|
'l
<br />BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns \"\t7 ,r?a/
<br />Erection Pads b\t"y v/
<br />UFER Ground /
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Rool Sheathinq 841-8 .<c 2\*+ ,-,o-{c-
<br />Shear Wall lo'l l l oo "4<2"-\Framinq ,,-v /on )
<br />lnsu latio n/E nerqy I u-/L -tT I ffrtm,x_:_:-/
<br />Drywall t o /lblt t El Mn tlt->
<br />102--Ext./lnt. Lath n/t(hx tu
<br />Brown Coat 7o'ie:is 4tat)
<br />Itrlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />a
<br />n
<br />G,/;^FINAL
<br />Certificate ol Occu
<br />Notes, Remarks, Etc
<br />z7
<br />,r K
<br />AJnl )
<br />(
<br />t-0 -"t. lB
<br />Cr-'//8c
<br />tbs
<br />'UE/4/ A
<br />OWNER DUII,T}ER DELCA RAT'ION
<br />I hcrchy rlnnn unJ.r Fnalty ol pcrju.y lhd I ah crcnPr lioE rh. Co.traclon Ltctrsc ljw roi rhc fdlowins rcu$n (Sc.7011.5
<br />Ar\in.\\ Md Pnna$iotr Codc)r An, Ciry o, Ci,unry $hi.h rdtrncs n lctrnir h coi{ru.r. rltc.. im|rorc. dcNlirh .r rcl],t rtry
<br />shrcrurc. prior lo irs nsnucc. rl{ mqutcr rhc lr,plica.r li'r ch Frn,ir b ilL r si8md sr emnl lhsr Lor dt is liccn*d Puruanr
<br />ro lhc ,mlisions ol rh. Conrrlctr\ t-i..n*d tjw lch!,rrcr 9. Comnrcncing {irh Sc.rion 7000 ol Divkion I .f rh. Burincs ond
<br />Proics\t'nsOrdc)orrhd hcorsh. ncxcmrlrhcrclromlnd rhc hasis for rhcrllcScdcxcmPrion Anyvk,ltrrioroiSccrt,trT0.rl5bvmv
<br />aptri.rnr ror r p.flnil subjcck lhc anplicani brcivilp.nnkJ-urnor.rrc lhln 6vc huidr.d dollare l$5uJ).
<br />-1.
<br />i\ owncr oflhc prcFnr. (/ my.nPlott \ eirh wnscs as Ihcn sb co'nFnsiti.n. qilldo rhc sork md rh. {trtuE i mi
<br />inrcn<l.al or offcrd for $lc I Ss 7044, Businc{ lnd Arnc$k,nr Codc Thc Conraclois l-iccn* tf,u drcs mt aplly n' 3. owncr ol
<br />rhc pnrpcny wio hu ilds or nnlft,B rlrm.. o whodo6such*oAhins.lforhcFclf.rrhroughl,is6rlrroPtrcnrdovccs.
