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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BiIII,DER DET-CARATTON
<br />I h.rchy rfilnn undcr pcn0lry of ocrjury Ih,l I m crc'n/ lmnr lhc Conueror' Ln\nsc liN fc rhc iollowin! rcs$n (Sir ?0.11 t
<br />Uusincss and Proltsion Code): An, Cir, or Counry shth rcqui,cs r Frmit k, coturfl.'. alrcr. inPbv.. dcmlnh .r rc|.n Jy
<br />\rrucrnre. pri{, ro irs irsumc, al\. rdquids rh. np/ica ror snchFmir k, filc. \i8ncd s,l.mnl lhal tEor shc h liccnsd puruotrr
<br />kr rhc |trvi\n,ns or$c Conkkbls Lisnscd tjr lchaplcr 9. ConnrcNnr8 silh Sccrioa ?(r)0 of Dilhio.I or$c ausnEss ind
<br />Pmrc$ions Codcl or thll tr or \hc iscrcnpt lhcrctromand rhc blst r{r rh. ,llcscd .rcmpiio. AnyviolarionolSccrionT0ll5l'yrny
<br />Dnplicrnr lni r r.rnn suhjfth rh. aprlicanr ro,civilNnrlryornor nbrcrhan livc huNlrcd dollor ($5dJ).
<br />-
<br />l. rs .wNr oi lhc popcny- (tr my cnDk'yccs s irh * rgcs rs rhcir {n. c.nrrcn\d nrl, q ill do rhc rork drd tlrc nfl(hrc i$x
<br />inrcndcd orofltrcJ fffr c(Sdc7Or{, au\incs d Prot s\n,nsCodc lhcC.ntrrtr'\ t,i.cn\c I-as docs norrpllyt,r oaicrol
<br />rtu Drt)trdy who 6uikh or i'nF)v.\ rh.'mn. x *hod,f,ssuchsorlhi'$clforl'.r*llorrhnuhhisorhcrostc,nployc.\-
<br />lr,vklcd rlDr !'ch nnprovcnE.lr !rc nor ir c sl q ollcrcd id slc 11: h)*cvcr, rl{ hui iry or imltrottunr i\ skl$irhhonc v. i
<br />or mnrplc.on. rhc ()wn.' Burldf r
<br />'ll
<br />hx\r rhc hud$ ol pn,vmg 0rr hc or shc n nol huild .; nryr(x rhc pn,pldy lnt rh. N4t s .r
<br />l. as owtur of rhd pbr.ny, ancx.tusnelycotrklcrirAw[h l(cnscd conrruth,nri cnn{flrr rlt nn'Jcd rSt TOrl liusncss
<br />and lhfcssion Codc:'ftu ConrEcrois l-i..n\c Llw do.s fl apnl' r. .wncr ol r.Fn y who hd ilds or imPro!.i rhcrcon,
<br />rnd who conr0ds tor such pmrcls wirh ! Conrmcr.ns) licc.se<l pusurnr b rhc C,tura.ktr-s Lic.ne hw)
<br />I anrcrcnrpt und$ SNlion ! & PC larihi\rcr{n,
<br />-l
<br />h{vcmdwill nminrain aCcnilicarcolConscnr to Scll-lnsurcinr workd\' .onD.trs0tioD. rs providedforbySecrnD.lT(Dorlhc
<br />htxtr c'od., rrtrrhcpcrfunmn.eolrhc wo* Inr qnich lhc p.nnit k hsucd.
<br />,l l vc inn willmrinrri'r work.6 .on,p.n\rri{)n i'*ur ft-c. a\ .cqurcd ht Sdri(r l7rx)tl rhc l.lborCod.- inrh. Pcrlnnnr ccot
<br />rhc*orkf{tr\hichrhi\IErmiiisis\t.{Mtsorkc^.o'npttrsrrioiin\uil .r.r,1i( Jxnicy nunrnc! xrt
<br />lccnilirhrlinrhcp.rfonnJncci,frhclqknrshl.hrhnpcrn,ir n n\u.d.I rhnllmr ctrltlk,yrLry lxson irrfyn nncr
<br />v) ,\r)h.coDr subjrcr t, rh. *orkc^ co ,tris rifl lxssorcrlilnnrir. r! {8(c l,nl il l \houl(ll{c. ,c \r[ftlr,df,
<br />workcr\'conrp.nuiionpmvi\i{)nsoiSccri,rl7(X)olrhol-nhtrCodc.lshrll,li)rllrrilh.otrrtly*ilIrho{pn)vNnnr\
<br />.ivil lirc\ trt' lo onc hu r.d rhotr\xnn,lol['\ lS](x).(xrrr. in rnlir drnugrs rs fii nfuJ ntr rhc
<br />\.riL ' lr,7r'-rrl'cl-,htrG ( ir crri. nl. ki'r!
<br />r'!!c: zZ r/ra
<br />^rp,icnn,:
<br />6 ,*,
<br />IONIIB!]qIJONTE!DT[4.&E!!I
<br />I hcrcby rfflnn uMci |Enalry of pcrjury rlur th.rc is . onsrflcrion lcndir8 lgercr a ihc |f,rh]mrie .r rh. "ork for which thn Pcrmil i\
<br />ir\tcd (S.. .l(D7, Civ. C.)
<br />AIPIICANIIECIAIAIIO!
<br />lltNhy inrundcrpcnalryolp.rjuryoncof ihcrhll{ieingdccl rrn,n\
<br />Dc x'lirbtr PonnitlAsh.ios Nolifi.ntiotr t'cJcnrl R.tuhnnx l lirlc 40. Prd6)
<br />Rcqunrd Lcu.r i N.rli.irir{r
<br />I ccdilirId Ihc ltdcrulrcsul,li,)tr\ rosrnliiE r\ttnosr.'rt)trl rc drrrtrflt lc t) rhis Po].cr
<br />l..nlllrhar lhivcrcad rh! itplic ifl rfl {rrc(h r rhr rhr. innn ri,n, tronrrr l n!rL\r,.oDl|]l!r'irhrllCiryrnd (i,tnry
<br />ncs oarhk Ci!y !nd Cou.ryt, ctrrcr tr)nrlrnrdrn.r+Jnd5,drcLJr'mlirinEx'huilJinr..'Ja,ri,.rndh.,chvr\{/r,rn'..crr0r
<br />.'h\c lrnliord olnncd),n, ir,i'k"."'t-*' // .Z .Z
<br />^pp,icon,or^pen,siE*,uR
<br />/\ qr*-/24q.-
<br />prmi,..Bn,.,pr,n,,: 7ai a PoJ,,2LrZ +z
<br />,/r
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathino
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL /-lt -/7 TleSaS
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<br />'r(r)
<br />Certif icate of Occupancv
<br />Notes, Remarks, Etc
<br />SITE-WORK
<br />Shear Wall
<br />Pool Fence
<br />IlrStrEas!:0uIIN$aII!)!
<br />DFCI ARATI(IN
<br />Ihcrcbyn nmundcrpeMltyoipcrjuryorcotrhcnnk,winsdeclarrrio (:
<br />I brBbynflr und&r..,hyofpcrjuryrharIonrli.cnknu.dcr[orhinnolChrptcrI(ohnk.ci.swnhsdri.nTtxI))olDivnn 3
<br />or lhc Susircss and Pofc$ions Codc. ond m, ltenr n in illl forcc md cffd
<br />zao-
<br />t.ndcr'. ddr.!\.
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