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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq slclR lrlt$/+,4 rt/4)
<br />{IShear Wall I
<br />Framing
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />1
<br />FINAL Yltrltt'finha^t 7u1--/
<br />Certilicate ol Occu n
<br />Notes, Remarks, Etc
<br />OWNER BUTLDFJR DEI-CARATION
<br />I h.rcby rffirm uMd pcnrlry of p.rjury lhrl I an drcnpr fsrn rhc Co mclo6 l-icnk Llw fd Ihc following rc!*rn (Scc.70:11.5
<br />susitrcss rtrd Prolc$ion C{{i.): ny Ciry or CoDnry Rhth rcqlncs s Fnnir b .onnruct, 0tcr. imPtov.. d.dolish ot rcPin anv
<br />drucfutu, prnn b ir\ hsrdrc. aho rctuircs rhc arpliclor for snch Frnir ro filc a \i8ncd slalcmnl thd h. o. sh. n lccns'd Nrurir
<br />io rhc f,ovnions oi rhe Cont,crdr's Li.c.€d ti{ (ChnPler 9. Con mncing wirh Scctiotr 7U)0 ol Divisi,n.l ofth. Busi.cs rnd
<br />Pmicsionr Codc) or rh h.orshc iscxcnDl rhcrclrnnlnd rhchqsis tuih. rl lcScd cxcnur io n Anrvnn ionofsstionT0ll5bv'nv
<br />appli.ndforupcnnirsubjccrsthcalplicsnrr.a.ivill.alrlor.ormorcthonlivchundrddolltis(S50O)
<br />l. ns *ncr olrhc,'n,r.ny. or nry cnrflolccs qilh wnscs as rh.ir viL roi!*n\dn)n. silldo rhc *ork nM rlf (nEruc is ror
<br />iDr.n{lcd.rolltrc lor*rk(SLr.?0{,r.0usincsrndt}olts\ion\Codc:lhcQ)nnklr'sl.i.cn{L,sdocsnrrPPlyrortro*nror
<br />rhc|nnFny who huilds or i'npnre\ rhdGni. m{ whn docs luclr q* hinsclfor hcr\clf.r rhr.ugh ht or hcr osn cfrpk,ycc\.
<br />p(,riilcd rhrr su.h inDn)rcmnrs rrc n inic'ldcd or ollcrcd I(r {lc ll, howcrcr. rlr huildin8 or illlnovcmnr i\ !,ld *irhi" , k \trr
<br />ofco.lphror rh. Owncr Intiklcr will havc rhc hurdcn olporing rhrr h. or \hc dil mrln'ih or nnprort rhc tlnrliny for rh. Puryxr{ of
<br />l. rs.sr$ofrhcnoocny- amcxclusiv.lycontrcridx triih lncn\cd c.nh.rr\h coiir.rrlt prci.r (Scc 7(Il"'r.8u\i,tr$
<br />ul th,li\\i,n Codc thcContacrofst-iccnscLlBdocsnorapplybriowmr.lnroPcny*hobuildrornnPn,v$rhcr.otr.
<br />rtrd wh. contncs lor suuh proF( *irh r Conta.d( n li.cnscd rusurnr x' rhc Q a.!r\ Liccnsc I r* )
<br />I nmcx.nrU nDdcr Scc
<br />t\tufuuitltlQrlLllrillQN
<br />DEtlISdIlgl!
<br />Ih.'chy.lTtr rtrtr cr Nmlryoipciuly.nc.frhc lnlkrwi'rE dc.hrrln \
<br />Ihnv. rl will mi.rlin r Ccniararc of Cod{ r r. sdlf-l surc fn r orte6 conpcnsar ion, ,\ F)vded li,r hy s*r ion l?(x) of r hc
<br />lrhor Cdq fdrhc perrofln5ncc oflhe quk f.r which rhc Frmir is i\sucd.
<br />I hdrc ntr{l $ill nmirt.in *orkcrs .onrpctrsrrioi i|*urrtr.c. N rcquired hySccrn,n lTfiioflhc tihorGnt. nrrhc Nrfrnninccol
<br />rlE *oik lnr qhth rhi( Dcnnil is is\ucd M y *ork.r{ .o nlrnsar io irsutrnccca crMdlolti numhcr ore'
<br />-l..rriliihrr
<br />ir rh Frronrnn.c ot rhc work lor * hi.h rhi\ Fi,nir it ,ssucd. I $nll nor cndoy ny |rr{,n in.nymritur
<br />n, Nl. hcc.nrc $htd x, rhc $orkcr.onpcn\arion hssotcrli(imir. rtrd xErN rh irl dxnlld h..om \ul,jd rortt
<br />workcr comrcnsrrion nr.'isionl ofSc.ri(,n lT0Oofrlt Lrhrr G)dc.l \hrll turrhq[h.omr]ly +irh rho{ povi{Dtrs
<br />l\',\R\Ir.'(j lJ Lrc !) ...tr,. r,rk0.n colc,rgd h nnhNtul. ond shaU \ubjc.i in cmtlolcr ro rininrl pttr,lr.s ind
<br />.iril inG oI b otu hutrdrcd i lm.fiX)). iMddirion lo rhc r.sr of.onwn\iiion. d5fluSc\ trs providcd lot ih.
<br />'/ /4t'n( (/ (1/t9 ll//W-
<br />I h.r.by xrlnn trntl.r Itfulrt olNrltrry hd I ur licctrd undcr F,eision olCnrprcr 9 (ontr1u.in8 wnh Scctbn 7000) otDivhim l
<br />of rhc tlu\ircs\lnd Pdc\!n,n(codc. r nylic.tr{ is in iulliitrcc d.ln.r
<br />L t3 EW ,1@+
<br />I h.rhy xllnm trndrr titr,'11y,n !c!rtry t a .on(tucri('n lc dirB Ucncy li)r rhc !.rfonn rc ol rhc wor[ t{r *hi.h rhis |xflnil G
<br />n{rd rsc. llr97. (iv C )
<br />tf,ndcr! Addrc$:
<br />-
<br />AIITTJ]ANLDECIABAIIaN
<br />I ixrby a,rm onrlci Fnnlry of pcrjlry otrc oilhc r{nbsin8 dccl,rarions
<br />D.nnlirion Pcflnirs Ash.n.s Norincarion icdcral RcEularions (Tirl.,ro, PM6)
<br />-Rcquncd
<br />Lcrtcr otNorilurion
<br />fcdcnl .clullrions rcsardine n\h.no\rctri,vnl c nol lpplicibk ro rhh loJ.tt
<br />A h.vc rcrd rhh appli.arid rd s.rc rhdrihc rhovc ini,xnhrioi n.orc.i. I iEnc l. con,Il, wirh rtLCiryand Counly
<br />nrc lj{s rcLtin8 ro huildi.S c.nsrfl.rn)n,iurtnri2. rdpr.snInrivcsotlhhCiryrnd Ci)xnrytocnrcrullrniltv
<br />w)
<br />-"7 y' ? tq./ - (.- t-l L)ortt. ( t
<br />C 47atvL
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