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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUI t,DtlR Dlll,( ARAT()N
<br />I hd.byafin u d Fnrhy r)r p.rjury rhir I d r r{c'tr {tu'n rhc coftr.k)^ Li.ctrs Ltrw in Ihc hllo*ins'rcFi rsc.?rrll5
<br />ausirc\\ rtu Prrt$idr C_()dc) Any Ciry o. C.unry uhich rL\tunN r [tirnir ro con{rud. llrcr. imnnve. d.nx,li\h or Rpri' r,t
<br />\lruclurc. prirtrlr) irs i$urncc. also rcquncs rhc otpli.nnl lor such Il nilio lile ! \i8ncd d cmnr rhd hcor sh.8li.cn\cd Pursurnr
<br />tJ Ih. F,vi\nn\ ofrh. (t ri.n s l.i..n{d lrw (Chnpr.r 9, C. rmm irg wirh Sc.tio. 7000 oi Divnbn I .l lhr Busincs ind
<br />PrclcssiotrsCodc)orrhal tf,orshc iscxctrrpl rhcrclro'naklrhchrsn for Ihc rllc8cd cxcnr ion Aryviobrn'nolSccri,r70:ll5hrrny
<br />arDlicrnlr'or rrcrnril subjcck lhc anplicrtrrtorci!llpcnrlryofrolmrclholivchundrcJdollurs($500)
<br />l.xs osturofrhcpn'pcny.or ryrfkJt.swirh*rg.\rsrhc,r{'l.co |fn\jri()n, qrll drr rhc {ork rnd ltE (uiurc F nrr
<br />nnctulL{ rtrollarcdlorqlc(SL.7Or4.Burirc$utrdlt.li\nonsCodc Ihc(inirmr{n \ l.i.cnsc li*doc\fr lllplvk,r otrrcrof
<br />rh. nr)r.ny who t{ild\ or rirrtrrs rh.Nn. drd qh) d*\ \hh soA h$\clfor h.r\clfor rhrough ht or hcr.wn.'npbycc\.
<br />pmvnhd ihrr \uch i'npn,vcmn6 m nor inrctoL{ or oficrcd fitr \rlc ll h)scrd. rh- toiUi'r! .r ,\,nn.'nnr ir $kl } irhin oDc Jcu
<br />of.uDfkri,n. rtr (htrd Bu,Ild qillhrtc th( hudcn olFJvirA rhd h. or shc dil ftn tni[ or i'npro$ rh. ptr,pcny f.i rh. puih{ of
<br />-l-rso*lErofrhcpn,lEny.uncrclu{vclyc.nlrlcrire*irhlr
<br />h.rnUccr(SLr 7l!4. Btrnnc\\
<br />rnd Pnri\:inr Codc Thc Cotrta.nn\ Li..nsc Liq doc( nor {nlyk, Mowncr ol[oncny{ho huilds or inrprovc\rhcrcon.
<br />and Nho co rachinrsu.hpntcr\ *irhrContr.kn(\) li.cn*d nursurtrrt'ihcCrnt..kr'!Lrcnsc Ii!).
<br />I rnrrx. ,pi tr'xhr Srcrotr . B & P( lnrrhn rcJ*rr
<br />Dorc. Osncr
<br />woRtr:Ra' coMPItNsATl()N
<br />DEIIdXAIION
<br />I lrrchJ JIn m unJcr ncnJlr) ,,f r!u1 .m ol rhr lnlhwi"s JcrlJdrFn.
<br />Zh r arxl wr ll rmrhD r ccn rridc or (btrsctrr ro scr.lNurc rbr workcs- conrcnsar ion. a\ !rcv'dcd lr try s.cton lroo or rhc
<br />r,1,. C.*, f,*,r," p"rr-nrn""ofrhc w.rk li, whi.h rhcFnnii i! issu.d
<br />-l
<br />hrvc {trd will nni rin sqkcr' con,tictr\rr i,n, in\urrNc. r\ r{uncd by S.crn,n :lTln of rhr L hnr (i,dc. tlr rlt $nnnrN. .l
<br />rhc work l.r $hich rhi\pcrmir is issul:l My*orI.^ comprn\Jri,,n i',\urr .r.nnici drd |Dlry truarhcr trc
<br />I\ni.yNunrt{r
<br />inrhcp.rnnn ncofrhrNorklorNh(hrhAIrn ir N ,\\ucd. I !lr.ll nor c.rDl,'y !ny tENon in uy mxnrcr
<br />\ihic.r b rhc rukcr\,..nr!.nsorion hNs .1c!lilornir. rnJ agrcc rhrr il I sh)uld b.conr \uhi.r ro rh.
<br />ns0rion U.vni.n\ ol Scclion 3'l(xr oirhc l)hor (irl.. I \hr l. n)dhsirh.onlply siih rkr{ Pn,vsion(
<br />ilurc b {rurc worloh (onltlcD\.ri({ coucrrlc ^ unhslul. nnd shill \lhtcl in cmnl,rycr b ai i',rl Ftuirir\ rid
<br />I oN h!rdr.(t rhotrsn dollr^ rll(xr.(x)l)). $ itldfi.tr !) rhc inll).nsrrii,n. drn g.\ r\ f'(
<br />i' r'r( rrl rrkrif,! \ lr(.*".21-lt{
<br />I h.rcbyditu r undcr Fndhyolpctury rhir I om licctrrd Dtrd.r provi\ion ofChrprcr 9(c.mnrnci',A sirh SNri)n 70fi)) ofDivisbn:,
<br />of rhc Br\im\\rnd Pmfc\\birC.dc, rrl rnyli.ri{ n i'r full f,r.c a lcli.cr
<br />t)
<br />FX:
<br />lalllaLl -1?12-Lg:Tazz-
<br />IANUBUI.IIANIEADAG.A{iENII
<br />I hcrchy arirnurlcr p.nalryof!.!rry rhd rhrrc is a.on{tu.rion LndirB r8cncy lor the pslbnmncc otrhc $orl fitr which rhn Itflnir i\
<br />tsucd (Scc 1097. Civ. C.)
<br />lluructrLut(Llarr(D
<br />I lirrhr rllntrr tr ., I{nJlrt,'l t)r'rur\'rrr !l rtu lL,ll,^\, Lllt\ l rnrr\
<br />l),In,n 1k,n I'r'nnr\ l\\Ir\r\ N.l lL.xl(,, l nl.,.' Rrgr,trnnN r I 11. 1o lr.tr()l
<br />ln1l,'
<br />'.Ll
<br />I.rn{.r N,{ lj.rl.n
<br />/1.,.'r.'1."tr'ir,',l ..r.,r.r., , . '.r..,l'. 'llr'.' .f',..
<br />olrhis city ind Coutrryb cnrcr uIi)n rh.4 z{z/tt
<br />,1Jir'r1.c.,n.l \r. c1.dtr,rc1",'na1 l"u'l,l rF JcniacrlE-{!
<br />Jt'rr "k.nr'.{r.d fn.F.n) r,tr tr',rt\l;,1rnry,y+ ' . )t{, 4 -t-*
<br />^ppri(anr
<br />orArc,rsiEDrur t Y r)< C-
<br />PGmi,F n,r. prin, r, /--tt3z l, r-Pl^,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />/^\
<br />FINAL 5-3t-tc v)ll,-)0 q
<br />Certilicate of Occupancy t/
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />SLAB Floor
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