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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNl]R BT]IT,DER DEI,CARA'I]oN
<br />I hcrchy ifllrnr uMdr ncMlry of Frjurv rhrr I anrcicr. lmrn rhc Ginr cro6'Li.utrsc tiq ror rhr tullo$rit rcr$n (Sc.r0ll.5
<br />Btrsi'rcs {l Prcfc$ion 6dc) Any Ciry or Cou y shi.h rcqni'.s r pcnnir t, connrucr. llrcr. impmvc, dcnn,lilh or rcpat rny
<br />snr.ttrc. I}nnr0 ir1 h\tsncc. rko rcqui'.s rhe lfflicnnr li nkh |rnn]r h lllc r ri!trt rdc'mnr lhnr h.or shc is li.cn\.d l,u*uanr
<br />t' rltc F)ri\i{,ns oi rhc Conrra.r.r\ l-i.cn{d Lrq (Chaprcr 9. Cohmcmiig *irh Sccrion 7(XX, oi Diltion .l orrhc Bu\incs .nd
<br />Pn,fcssids Codc ) .r r hnr h.or\h. ilcrcnrni rlfrctiorlnd rhc h*n i,rrhc all.gcd cxcnrprn)n Atry vnndiotrolS(rion?0315 br rny
<br />rmllcr nr rpcnni, nrbjccFthc rptrli.itrrb r.ivilpcDrlryoltror
<br />'norelhin
<br />rivc hundrcd dolla^($5( )
<br />l.r\ otrmroflhcpniperly.ormyenr o)ccs vilh wrtc. a\ rhdir slc $ rNnsar i,,n. will do rlr s.rk md rlr iturur L Rr
<br />inloxkd orrrlcrcdr(rsnlc(SccTINJ,Brsinc$lndftotisionrCdc rhc C.ft..rtr s Lic.nsc Lnw d.cs nor .Dtly x' r. owocr Df
<br />rhc!n'Fn, whohlild\ornry(,hsrhcE)n,rBl*t$d(Essu.hwrkhnnsclforhc.lf.rrhii,ughhrorlrrouncnlPl,,yccs.
<br />pn)vidc rhar slch iq)r.{m.ls rrc mr inrcMcd oroffcNl for $L lf. hqcwi rh. trildiig or in{mvrnrhr k *ld wirhnonc }rttr
<br />ol(nnflcrhn.th.owncrBuildrxitlhrkrhcburdenol'rmvinsrhrrhcorshcn not ttrild or improvc tnc pmlcny lor rtr puqn{ oi
<br />_1.r\o*ncrolrhcf'D.ny.iDcr.lu\n.l!.. krrrinE \irh li..n\cdcoftrr.hrh.on{rucrrhc llx+cr(Scc 7r}{,l. Bu!trc\\
<br />and sho conh.(\lorsuchtrilccr\\irhicofra.knl\)liQrncd|lntrr rbrh.Gnrracrn\l-iccn*l]$r
<br />I rcx.D,pt undcr Scclior-. B &IC larrhnr.n\or
<br />Dalc: ()rnr.:
<br />WORKFRS' (TllriPFNSATIiIN
<br />DLCLIAAUAN
<br />I h.rchyrrfinntr ds Ftrtrlryorncrjrrtonc or ihc n)lhwnr8 rlccrir.rions:
<br />-lhrv..trrlBillmrinrrintrc.niiicar.otConscnrroSclllnsmtorworkcr'corycnsdion.0s,'rovidcdfornySccrion:17(x)olrhcljkr Qrdc, aor rhc pcrforoEnc. ol rhc so* itr whi.[ rhc p.nnir i( issucd
<br />I hrlr riil sillmainrain qorlcra .onpcnsarion insuru.cc, as rcquncd hy Sc.riu ]7fi1 of rh. l-rhor GJdc. ti,r lhc Frfoirnuncc of
<br />rorwhichrhn pcmi n nsucn Mywortcn onDcnsnrion insurancc.Micr lnd Fli.y nu'nb.r ecl, Stuue &.tr.J
<br />1z1t 35 6\ I s /2b l8
