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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.. CONiMENTS oWNEN BU!I,DER DET-C RATION
<br />I hrrchy a{finn undd p.nalry r)t trrury lhol I m cic ur fro ih. (htuador'l,iccn\c Law r(r rhc nnhwi'r! rc,on 'e' 7olr s
<br />ausiDcss itrd Piorcs{i(,n Codc) Any Cir, or Counry which rcqun \ r Pcflnir b .on(fl.r. olrcr' nnPord. d.nrlirh or rcloir mv
<br />{fl.rurc. pr ro iF issuocc. aho rcqrircs rh. rptlf,,d ror such,Eflnir ro filca \i8ncd slalcnE.l lhd ncorrhc h liccnscd !ur{ r
<br />h rnr !n,vni(,n\ or rhd Cotrrri.rofs l-iccnscd 1,0$ (ChaPtc,9. connncNirrs wili S.dion 7(xD or Division I ofrh' Btr(in'( trtrd
<br />Pmft$nnsCodc)or lhar hcorshc i\crc'npr rhcrcfiorrnd rhr hisis lorlic allcCdd dxcmrri{)n Any riollri{nr ofS(ridr 70:ll 5hY!nv
<br />trpplicrnr forr p.rdir \ubjursrhc atlliclnrl.icivilpcnshyofn r flr hM llvc huodrcddollr\(S5fi))
<br />-1.
<br />rs o{ rur ot ih. pn,Fny. or nr! cnllor_cc( r'irh tr ryc\ os llrn q'h omF tr{ri.n. + 111 do rrt s.rk xtrd rh. srnrlur. i\ nor
<br />iN.ftldl or orhrcd ntr sl. lse.70r,r. Buincs!rnd PrcIcssion\Cnd.: Thc Co ndoi!l,t.n\.li'wdocsflolaPPl]rodn.\.rol
<br />rhcnNlEny *hohuilds.rioltr*.srhrd)n.mdwhod.c(\t.hs.rkhirnrli.rhc^.ll.rr)troughhtorhcro*nc tlk,rcc\.
<br />ofcdnrnldii.d. ilr Osncr auikl., will lrrc lhc hurdcn ot Forin8 rhrr hc or shc dil nol ttrild ar i'nPn)r rhc [ln,r.nt lor rhc purno*of
<br />l. Nrqnc.olrhclmncny. rmcxclu\irclyconrmcrin! qirh li.ciscd .onrr&rD h con{rucr rlt l),Ic.r (Scc 7(11"1. tlulnr$
<br />rd l1.fs\fi Codc 'IhcG lrmtd s Liccnrc Lrw docs nolrpplvb aiolrno olllotcrry$ho huildsor in,[.v.\ thcrcoD.
<br />dtrd $ho coNacr\ li)r s,ch proj(( $ith r Conta.d( n !'..f\cd !trBtrMr ro rlr Contactn's I-i.M\e Lrtr )
<br />I rncx.mJn un.r Sccli,n,-, B &I'C hr rhk rcr\r,
<br />Drl. OEne.
<br />woRKFRs' a(;[iipNsalloN
<br />DII;LAAAIION
<br />I hcrrby afinm trndcr ncMlryofpcritrryonc orrhc ink*inr dNldmiotrs
<br />I htrtr arxl+ill nninlrin rCcnific rc nf Con{ tu n) Sclf.lNurc lir $.*cn .o'np.nsnii(ri. x\ l]nrvilcd tnr hyScdion:rr(X)olrhc
<br />LnlitrC.dc.l.rrhc ltrrlornDo.cofrhc *ork f(tr Nhich rhrrcnni i{ rsrd
<br />I hrc rDl qllln,rdrin $orl.N .f rnar
<br />rh. so,k ntr sh.l! rhi\ |tnnir'\ rnul nl!
<br />sorion insurlmc. rs rcqutcd by Sc.riotr:17(n oflhc l-otx, Gxle. for rh. P.rlot.mn(.1
<br />\.rtc^ .nmrcn\olininsu'trrc!Jr'.rrdFlic' numh., 3.l.tft*x v(r{ (tqG
<br />-e'n*.
<br />,l
<br />l..diIr]rrirrhcrcrhnnrn.crlrhc$o'krtrqhirhrhi(|tnnrri\i(ncd.l\hllnorrnDl.t 'rt|rr"riirr yn Dncr
<br />q,x\r'lf,cftrf,suht.rk,rhctrrlkcr(.omEtr\ i,rhtrrnrCilifurnix.xtr,lrlrccrh irI \lnrld tNok uhj.lr hth.
<br />\ro,k.^ rontrisrri(o pmrNiotrs ol'S..1ion.17(x)ol rtu I rhtr Cftll,I lhrll. f,rrhsirh.umnly rirh rl"d{ |m,rrnlN
<br />S..r,{, .lo?a 'n rh.lrhtr(itrld. nicrNrr d nrr
<br />=w DU( L.\R.\ tI(r\
<br />I hchhy amnn undo pcnanyofpcrjurylhal I u licnel undcr rrcvi\i.n orChaEcr a (omftncins wirh sc.rio.70u)) ofDivisbn:l
<br />oi lhc Busirc$ hnd Pr.r.sio.s Codc,ond nry liccnt is in tu ll r'otcq and clTkr.
<br />\o\o\I'r
<br />5l I
<br />CONSIBJJEUANIEN]2INC.ACINCI
<br />i\srcd (Sc( :1097. Cir C.l
<br />l-c trdcC s drl rcrsr
<br />-
<br />A.SIUIANLDECI.AEAJION
<br />I h.r+,y amnn xnd( p.trilly oftcrjuy orc otrhe lolk'{ina delrxrionr
<br />Dcnulirion Pcrmirs A\h.{os Nolirrtrlion Fcdcr.l Rcsulilions ('lille,K. Pan6)
<br />-R.qrircd
<br />lx .rorNorii..lion
<br />l.cnilr_rh[ rhclc(lcrrlrcEU]rri{)ns rctrnli'rF hhcn,^rc r^xlrrcrorrt|li.rhl.n,rhnlr!c.r
<br />-lccniftrhrlhrlctundrhisrpdnriotarlsrilcrhrlrhcrh)\rinl{nDui('d1\ronc.rlrBr(roinnPlywirIillCiltrtlG{rnryoi.li'[NCs rnd Srrrc I-r\\ rcL roburldirE.on{n'.ri,nr. a lErcby irhrizc rcr'rcscnlJrircs oirhis Cny and Counry to ctrrcr uFn lhe
<br />.bnrr trrnli(r.l no|Iny f{n
<br />^pp,i(onl
<br />or llent Si[n!
<br />(-/
<br />@nr ql,r^-
<br />Set Backs T7-S.
<br />Forms/Steel/Holdowns 7rv 7/6 M cfib8,
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framino
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry slchl *htd-,o>
<br />T-Bar 7
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil
<br />lF) D/-|-D D//t*te.ia 4e/*- e ;rfuVn-$=-
<br />FINAL :t/.t.<ltk I 'rVrl*-lA,/'
<br />Certif icate of Occupancy '[ " lt -
<br />Notes, Remarks, Etc
<br />Erection Pads
<br />Pool Fence
<br />",.\71-10
<br />i-+-
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