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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />-l.isowncroirncnrcpcnt.ornycmployccsenhwrCc(asrhctsolccon{cnsorion-willdorhcworkundth€ntur@hnnlinrendcn or ofcred lbr ele ( Sc 70,i4. Bu\incs lnd Eofc$ions C{dc The C.nkrtoir LiLu{ trw dds nor ,prly ro an owncr ol
<br />rhcpmFrly who buildr or i.lpnrEs lh.@n. snd nho drcs such wolt hnnscllor hcrrllor rhmuAh his or hcroNn cnpbyccs.
<br />prolidcd rh srh inD.ovcrrnh aE nor inrcndcd M .ltftn foi sh. Il hoqcvcr. rh. huikftB or inrrorcmnr is skl *irhi! orE )ra
<br />or.on{)Lrkr. rh. Own* BuiUd wiu hM rhe bordcn ofF.viog ild h. oi shc dd frn buikl or ihp(nc thc ,oF{y for rtE purrDc ol
<br />-1.
<br />r\ owrcrofrhc popdy,.mcxclusivclycont..i'nE $nh li.cnscd.ont!.ron rr cotrrd.( lhr pro { (Scc. ?0+t. Bu\i!c$
<br />a'xl Pn,fcsirCodc'IhcCiJnrtu.ktrrt-i.cns€L'wdocsn rarplyt,dnownfiofllopc y who builds or improvcs thcrcon.
<br />und who $nr[cls lor such Ifojcts {irn a Co odo(n li.cnsed Nru. r ro rhc Conrrocror'\ Ltcnsc tjw)
<br />I am.xcnlnr unJcr Sccln'
<br />llaaa!&r:sDltrNrilra!
<br />DrcI,/lnAIIO!
<br />I hcrchy{l,irnutrdcrlEnaliyolpcrtDryoncolrhclillowilad.cl rliors
<br />-l
<br />hlvcand*illnninroiraCcniaEorcoaC.n*nlro Selflnsu.c lor rorlcF' con{cnsnrioo- as rrcriddl forbys$rtun1700orrhc
<br />Lnbo! Codc. fo! lhc p.norlMncc oi rh. Bork r'or qhich rhc Fnnn ( issucd.
<br />-l
<br />hrvc rnd w llnuirrrir sorkcn contpctr\rrion i'NUrincc- r\ rrqDncd hySrrrnnr.lT00ofrhc t-nborCodc. LrllE pcnorinrnltol
<br />rhcsrll:rsl1'hrh\t\'{'it'.i..u.JM){,1|,a.'c{n'f.r\'!trrin.Lr'.r.Jnn'$lT.li)itr'rh.rrr
<br />..". - gf-\p ?-'rJo 0--,oz-9t11 1r,-)(-
<br />-lceniiythrl
<br />inlhc pcrformrce ofrhc{ork nn $hthrhnn rnrir h nsued.Irhrll ior c 'tloyanyF.non n' dnym,nrcr
<br />b .s ro lxc.nr subjsr rd rhc workcrJ.o.r$ sarnr hw\ orcaliro'nir, ind .grcc rhar il l should hccom subjccr ro
<br />'hcwor*(s.ompcnsdionpovisioNofseri.n:1700.lrhcLabrCod..Ishdll,lbdh*irhcomplywirhtlne[ovisions
<br />\1ARNIN(; I.xirur. r) ro(n'c q0ltr^idr.dvdtulc h u.hwful. $d (hdll suhjccr 0n cflrplorcr !) ainrinll pcnrtics a,ld
<br />. vil nr.\ un r' otu hrndr.J rhoxsr d dr (S|(X),(XXD, id iriod k) rlr .o{ oi..trrNn\rrion, drnr8cr !\ !rcvidcd fttr rhc
<br />Sc.ri,n' l076ol rhc Irhtr
<br />,,": r /q.lt I
<br />o[!Ll&u]ar
<br />, hcEhy allirr undcr !.nrllyofpcrjury rhar I sm li.cnEd undcrymvniotrlt4haprcr 9 (@mmncin8 wnh s(rb.70(x)) otDivision l
<br />ot th.ll!lnc\srid Pnn.\i,n,\ (intc. rnd nir_ l'.ctr\L i\ m lnll
<br />F,az I t1l?t1
<br />"^," lwTI g,-
<br />CANIIBIICIXINITTIIIC-AGINCI
<br />I hcEby 0lfirm undc. rEMhy of pcrjury rhar thcrc is r con$ruclion lcndins ascty rd rh. ncrf.@tut orrhc work ror whiit lhis Fnnir i\
<br />issucd lSc.. 1097. Civ. C ).
<br />APIIlsi lNfllECLAIdIllr!
<br />I lErcb, {llrr undcr Fnahy of r.rjury om ollhc loln,wins dcclsrllions
<br />r,r"*!,rZip",,nr, q"n"u* rr.rlhrr,otr lcd.rdl t{ceulnr.' F '1 1.4r', P0n,i
<br />aRcqurcd Iifl cr (,f I'Iorr',rJrDn
<br />I..nil.vrhrr rh. rc(hBLrrgdlariors mArdin3 r\h!{o\r. mul rrc nur ntpli(blc t) rhi\ |n.]-cr
<br />I ccniiyrhd I h3rc rcad
<br />'his
<br />rp ord stircrhdrhcahovc inlornurion n comcr I 3sN b.omply wnh all cilt trtrd Cou.ty
<br />o irirtr.c\nnd Srnl. Lnssrlrr nifldnrtr oil h.rc6y lulhorizc
<br />rhorc nf,nri,nrcd t,(,lf,n! f(r i'N
<br />,{ ptrli(trtr1 or AIo( Signn
<br />C--4.\..
<br />**TJT;li?":"
<br />Set Backs
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Ene rgy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />lr/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />I
<br />FINAL zhq ltQ rJG ol
<br />Certificate of Occupancy '' ' I I
<br />Notes, Remarks , Etc.
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />OWNER BUILDER DELCARATION
<br />I hc,cb, afiln hdcr pcndl, .i perjury Ihol I Br crenrfl lo.r lhc Conlftcror Li.use llw fitr ihc foll.wing tu*,n {sc.70:11.5
<br />Busincss rd Pbfclsi.n Cdlc) An, Ciry or CoMry whkh r.qun Fiink ro .oniru.r. nlrci nryrovc. dcmolirh .r rcIl]t My
<br />srrucrurc- rior ro ilr iss!!rcc. aho Equircs lhc lpdicanr for such,Ermn ro nbosisncd srarcmnt rh ico.shc ! liccnscd llxNrnr
<br />ro rhc prcvnions of rhc Conlracror's Li.cnscd llw (Ch0pt$ 9. commncnrS wirh S.dion ,Ol)O oi Division :l oi rhc Busincs ord '
<br />Pmfcssions Code) or rhorhc or shc is crcnDt rhercfnnaad rtu b$is for rh. alkBcd crnrrio! Any liohri,n of sd bn 71,.115 bya.y
<br />r!pli.,n.lor.pcr6nsohjerrhc,pplicrnrt,acivilFnrlryofiordtr rhd fivc hnndrcd dollars ($500)
<br />\t\ \/D
<br />I.n,l.r \ Addr\..
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