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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.OWNEII BUILDER I'ELCARAI'ION
<br />I hcrct'y lllifl! unJcr pcndry orFrjury rhar I mcicnlpr fmm rh. Co.ta.ros l-t.rsc L1s fttr lnc folbwing rcaqrn (Scc'7(,315
<br />au\ir.\s and Pruf.sn,n Codc): Any Cily or Coutrry Rhi.h rututcs r Fnnil ro .onnrucr. trlltr. in{rovc. dcnsli$ or n,)'t any
<br />eflcrurc. prdlo irs issu{mc.,ls. rcquircs thc anrli.anl hr su.h pcnnil lo filc! sisicd sldcoEnl rtur h.or shc n licctr*d Puisu.trr
<br />b rhd pnili\ions 6f rhc Coita.ttr s l-icc {d li! (Chxpidr 9. C.n rn.nrg wirh S.ctim ?(Xx) ol Divhn'n ] of rhe BurinG\ a.d
<br />Pnna\rt,ns C.dc) .r rhar hc.r{hc iscxcmpl lhcrcftoornd rhcboris forrhcallc-ledcxcryrion. Any viohrion.fS.ctk,n 70]1.5 by iny
<br />rupli nl lor ! lcnnir subjcclsrhc lprlicanr r.0civilrnrlryofnor mrcihaD filc hundrcddolhs (5500)
<br />Lasowftrorrh.lr(,tdy..rnr,.nl,kryccswilhwa!c\r\rh.ir*nc.ornpctrs tun. $ill do rlrc *olt and lhc {ftn,rc n n
<br />nrrctucd orollcrcd tur {lc l5(.71},l.1. Busircs! and Profcs\ion( Gdc:-llr Contrckn q l-ic.nsc lis do.s nor.pply lo nn o$ner.l
<br />ihc nolfn, kh,tnikk.r inpiov. hctu)n, md whod*\{rhaork hin*rll orh.r.lf.rrhnruBhhh or hcr owr cnrln'yccs.
<br />providcd rhrr such irn.knrnls 0rc nor mrcftlcd ft oftcrcd fi, srL ll h.scvd. rhc hoiHitre or inrpmrcrmnl i\ sH wirhin ,,nc Jt
<br />ol .onfhrintr. rlr Owmr Bxildcr will h{rc rll htrd.n of pm nFrln hcorsh.diJfr hoi or irr$n\t rh. pmtcny fin rlF nuqnsof
<br />l. rs o$ncr of rhc |x,lr(y. .nr .rchrivcly c.nkrl ins Birh lietr{d nnrlr!.t'n h (mirud rlt rojL! rsc. r(!,1. Buqnc$
<br />rtr,l ttolcsirn Codc:'l hc Cont tr'r Lic.nsc Lr$docs nor rnj,l!k, rno(ncr offr'Jl.riyEho buikhor iDIrovc" rhcron,
<br />ann sh. conrid s lor su.h llotccrr u irh r Conrrrcron s) li.enrd nur\urr h rhc Conkrtr\ t-icei\c hw r
<br />I xn' crcn,l trndcr Sccri,tr,
<br />trAf,f,TB.rljAUtliNIAIIAN
<br />IEITANAIIO!
<br />I hcrcby otllrm u Mcr |rNlly oi ncrjury orc or rhc lnll,,*ir8 dccln i'nr\
<br />-lhnvc$d*illnDinrainoCcnificarc.iCon*nrroSclllnru.cfor!orkc6'cony.sarion.Npbvid.dhrbrScclion3?00oflhcht C c- forrnc pcrlornErcc oflhc *ork for which rh. rrcnnii h isucd
<br />I ha\cnnd *ill nrn .i'r sorkc'r o.!En\rri(i in\urnncc. a\ '.qutrdhySc.rnr:17(X)olihct-rbor(oilc,lnrh.F'roflnrnc..l
<br />\ rhc sorlr f,, which rhis |lcnrir i1i\\ucd. Mywdkc .onD.i\ ri(u i'rstrrtrco.Iricr md p.licy nnnficr ffc
<br />X;
<br />\ta-
<br />,-S t_ t&
<br />I ccnil.v rhd in rhc p.ifonMn c ofrhc po.k i(tr whi.h rhi\ l.nnir is hnrci, I \h{ll n.r c'npk'y rny ndEon irr rtry nrtrDct
<br />{, r\ l,) bcdnm rlbjcd t, rl'c so crs co'nncrsrrion hw\ol'Cilllarnir.a lcerrd irIdx,uld h.orc nrhjcd ro rhc
<br />*o*cr ..nr|tNrin'nlruvtion\.fScrin,n:17fi)ofrhcl.rhtr(inl..l\hrll,fo hwirhconTlywirhrh.cprovisions
<br />llARNlN(;: F,'ilurc h *ctrrc wolkcr comFn{ri.n.olcrrgc rs trnhtrnll. aM \h!ll {,hjccr ao cnrpbrcr t, dimirinl F_Mlric{ ttrd
<br />.ivi! lincs np lo onc hund.cd rhotrs.nd doll.n 1$ll[0 )). nr ro rlE con ofcoapcnsrrnnr dr rrr. rs fr,viJ.d lor lhc
<br />\>,r 1076olrhc tjhn Gxlc. inicrc$andnrrorrcy sltc(
<br />f-?-t( n,,,**,,
<br />DECIJSAID!
<br />I hcrchy.rfinnundcr !.nrhyofpc,jury lhar I am lienan undcr pmvtion DfChdnrcr 9(..mnrn.in8 wiih Sdion 7000) ofDivi\ion l
<br />of rh. Busik$lnd PmLssionsCodc. lnd myliccns is in tullrorcc oln cltsl
<br />C-r 2 lo o 7 66'7
<br />Y'6? 't k .^"*",
<br />CONIIf,UqIAN!:llzlNlirrclNEl
<br />i\srd 1S.c.109r, Civ. C )
<br />AIIII.IgANLITESABAIION
<br />I h.rt y annm unlcr Fmhyolpc'jrry onc oirhc rolbwi'rs nc.hrarn '\:Llcmlirio. Pcrmn+Ashcsros Norilicarion ttdcr.l Rc8uhrions (Iirlc 40. PldO
<br />Rcquncd L.rrcr ol Nolifrnrioa
<br />lc.nilyrhn rh.lidcrrlrc3uhri,,n\ ruS rthn! r\b.(o\r.trnrrlr'( trrrt'ttni.)1,I r, rh. froiil
<br />l.cdiltlhatlh,vcrcndrhi\rlpli.di r rl slardhrr rMfirvc infornnrion i\concd l,srcct,.omflyBnhrllCirynnd(buDry
<br />ordinrn.cs dsrar.Llw\r.l itrBk,huiklirg.otrslrucli(,r. dhcrchyrurhorircrq*$cnrrrivc(,,rrhnCiyandCouniyrocnrsunonrhc
<br />\ \t,t,riixtrr "r ixur \,antrrtrre/ /-1
<br />yen ( mr.,nrr,, lrl'-L
<br />l-' 2:-4
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handi cap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL T//14 ,.v tp-lE-iLd
<br />Certif icate ot Occu pancy
<br />Notes, Remarks, Etc
<br />7
<br />I
<br />COMMENTS
<br />Set Backs
<br />Flood Zone Certil.
<br />&-"'"*-
<br />alx)r. trf,nri nl t'on dr tur ir\rc.ri.nturt.sc\R^_t^-
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