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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/Energ y
<br />Drpvall
<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 />/ -'\
<br />FINAL nL4't:tt.z/zthq
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />OWNI]R BUILDEi DELCAR TION
<br />I td.B .mm onda FrXy ol Fru,l lha I m dmF too rl! Cdr.doB L.de l,w aor itE 61h*Es l@; (Sd 7O]l J
<br />Buin6r &d P.ol*on cd.) Any cty or coudy *ni.h r.qut6 . Fmn lo on rucl. !16. ilprovo &mlnh or E!.n e,
<br />sbudur., prer lo nr isuan... .t!o r.qlnB lh. l,plk l for luch F.mil lo 61. a sisicd n.lml lhar tE or ih. i! licd.d plmrl
<br />ro rh. FovilioN of di. Codr.clotr! Liaisd t s (CrBp.d 9, Cormtrin8 wnh S*lior ]000 ol D'!i!io, I of rh. BBi.d ud
<br />PrcfsioN co&) or lhrl lE n nE i! ddrpl l,'d.fiom !d dE h.ri! fo. llE dLs.d .rarFio. Aty dolrb. ofsdrbr ?011, hruy
<br />lpgliotn for. Fnn $br6l' rh. .ppkel ro. civrl poiy of @r me rhd nr. hudr.d dolhr (!50o)
<br />-1,
<br />a o*ffi oath. FbFny. m ny aryloyg rnn w.s6 d lh.n rk comFq6ahn. $1! & ttt *qt txl rlE tulr k ml
<br />i dr&l or olI6.d for e]. (S(.?044. &!ind &d ProfB!68 Cod. TlE Conldclo* LLru l,w do6 rol 49ly lo d ouc ot
<br />rh. prrFty who 6ril.h tr nqiw6 tlEatr id who drE lEIr wd ninEll or hcell or l16ush hb or hd.m mpLr6.
<br />provid.d thd .u.h inFo16id. c mr iroial or olE d 6r el.. ll trBq, tlE hrildnA or lqrcwEn n $B wthin oN )d
<br />ofs'rpliion. dE olE Bu'ldr * h.r rlE hldcr olFlrq u.lEd JE dn d hild d ins.!!r thc FoFry 6r tlE Fnro* of
<br />_1, B .$E of ih. FoFiy, m .r.lNiv.ly codMir! wth lkds.d conrrroE ro Ntrnru!1 rL Fi( (S< 7044. BcilB
<br />5rd EDk in Cod. Th. cont.ctoas Licsk l,* d{r6 tul,ppl, ro do*r6 oapmFny who b{ilds or ihprovd rhd@n.
<br />rd who co.rEclr ad ru.h Fojers $nh a ao 6.10(, licdal ,,uEu.ft lo lhc conl[.k, i Lic@ Li*)
<br />_l m crmpt undd Sdrion
<br />Dtr. Oxr(
<br />\t oRxERsicotrPl Ns^'tio:t
<br />DECU!dI|!
<br />, h6chr. nn uds !E alr,ofrEruryoncolrhclirllowms d(ldartrdr
<br />_l hrvc id will Mir i! r C6rifra. of Co6an ro S.ll-l@E f Nt.r ompdrirn,. FviLd for by S.(trn 1700 otth.
<br />Lrbq co<lc. fd rh. Fll!l:1'.e 6f rlE s6d fd stth th. FDn a i$.d
<br />-l
<br />h*. !.d will mainrrin w.rt.r' conFEllirn 6urmc. s rotuiEd bl SBi io. I7m olrh. tibor Co&, for th. F mlfu. of
<br />lh. worl for which thie psnil 6 irs.d My @tk6t omF$Iion iNurecc .6d .trl Fl'cy .onhc E.:
<br />Pol(y N6b6:-E!tG
<br />-l
<br />c61irythir rlhcFrtutrm.of th. worl ft{ whkhthis Fnil B isu.d,I sn I @l @rhy &, F$ninuymuEs 6 ro baonE rubjd lo lh. "o 6 rcdF!.liofl ld6 ofcilifonia, ed.8Erhd ia! Jrutd tcom 3ubjcl lollE
<br />wort6'.omF*rionplovirio6ofSdion3700oIrhcL.horCodc,Ilhrll.fonhsnh.omplywnnlhosF$virion!
<br />WARNINC: liilu. to s@ *ortd omrosiln Nvde. i !nl$ful. ud sllrl rubj.tl d dpLtr ro oimim] pqlti. ad
<br />citil n.6 up ro oR hundrcn rhou!.d doll6 (ll0o.tDo
<br />Sdhn i076 oflh. L!&r ( ode oldd.,n.nMrEy! fc
<br />or .omFdion. {h,r{6 6 Fovil.d for lh.
<br />r /zclA,tt
<br />I hd.by.mfln und( pqaly o I lFjury lhar l o l n ol( hdfl6 0lco,nnmcin* snh Salion 700{) oaDi\isn)n:l
<br />of rh. BuriB Eld Pmf*i.c CDd., dd nr I
<br />"- ktl,fi>75t
<br />"'" 'F[t"
<br />I H'y .ftm un<16 Ful) or FrruD lhi rh6. 6 'isu.d (sd 10e7.cn c )
<br />lor lh. Fa(ffi. otlr. tr\,rt for $hth rhi! IEnr ir
<br />Attll(aNr.rf4lJaAlrax
<br />I hnd, &ifn udE ponrt of Fr!., oR of rh. folh$rg &LErbB
<br />Dcflohion Pamn!-Asbdrot Norillc.lio! F.dd.l R.BlhioB (Tnt40, Pd6)
<br />-R.qui!.d
<br />L.rldolNrilidrio.
<br />I cdt 'ri rhd rh. f.d.rn r.su! ioB ESding .rtErd rmrJ r. .o' 4,pli!bL ro rhn rmFi
<br />-l
<br />csliay lhd , h!r.,..d th! iFltsrnn trl.l!l.lhn $c rbor. 'nnrtui)n i coFd I .!1a to onply u'nh .U (''rl .nd Cou.rt
<br />ordinan6rdShr.k*,.!dinsrohliklrngconso<1oc&dh6.ty.dlD...F.5,iEoflhnCnyadCouoryroal6!p.ntlE
<br />db.v. mn'ion.n ropdy lor irsFln,n purnG
<br />^C-rl',b
<br />Appli.rnr or Aldrl Sign.lur.
<br />Pd'nr nrn.lprlno: &j-Iol"
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