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DING. INSPECTOR RECORD
<br />SITE.WORK DATE lD/stG.
<br />-hirEttTS
<br />ISet Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif ,,^fdt4tr 4$hciirlg/.7-7-x l- lq)t"/{jtI
<br />FINAL 7"1t-l'l t.wlil
<br />Certilicate of Occupancy v t\7
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />I hcrcl'y aafirnr uDdcr rEnxlry {)i r^-^rjUry tn:( l on cxcmDr lnnr rlN Conrrrnm l,iccn{ L]ls tnr rhc rallo*ing rrnv,n (Ss7oll5
<br />Buli'rcss r Pnncssn Codc): Any Cny or Cor y which rstrnc\ p.nnir lo .otr{ru.i, rlicr, i'nFrvc. dcnnnish or rcpatr rny
<br />nfl.trtrc. pr ro ih issuancc. iho rcluncs thc ilpli..nr lor nkh Frnn Io filc.1i3trcd slolcmctrr rhrlhco! shc n liccnscd pusurtrr
<br />b rhc prcvi\i,nr of rhc Conkr.rtr s Li.c.{d I-aw tchrprcr 9, Co mcking wirh S.crdn 7fin or Diri\ion :l ol rhc Bu\irc* ,nd
<br />Prolcssions C.d.) orrld hcorshc iscxcmp( rhcrc(onrnnd rhc brsir ktrrh. illcScd cxcmrrion. Anyvnn bnolSeclionT0lll 5bynny
<br />applicanrinral.nnilsuhjechrlrc.prlicanl(,arivilpcnilryolnolnnrclhxnfivchnndrc do!lrr\($t(x))
<br />-1.
<br />!s owner oI lhc lmrcny. or nry cmplores wili uscs is rhct vrc conrpcnelion. rill do rhc sorl and rtE {turm n nor
<br />imc cd orollcrcd fu elc tSLr 7{X1, Au\ifts\ nd Pbfc*in\ Codc: Thc G,ntr.kr'\ Lhcnsc bw dds not +r,ly h m oqncr ol
<br />rh. pmncny wh) hdilds or inlmv$ rhcNn, and wk' dds suh *odt htr.scli.r hcr\cllor rhough hh or h.r osn cothr.cs,
<br />8)vidcd rhrr \x.h i'npmrc'Enrs m mr ifcn]dt d ollcRal fd slc. !( lk)mrcr. rhc hurlding or impmtuEnr is stl sirhin .m )rr
<br />ofcomphrion. rhc O$nc! Blil.icr willhlve rtE hurd.n nfpovin-q lhlr h.or\hcdil to buikr or in\,oft rlf la,tdy nr rh. rurlrr{ ol
<br />l. as o*ncrolrhc nmFdy. rmcrclurivclycontrcriig sirh liccn{d cotua6n b.onnrud rtr la,jccr (SLr. 7(x,r. Bu\inc$
<br />rtrd RoL$i,nCod.:ThcContri.roi\LiccnscL!$docstrotrt,rlyl,)!no*ncr.lp'opc,whobuildsornnpnrvcslhrcotr.
<br />rid {ho conk cr\ lor rurh !n,}irB sirh , Conhcn*(, li..d\cd Nr$a io rhc Cutrtr.crols l-iccnr tiw)
<br />lu,ddnrt, un,lcrS.cri{tri .B &PC ln'rhnrcr([
<br />l)!le O*n.r
<br />]!.QA[[BS:raUr[Nl.lIl!.)N
<br />UI'g.JAAL9I
<br />I lNnh! rfinn uidcr pci3lrt ol trlury.rtr.l rhc lnlk)wi'rs dc.lnrrri, !l
<br />Ihrv.aidwillnrn anrccniturlcolQr*nltusclllnsurcfosorkcm.oDrtcnsilion.as pn,virtcd fu l,rSLrti.n:l7tx).fihc
<br />trhor C.dc, for rh. pdr.ntuncc ofrh. {ork for shi.h rhc Jxnni it nucd.
<br />,l lurcrnd willn[intlin *orkc .onlrn\rri{nr i'xtrrm.- J\ rcqun d byS&li( :]Tlnofrhc L{t!tr(od..lorrhc t^-rfonlrNc.l
<br />rhe shrk li)rshichrhn Frn,ir is i\\hl My*orkc comFn\di,,n i'rsurdncc.,ni$ Ilolicy Nnlhir nc:
<br />_l.cnilyrh r h rhc !crln.n,n.cotrhc *ork fitr ehi.hrhn pciinir n is\ucd.l\hrllforcmrloy rtry trNon i.Mynrlnncr
<br />$ r\ro b.conr sxhF-r ro rhc qor kcr{ conlJ*r\r r i lrws ol Cllili,nir Md lgrec rhrr if I sturuld h.cotrr \dhj!--r h rhc
<br />workcrs compcrr0rion nroli\ions olS.crion 3700ot(hc lf,txr Codc.l shrll, Ldhwirh.orpl, wlh rh.* B)visiois
<br />WARNING [nilur. t, {rnrc aork$J co.r,f,r\nrion..vcn8c i\ unh$lnl. r \h!ll \rhic.r d rtrlPkitrr b di riMl Ftrnlric( r.d
<br />c'vil li..\ ur n, onc hd rcd rhou\itrd
<br />Sr.!i.n 1076 olihc l-rhtrCodc. nnrr.n
<br />trin, x h!c\ r\ nnvLJcd tnr I
<br />s 3I IK
<br />at)I.( L\Rltl()\
<br />I hcEby,fatrfl undcr pcnalt]olrcrjury th.t I o liccKn undcr pr.vhion orChrpr.t 9 (.onnmncir8 wlh Sati]n 70(xr) otDilhion.l
<br />ol rhr Bu$nc$ Nnd Prorcssons codc. nnd my rrccnr rs rn full forcc m,: cnali
<br />D IDO Lor4z\
<br />\rK MdVT^Atud-
<br />C!}NEIIIISIONIEBDINC.&EINCI
<br />I hc(by ir undfiFtrrllyol|xjurythallhcrcnrcon(ruclionhdineascmyforrhcpcrrormn.corrhcworliorwhichlhisPctnrilis
<br />issucd (Ss 1097. Cit. C.)
<br />L€ndcrs Nam:
<br />-
<br />AIllllAltDEcL/$AIIllN
<br />I lItb, dr6n und.r FnaX, or !.!ury om of thc {dl{rw,ng d{laral iom:
<br />Dc!tunii.i P.mir\ A\hcdo\ Norincriio. F.dcirl Rcgnl.rio.s (Titlc.10. Pan6)
<br />_Rcquncd lf, ncr ot Norit.drirl
<br />I ccniiyrtu rlE lcdelrLrcgulrrion\ rc8rding r\h.{os rcnn,vrlrrc m( lpIl'crhlc t) rhn |,oj..r
<br />_l.cnilyrhdIhrvcrclll]rhi\xfrfhcrio dd {rrcrhrrrhcrhJvc nnn idr ir corecr lilrccroconrlly*irhrllCitylndCounry
<br />on!inxnc.s xnd sri. l)s\ rcltng n)Drcsctrr0tivcs olrhi\ Ciiy rnd Cou y b cnrcr up.n rtr
<br />rhivc nrnri(nrcJ f0r^-dy rbr in
<br />Appli({nl or E.nl SiEnoluE
<br />tr! con!nr.1(i. I h.rub)
<br />+bt ltx
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