<br />_lccnrfy rhrr nr rhr p.ifo.mn.. ofrhc *ork ror shici rhis pcrmir n tucd. I \h!ll nol cmfloy any ncr\on i. rny 'nlnmrk, ^ k, hcdnm $bjccr r,' rhc $.rkcr'comncnsol i, lwsofcrlifonria.rtr(ll3tu.rh rill \hould }r.otu rhic.rrorhc(nrkch conrp.sarn,nntuvi\ionsolS..lt ll7(r0olthchL,Cixjc.lshrll.fonhwh.onrrly*irhrho{Fbvis$n\
<br />$ARNINC tiillrc lo ccur! s.rkcr' (np.n\nriotr .ok.rgc i\ unhsful. snd shall \ubj.cr sn cmtloFr k, rinitul lf,nrhis rnd
<br />.nil fidc\uproonchundrcdrhouslndddlhrs($1m.u)0).iirddirrnbr}[..{.f.olrninriotr.drmrecsdst"ovidc f(tr rhc
<br />sc.r(, r r07r, rr rl[ I rhr (.(i.. i,f. .{ rn(r]rk, trr'{ t(.!
<br />5ttr>112 It't--*
<br />DECIABAII!}N
<br />I hcrchy.fllrnrund$ p.naxyorpcrlury rhnr Lfr liccn*d n c. pmvhion ot Chaplcr 9 (commncnrs *iln Sat ion 7mO) ol Divhion I
<br />ol lhc axsinc* dd Prcltsions Codc. and nryliccne t in aull llrcc xlcfltcr
<br />. R riccnsc rura*r: -i fgljpl(L c.,*".,L
<br />CONiIBIJ!.II!}NITNIINCTCENII
<br />I hcrcht arfinn uid.r pcnalryorrcriuryrhar rherc G o cotr(ructi)o lcndnrB l8cmy fo! thc tclfomBmc ofrhc *ort for $hich lhis pcnn n
<br />hsu.d lse ]m7.Civ C )
<br />AIELICAITfDESAAAIIQN
<br />Ilt'$yailimu .rruNLryolp.riuvnncolrMhll(rvirrdc.lnrnri,nr\
<br />l)cnmlirio l,cnnirs rhcios N.riicnrir)i lrd$tr1RcgtrlJii.n\ ('lirl.40. l,r'6)
<br />-Rcquir.d
<br />lxtrcrorNorih. krl
<br />Irc'r'l!rl,irrltli(I.'rlr.lnliril)n\Rt il,!x(r!!r!i.trtr*rl c .rl|dirxht k) rlii\ t'(ijccl
<br />-lccniryrhd
<br />Iha\.r rhkaprli.,rn,i!' nrrcrhlrrhc o\c irhrnmri.n ncotrccr la8lehconll'lywnhillCiryandCouniy
<br />.dilrn.cs rnd Sr rcl-r*stularingruhiklingcondn'cliotr.atrdhcrcnyauth.ri^rcfrcscrhrircsofrhisCitr0ndCounlytoentcruIi'nrlE
<br />fi)vc ntnrn,ncd prop.ny ti,r inspcclion purra,scs
<br />ADI,li l or,\[0tSiEn' uro X
<br />I'um,ilfr n,nm rpnd): K Z \Lrlt,
<br />5/t6llb
<br />Set Backs
<br />Forms/Steel/Holdowns fz 5 tf<
<br />Erection Pads Zt iE W.'S*
<br />UFER Ground
<br />SLAB Floor
<br />Roof Shealhino
<br />Shear Wall
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/ aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En ineer Final Re rt
<br />Flood Zone Certif .
<br />7/4/s ?96
<br />Certificate of Occupanc v
<br />-)
<br />Sublloor/Vent/l nsulation
<br />Framino
<br />ln s u lation/E nerq y
<br />FINAL
<br />Notes, Remarks, Etc.
<br />t i.t,1'. 4 L,tr..
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