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BUILDING- INSPECTOR RECORD
<br />COMMENTSSITE-WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulation iu-ztRoof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lrlaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />tl t(lllkl t tn)-7lr\i q,FINAL
<br />Certificale ot Occupancy
<br />Notes, Remarks, Etc
<br />\
<br />0\\ Nt,:R ltl ll.])1,]l{ Dl.ll (',\R,\ I l()\
<br />,1,I h.rchy rl6rn undcr Fnslry of 0crjury rhd I m.r.nll)l lron, rh. Conr.cloF Li.cn* ljw t- rhc folloqinC Easn 1S" 70
<br />Businc$ oNl Prclcsi code) An, Ciry or counly $hth rcqutcs ! Fmir ro .ondtucr' rlrd' inworc' d'mlish or rcprt
<br />idcturc. prt, b ns is$rrNe. dh. mquircs rh. aPPIi.,nt ror such tf,rdir o filc . sisn'd ear'nEnl rhd lE or shc n liccnscd Nr ir
<br />l.lhclnvhioNoilhcconracrolsl-ic.nscdtjw(ch{'lerg.coannenctlBNithseclionT0o0olDivhion.]oflh.Bu.in.s{ild
<br />Pmfc$i..sCod.)orlhrl hcor rlt is.rcmlr rlErcfron and rhc h$is I{r rhc olk8cd crc'nprioh' Anv vion{ionofSccri'n?Oll'5 hv'l
<br />rynlica.t lorapcnnn subj.c( ihc oPPli.rn o r.ivilI,ctrahy.rml nmrclhm nvc hututcd doll'is ($s00)'
<br />-l-
<br />as owtui .l rnc I'mFny. or my cn{'lorcc\ sirh w.Ecs as rhcn $lc conPcnitrlion. will do rhc sort and lhs NMIurc tr'mr
<br />i.k l,n m onircd atr ek I SE 7044, BuiiR$ rnd Prclcs\ions Cdc: -ftc Ar rncbls l-iccn* Lrw does nor APlv ro 3n 'wn'r ol
<br />thc pmp.ny *ho buikls or irt]o$ rh.Nn. lld slx, dds sucrr w)rl himscllor hcrel'or lh'oqi hi\ or hcr os'cmpbyccs'
<br />p-ia"arlrnr tr.t imln^qntuemr i.rcftlcd or oFced f$sh ll lrwcvci rlt t{ikling or iirotrxor is $Ll wilhin "nc R
<br />;ionrlcriofl. rlx Own;r Buildcr will hlvc rhc burdctr ol Pmins th, hc or shc did or build or in{'nN thc,'rcFnv ror llE puqx's or
<br />-l-
<br />as owncr of lhc Dropeny. an crclusikly .onkrrin8 uil h licd{cd co ruckn ro conntud rh' liojccl (Se To41 Bd\incs
<br />,trd Ft lls.i"nC"d., Th; Conr,.n sl-icctr\cLn*docsioramlvrodnowncrolpmp'rlvEhoI'uild{'rimrolc\rh$con'
<br />and {ho.onlracr\irru.hn$r!cwirhdconlmctor(9licctr*dPuFUanrktrhc(nntradofsl-iccnscljw)'
<br />-l
<br />rn.xcryrund.r S..lion-. B &PC lorrhi\nN).
<br />Dole: o,n.r:
<br />lvotxsns' riiiiit
<br />^is,\rxrxDECIAIIIION
<br />I lff.bv itnnr undcr Fnrhyol petjury..c olthc tollowins dc.liftlnN
<br />IhrvcardsillfriinrdnaCcnitlcarcolC.nscnrrosclflNurcf{nwotkcr'onpcns i.n. N lFvidcd forbyS(i'on lTrx)ofrh'
<br />ljtn Co<lc- for rhc tftrornEme orrhc ro* lor shich rhe p.flnir n i$ucd
<br />4 hnve and *,ll nrnhrn *,rlc(' comlrcn'artr,n 'nsuERc-
<br />rs ruqurci hv Sc.ri.tr l7(xr of rh' tinor Cnle ro' lhc pcrromEn" of
<br />rhc work ftrshi.hlhG P.tmir is ilsKi. Mywortor conli)cnsdid insunmc cari'r ard Fnicy nunthr otc:fr,-
<br />?a77388. n^,n*,3'/- /?
<br />l.enily rhar h rlf Pcrfolmnc. ofrh. uo.k ttr wh{h rhis Frmir ii is\ucd- I shrl! nor emllov rny F ru r rnv tnrnB
<br />*. . 1'"""* -r,;*i u, tr'" *otk.^' .o [.ns.r i.n hNr or cnhlntntu. 3nd rSrc lhlr ir I stk'uld tEtotu subi'd lo rhc
<br />*o*cr' compcn\riioh ptuvisionr of s..r ion ]r($ .r rhe Ltrhtr ( qL. I \htrll. tnn hs irh c'nflv ] irir rtx'r Ptovision\
<br />14ARNIN(; i,ilu.c lo r.n.. workcr' conrP.h\nli.n .ovcEsc i\ utrliwful- rnd shall subF r rrr cm!Lrs ro aininll F tlits 'nd.ivil nncs op k,.N hundrcd rh.usrnd dol[^ (Sltn.L\x)r. h rddirmr lo rhc "sl ofcon+ctrr'rn'n drtuecs m prrir!'(l r'r rhc
<br />s..rio, 1076rlrlt l.rl\r (tr|c. 'rcr.{ r rrttrr!!I
<br />9--/-/g
<br />DECI.AEAIIIJN
<br />r h.nby omrm !n dr p.Mlr) ot Frjury rhal I !d hxnr.d undcr twi\ion .t chaprcr 9 (comnEEing lirh sccr i.n 7os)) of Divtn n l
<br />o{ rhr Busitrc$lnd Prnf.sions Codc, srrl nr} lkcn* i\ in fxll foie u cff(l.
<br />Bl <32 ,.i.ciscNu,$.r L/
<br />g ..^r,,*,,, (r!4o4 U,- Za
<br />c(lNs rRUc tl()N LFNlrlN(: A(;IiN(:l
<br />(9
<br />I heEby,lrtrm undcr p..ily ot P€rjory rhd th;rc is ! oi<ruclion hn.line,8ctrv for rhc psfotu' of th€ uo* ror uhich lhia timi' ir
<br />tsncd lsc.. 1097. Civ C I
<br />tx' dcr . \rnr ----
<br />Ierd., ! Adircs
<br />AITLICANL.DIICITTEAIIQN
<br />I hcE$, afllmt u.dcr Fnalryofp.ryury on. orrl[ lbllouins d(lrntions:
<br />Dc.nl ion PfinirsA(bcsro\ Nohlic4lion Fcdcirl Rcgul.rion\ (Tilc10. Pan6)
<br />-Rc+t
<br />d hxcrof NoriLarion
<br />I.cniiyrl,rritu lcdcrtl rcguLrnnN tgrnling r.lr(o1 om\ rl I' I trtriltlli'rnh rr rhn fRrjccr'
<br />ri(f,rn(t {.rc rhrr rh.rh,\. rni'rn riin,is.or..r lra'ceri.onrdvsihrll('rr_rd(lC'idY
<br />uDrhtrizc reprcscnrdivcs ollhh ( ny tnd Colnryro cnlc, lllon rlr'
<br />-lccnify
<br />rhrr I hrvr rcrd rht.Pt'licr
<br />4/? r-€/2-
<br />,o* 2 /C.'a/
<br />ID/SIG.
<br />UFER Ground
<br />b/02/a
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