<br />providtd rhar such nnlrowmnh m mr inicndcd ottfi.Gl turelc.ll howchr. rh. hxiUnE or in{mwnr is k'tl *nhin"m Jtr
<br />o, q,,r{,krioo. rlr ownfi aufitr rill haw rhe l,unlcn oi rtrovi.8 rh.r h. or shc dn not huikl or nlqldve lnc ,olEly ttr rhc Nrlft ol
<br />\L * o*nnorlhc pn,!cny. rflcrclusilclycofiNinE wir[ ]ir.ns.d.o mcroF ro .on(ru.r rhc pmjcc
<br />dnl ftr'tusb. Cinlc rhd ConrNror's Licctrsc l,aq do$ nor lnplyb,nowncr ofpioPcnysio hui
<br />rnd sh. .o[n'cr{ lo. srch lroFcG wirhrCunkacbds)Ii..tr\cd PU
<br />I dr cxc'nI undcr S(l
<br />\\ otali!,t{\ r rrltPt:Ns,\'l l()i\
<br />DEIIA.IAIIOX
<br />I h|rcby rfllin utrdcr Nnallyolp.rjuyonc otihc n,lbwi'{ dc.lnmn.ns
<br />lhr\c r,kirrll htrriinrCcnricarcotCon\ctrrhSclil'r\urcturNorkcrr..nlEn\rrnnr.r\')(ndcdliir6yS.crnn,17u).lrhc
<br />Utrr Culc, fitr rhc !.rhnmmc o f ihc $ork fo. shich rh. pc'nrir n i\\&rl
<br />-lhtrvc
<br />and{illnrainiain w.rkcs coDlEns(nnr insurlncc. n\ rcqli' cd hl Sct ior l7l)0.i rhc I ihor Axb. lor ihc Nrlj,n.mcd or
<br />rhc work lbrwhi.hrhi\ pcnnir is iskd Myworkcn conrpcnsllion in\ur tc.rfticr J p.lcy numb(dt
<br />I ccnifyrhfl ir rh. pc ormMcofrh.sorkf(,whi.hrhi!0.rnririsissucd.I\hrllnor.nlployr.,nc^oninuy'nrnncr
<br />$ .s ro hccom strhjc.r ro rhc wo*cs ompcn\lrion la*s ol Caliromi!. d 08NIhar ilIfi)uld l. .ut hlcdtolhc
<br />worksl conpcnsnri.i trovisions of Scction :lT0O ol lhe l-trhr Codc. l dBll. fonhwilh comP!, wirh rlx,s ,)nrvhion\'
<br />$/lRN|NC l{rluc k) sccurc qorkcrs .onll]ctrs.toi ..vcri!c is unlr$hrl. d0d cnlnk,ycr t) ai' iIilJ.Dilri.s itr,l
<br />nr drnhlcs r( t,r,ridcd nn rhccivil rincs up ro onc honnrcd rhou$Id d.llnn (Sloo.&n). i. ddirion
<br />Sccrn,n 10?6ofllrc L{txrr Grlc. inr.rc{ and inonry s lccs
<br />9-8 -e
<br />DI.CIAEAIIQN
<br />Ihcrcl,yllfirmun<trFnolrytllcrjutyrhdIamliccndundcrPn)vn6.orChq'lcr9lconnmn.in8wirhScdhn7lxt,nrDivnkn'l
<br />oi lhc fiusincs lnd Profesion\ cod.. iJld mylicctrs is ir lull li,rcc lnd clliti
<br />-t,
<br />fr'*tn) coN'rslrcuoNrElDlNc-[aExcr
<br />I h.rh, afflrm undcr llcnah, of pcrjry ih.r rhcE h a .onstructi,n tndins !!. y ror rhc lslbrmrcc .r rhc *ork nn which lhis lEmir t
<br />hsu.d (se.:1097. civ. c.)
<br />l. ir\ dd',.\
<br />-
<br />AIEI,ICANLDEq,AAAUAN
<br />I ltnby dfiim undq I'cnrlty oi rcrjury om of$c fo,lowirg dccladions:
<br />Dcnniri.n Pcnnirs-AsiEsos Noriicarion Fcdcrrl Rclxhrn,nc lTirlc lo. Pan6)
<br />Rcquircd rdlcr of Nolificario.
<br />-lccniiyrhd
<br />rhc rcd.dl tugu l,rions rBrdins !\bc(os rcnn,vrlm nnr nmlic.bL ro lhn px'jecr
<br />rh.r I hr\trc.drhis rtplicrrio.aid {rrc trtrrD i,r i\.orccr lr|rlcci..o rplynirhrllCirtr dCotrfrt
<br />ordi'fitrrc\ rtrd Srrt Lrtrsrchrir!n)n iklirN \rnrrf!c! ollhi(( iryrn,l(, nt k, crrcrrlrf rhc
<br />orc nrtrrnnnl pn)|f,n, ro' insNcliol
<br />Aplli.ul o. AxeDl sitMltrre r'B- ( g
<br />I
<br />Lcndc' qNJn'c
<br />Pool Fence
<br />Flood Zone Certif.
<br />,+A.a-L,1L
<br />U lr,t
|