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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing to.ze - /8,/)"L?b '-zl)lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ir/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL 12-//-/6 ,/le{il-6A
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />OWNER BUILDOR DELCARATION
<br />I hcrcby !flirnr uftlcr pctrrlry of pcrjury lhal I !D cxcnpr liorn lhc Onrr,0ch6 Liccnse Lnw lor rhc nnhwin- rcr\on (Sec 70-11.5
<br />Dusinc$ and Proicst,n Codc): An, Ciry or Counry qhkh rcquircs a ocrmir to cotrsrrucl. !hcr. impfl,v.. d.mlnh or r.p3il any
<br />srtucrurc- prior h ns nsuancc. rl\o rcquncs rhc applica tur such pclmir h lile a \iricd nnr.mnr rh,! rf,on hc r lic.nrd pusuitrl
<br />b ft F,vhio.s ol th. Conlnclols Liccnscd l-r* (Clr0trcr 9, Conmcrcin8 uilh Scclion 7(I) or Di!i\i,n 3 or ihc Businc\s ,Dd
<br />l'roli!\n,n\Codc)orrh{ncorshctcrcnDrrhcdromlMlrhchasi\turrh.all.gcJ.xcrtrion Any vnlariotrofSarionT0ll5 hy rny
<br />rppli.itrr lor.F.n subFrurhc l,)plicanr r. acivilpc.,lryoinor mrc th!,livc hundrcd dollan 1$5m)
<br />-l.
<br />r\ oNncr of rhc !!'Ilerly. or nry cnrln,yccs wirh wrg.! s\ lhcir v'lc comp.n{dn,n. *ill do rh. *urk dd rh: slulm it nur
<br />in.nd.il dr onar.n tur eb (S(.7tl{4, Busircss dtrd Pofclsions Codc: Th. Contrcnr'\ Li.cDse Llw does nol llJ]ply h,n o*n.r of
<br />rhc pR,pcn, {h, huild\ or i'rq)Rn$ $cdn. r Rh,drf,s\u.haorlhi'ns.llorhcrsclforthoughhisorhcro*o.nDloyccs.
<br />providcd rharsuch imnmvcnrnhm rer inrcnncd oroltcrcd lorqlc.ll horrru. rh. boikling or nnpnMn.nr is$ld*irhtr",nc )c.u
<br />of.onlPlcrbn.rhjOenrAuiB.rwillhvcth.hunlcnorpn,vin8rhdtror(hcdilnothoitlorifi|novclhcpmpcn,forrh.l)lrln{of
<br />l. asowncr olrhc pn,pcny. afl *clusivclyconr,rcrinB uirh liccnscd cDnrra.loF r,) con{tu.r rhc !ft,jc.r (s(. 701-1. Busirr\\
<br />ond thnlr\br Code: Thc Conrrn.rn r l-iccnsc ljs doc\ nor nprly kr rl.wncr orpr'Frly who builds or nnpnrcs
<br />'hcrcon.rnd nho conkactslorsuchpmjccrswithrConhcro(s) liccnsd pursu0trr rorhcConrrrcrols l,kcnE u!)
<br />-l
<br />mcrcmpt undcrSdiotr-. a &PC lorlhhrcason
<br />tvoxxrns ioutrlrl'ttont
<br />l2EcI]ln .roN
<br />I hcrcty llljrmundcr Emlryofpcrjury orc otlh. nnbwir8 dcclsartnN
<br />-l
<br />hnvc Nlwill nminrain rCcrt ictrreofCoNcnr to Scl,:lniurcfor worlcn conrpcn\arion. !s proliddd fttr by seliotr r7m .f Ihc
<br />lf,lbr Cdlc, lnr rhc Fjrfomm. . f thc wo.* for whkh rhc p.mir is hsucd.
<br />_lhivca willNi riD + orkcrr .om|]cnsrr i{n, insuBmc. rs r.qui'cd h}Secri{r l7tx)ofrhc l-nhorA)dc. ntrrhc pcrfonnrn.c ol
<br />rhc *ori nn which rhisp.nnir is is{rd Nly*orkdtr coNpctr\ari,nr ln\utu .c.r.iicr xl Nlry nunrh\r nrc
<br />I $nify rhar in rhc rc.funmns ol$c *ort for whkh lhis p.nnir N isucd lm( cnuloyrny pcr(in h rnyn n.rr
<br />$ s to hccoflE subjcd to thc wortc comDctr!(nrn hqs ol Cililonrir rhlr ill \hould lf,con'c \!hFr ro rtf,
<br />so'k.r\ ..n)lNri{rD l,'ovi\,,tri,,1 s..rir), lTlrl)dl
<br />tl^RNlN(; lirilu.c k, {ctrr. *'*c^'
<br />.i\rl n]r\ r|] kr d. hu Llrcd rlror\rtr
<br />ry:ifl:Tg*
<br />l.2lALi-l!:!"Il1l)t
<br />I hcmhy rrftmtndrr Nnrhy.ftrrjurt thdr I m lirhsrd uidcr
<br />oi rlt Busircs rtrd l,rofcssiorr{ (nlc. nDJ my liccnsc ir ir Inll
<br />Chrfrrr 9 rcontrrtrn.ifg trirI sr.ln TlxN)roll)nis ]
<br />83q.rylg
<br />Ihcnhynlllrnuhdcr|*n ly.lfcrjurylhd
<br />n\u.d rSL{ :l(D?. Ci! C I
<br />ru.rion LMirgr8cNylor rhc pcrion mcc ollhc work firslri.hrhil pcnnir is
<br />dltLl!:dNI"llElL/$AIIoN
<br />I hcn$y rfilnn !ndo l]ctrrlly oipcrjuryonc olihc followirg dc.lararioDs:
<br />DcnDlirirn PLrmis-Ash.{os Nolifi.alion Fcdcral Rctsuhri.nr (Tirlc 40. lfi6j
<br />_Rcquncd Ir .r ol Norifrlrion
<br />I rc'rir! rlixr thc lrdc'rlr.grlnri, !x\lrn.\i. o\rlr'. nlr,'ftni.lhlt. k, rhir 0,or.cr
<br />4@ botrlP], wirl.llCiry rtrd Counry
<br />ofrhis CIy rtrd Giunlylo ctrrcr unon rhc
<br />*,9-zq -tB
<br />Set Backs
<br />UFER Ground
<br />Flood Zone Certil.
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