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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNIiN BUIDER DI'LCARATION
<br />I hcrcby lffiirn undc. Ilcmlrt of pcriury lhal I m crc'ryt fmrn lhc Conr.ctor' LiccnE ti* tu rhc Lllowins rdasn ls..7o.ll 5
<br />Busincs and Pmlcssion Codc) Atry Cny or County which rcquncs r pcmil ro onslrucl. alrs. inrprovc, d.nrlnh or nPan an,
<br />srrudurc- prior to ir1 issulncc. aho Equircs rheapfljc!trt lor such Fflnir b filc r sisnql n!'cmtri rhll h.orsh. is lrcnscd Nr{.nr
<br />to th. Imvisions of E conr0dols l-iccn$d LlR (Chryrc.9. Conn,crcins wilh Sectiotr 7000 of Divi\ion :l orihc Busin.$ rnd
<br />Pmfcssions Codc) or rhar h.or sh. n dcnpr rhcEfiomand rh€ bosi\ rbr rht llleacd cxcmrrion. any !n ,ri,nofScclionTo.ll 5 bymy
<br />rytli.dd lnraFnnn suhj (rhc rppli.dlorcivill.dhyofnotm'.rhanfiv.hundrcddolldr(!500)
<br />-1.
<br />owmroflhc pmF_ny, or rlyeDDloylrs wilh wiacs $ lhci $lc conucosrrion- willdo rhc aork and rh. ifl.tm i!.or
<br />inrcnLn orolTc.cdforek(SLr70.14.Busin.sr.JPr.frssn,nsC(xl.Th.Conamror'sLiccn*Ijwdocsnorapllyronnowncrol
<br />rhcpmp.ny vho buildsor impDvcs rLro(,rxl wbo dds such M,* him\clf or h${lf or lhnnrth his or hcr own cnploy.c\,
<br />prcrilcd lhar such nnpmrnE h m ml inrcndcd or oficrn tu eb. It homrr lhc tDilding or inlrorcmnr i\ *ld $ih oDc yutr
<br />6rd,n{'lcii(,,. rhc Owncr Auius qill haw rif, bo(kn of provins rhrr hc or shc d'd n'r t{iki or i'rpo[ rhc pnrply for lhc purlxrsc oi
<br />l. ds owno.f rhc !n,pdr, trmcx.lurvcltcoNacrine snh li..rsrd.onrr.rorsro onrfld rhc pmrlrr (Scc 7(11.{. Bu\inc*
<br />arl Pntsi.n Co.lc:'Inc Conrrrrors l-icctrsc l-aw docs nor onply ro anorncr otpopc ysho brild.or imrotcs'hcrcotr.
<br />ud who ..mn.( for such prcicch wnh r Ci,nr,.b(s) li.onsd ptrrsuMr l.lhcCd rlctois Liccnsc L!u).
<br />-l
<br />imcrcryr und.r Sarn)
<br />}OAIiIru:TQT.ITXNSAIIAN
<br />Dl:cL!.BtrUA!
<br />I hcrchy !fltnr undcr $nrXyof lcr.Juryonc of rhc tullowng d..lard!.ns:
<br />-l
<br />h!!c d wru rmn ain . Ctni6.alc of cl)n*m o S.LInsun for wo.kc( conDensalion. * Droidcd for by Secrion :l7o(l ol rh.
<br />tibfl C,{r. lo' rhc Fr,',mn.c.l rho qurk f.' shrh rhc F mr n ts\u.d
<br />kftr,.c ,.d *r ll m, mE m *".lcn cnn'I]cn\arion rn\urancc- as rcqun.{ b, S.dion lTOo or
<br />'hc
<br />bbor tu.. ro. rhc ,)sfomurcc ol
<br />rh. Rorl i(tr $hl![ rIn Nrnir n i\\ul1t Nl!n,)cDsrri{)n i'rLmn.. crrirr rrd I(,licy n! $rr ttrr
<br />I ccnift rhl in rhc Nrr(r rn.c ofrhc B.rk tur which ihn rcrrnir is s{ucd. I drll nor cmplor.try I'cron in any mmn€r
<br />{r slo he.onE subjcd ro rhc Norkcn c.r,pcnsorion lass 01(-rliromir and rsrcc rhar irl \h.uld }..omc \uhjc.r ro rhc
<br />*orkcr(compcnsarn,n,rovnion\ofS.cri,)..l7ll0ofrhl-ah,O..Ishrll,f(,nhwnh.o.rdy*irhrho$[ovisid$
<br />WAllNlN(; IxrLu.c b {ctrrc s.rkcr conlxn\rtotr c.v.n!c tr u by.r ro nimirnl lEtrrhas rnd
<br />ddmgcs ,s ,rovidcd lor lhc.nil ln,.s up ro .N hu '.d r[ou\atul ,lolrr\ ($l1x).1)lrlr). ir . lil
<br />::::rru\$::":r
<br />I h.Nby lfllrin x.der pcmltyofp.rjury rhar I m li.e.*J u.dcr roljsnrn ofChdlr..9 (omm*ine wnh Scclion 7ofil) oaDivisbn 3
<br />.l rhc Busifle$ sM Ptr,icssions Codc. Brd my li.cnsc is in full fde ard cflal.
<br />f-)
<br />WZ6
<br />IOISIBIJCIIOIIENIITIC.ACENCI
<br />I hcnby lrlifln undcr !.nallyorp.rjuryth,r rhm is,.oNrru.rbn hndinS ngcn.y nr rh. !,c onndmcoflhcsort f.r whichrhtFmili\
<br />is\u.d (Scc 1097, Civ C )
<br />A.ETLICANLDECLAAAIIO!
<br />I hcMy inim u.dcr l]cnrlty o, lcrlury onc ofrhc li,llowin! dNlararn \
<br />DcnhlirnrnPcrmirs Asbcdo\ Norilicrrion Fcd.ral RcSullrbnsl'tnt40_ P!n6)
<br />l{cqut.d I. .r.iNorii riol
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall I
<br />Framinq 7/A/fl .hxqt
<br />lnsulatron/Eneroy {/r/l(.rM
<br />Qrywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence I
<br />T-Bar 8/fr//f r'>R6
<br />Handica p Req..v
<br />Deputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL //oh 2/t1 ,n M4i )
<br />Certiticate of Occupan-y-7 I
<br />t )-1- 17
<br />L.ndft r Nlft
<br />-
<br />l.iJ.r.
<br />^J,i.
<br />r
<br />-l
<br />c.n ily rnal thc lcdcral r.guhi ions r8ddrn8 asb.{os rufrrv.l arc nor ,t pli:.b,c ro tht proj.cl.
<br />-l(nilyrhd
<br />I lurc rcad rhirdnnlrar'onrd.rrrcrhd rhc ohtc ,nrarnldri.,n trJnmr lrsmrocnn'rly* h llctrJ.nJtbutrr'
<br />,.'dr'r..JDr srdc Ln*. rEjnq h huirdirs,r,n{n.hndn hcrebvd$.rc '.F.+ rnAirrh'\c vJndco! r/F.orsuFn,h.
<br />.hrc 'mnn"nc,rtrmmnt rnr C*-,-"*il,d*. Il /./ /,
<br />n0o,,,,",.,ou.,',,-,V.W1 .&i- t^,. ru/a
<br />**u*-..,0,.1_ AofJ. S/uo
<br />Set Backs
<br />UFER Ground
<br />Flood Zone Certil.
<br />Notes, Remarks, Etc.
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