnc C-o toct, \ Li.cnc tiw doc\ nor sII'1, ro rn nwncr ol
<br />rhc t)n)pcny wh. hilth or ioprovcsrhcEr lnl who docs ssh s.* himsclt or hc.sll or rhmu8h ht or hcr own c'nplotccs.
<br />t,rovid.d rhrr skh impmvcnrnrs m nor inr.nd.d u olltrd f(n eh ll h,*.!rr, rh. huiBi.S or iqr.Em n ell wirhin orc }!u
<br />or conDbtion. lnc ownc! BuildLa *i!l hlrc rlrc hrdcn ol pmving lh{ hr or shc dil mr truikl or nn mvc lhc tnn ny ntr rhc ttl[{ or
<br />-l.rlowtrcroirhc|nopcrry.anrc\clusiv.lyconnding*irhli.ctrscdconrrr.bnhconetucrrh.pmJ.ci(sr.70,rl.Bu\irc$trM Ih,fL\\. ('.d. Thc Cont rof( Li.cns. Lrwdoc\ n.r amly k, M osDcr ol p()p.ny sn. huildsor nnpmvcrlhcrcon.
<br />ond *ho .onrnch ,or such nrqccls wirh n Conrmdo(s ) Iicc.{d rusuanr rorhc(},nrrucxtr s I i.cnr ljN).
<br />IamcrcmF und.rsNrnn ,B &P.C fnrrhnrco$n
<br />D .: OPrc.
<br />IIABtrEBI.qOI{TBSAIAN
<br />DECI.ABAIION
<br />I hcrchy oinnn undcr prMlryol0sjUryonc.frnc n,lb*ins dcch,elt'ns:
<br />lhn!.{xlwillnuinr{inrC.nifi.rrcolCon\ctrrroSelfln\lrcnn$orkrionp.ne.oi,asF)vidcdrorbySNriotr:l?U)olthc
<br />Lnbor Codc- lbr lhc pcrloflnarce oalhc wort ror uhich thr pc nil is ksucd.
<br />I hnvc a.d w'llnrinrai'! *ork$s .onllcnq..n insurancc. rs '.quncd by Sr{rion ]7m.irhc l-ihorCodc. forlhc pcltorro!.c ol
<br />rlt worl lorshi.h rhisrfimir is ir$c,l MyeorkcA . nrNn\mion in\xr!tur.dnicr 0nd Bnicy nuNbcrm
<br />Poli.y Nn,nbfir-Expnes
<br />l..dl[ rlrl i'rrh.pcrf{n n..i)lrhcsorknn\hi.hrhnFonir ]\ isu.,l.I \hrll o(rnrpo,rnytcAo
<br />!,r\n)hc.rrf,\uhE.i1o1lrso,lo\.onrP.tr\xrn lxw\or(xlitu,nir.r rgr.. rhxr ,l I nn{u
<br />*orkcr\' comFn\in,n tn,vi\i(,n\ .f Scd i(,n lXX) of rh. t]tin Gxtc. l \h ll lnnhtr nh co ltll
<br />WARNING l{ilurc k, sc.urc sork r'comp.n\nrion.ovcru8c is utrlrslul. rnd shrll su
<br />civil ftrs up k) onc hundrcn th.unu dollan (t100.000). iD rddiln'n lo Ih..on oi ros x\ tnr tl.d r(n llrc
<br />S.cli(r.10T6olrhc trhn Cixic- inrscrl rntlJrnnEy r
<br />I hcn'hy rfln u.dcr lltfully of p.!!rt rh r I a r 1 undrr ln,ri\i,,n o, Chdtrd 9 lcomnrmnrS wir
<br />ts
<br />q
<br /><--/6-corrmrorx:
<br />CONSIBIJ(:IIONIIIDINIj.&CEN(I
<br />I hc(hy arfinn undf Fnnl'yorp.rjuryth,( rhcru is r.oNrru.rhn LMin8 agcn.y for rhc pcrfonmrcc oflhc $ort lor qhich rht lclnir i\
<br />i\sucdlSec .1097. Civ. C ).
<br />APtLICANI-llElIr'latrIlQN
<br />I taRby lllim undcr I.nllr, ol prrjlry on. or rhc r.lbwi',s dcclrrarionr
<br />Dcnnlirion Pcrnitr Asbc\lo\ Noli,icrtnin l1dctul RcEtrhlionr al illc (). Funi)
<br />Itcquircd trlrcr of Norifi cnrion
<br />l.rdirl rhrr rh. lcJcrrl'cguhrtr) s'cgn'd t r(f, (os'.nn,vx [r or
<br />-X,*",',rhrr I hr\t r.rd IIN appli.nrionimdn crhrl rlr n A.otrcc'. I ryre roc.mlly wirh rll Cnrrhd c('otrry
<br />trd SIrr. l-rus ft irrirg ro huildirg.orslni.rior.rcprcc.nrilivcsoirhlsCirvr CounryhcnrcruBn,rhc
<br />rtxnc nrtrrirnrn InrF-dl lar in\pccrtrn,!tr
<br />'\pplic,nl orisrnl Si(nih'n *s-/6-/&
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing (lzzlv b Al*ttrl' / t
<br />lnsulation/Energy
<br />Drywall I Qhrl/r t '1n/fufL r'b
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL Ir /t//,f 2Zl*r*/tr?_-=- | '/'Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />Set Backs
<br />9- u- r8
<br />ol rtu llu\inc\\ arl ttoic\\nnN Co.lc- rD 'nt licrtrsc i\ in tu lli).cc r cflkr
<br />-T------
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