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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OTT NEN AUILDf,T DEII'AR TION I h6.t'! llIm un& Flht ot pqju] rhn I m crmB 6om lh. (ir rlo.' 1...e I-{ lor rh. folhrn4 i@n tsd nrrl 5 Bun.63 r.d Prolsirn ( od.) Ar! Cir! or (nunry $h(h r.qur6 . IEmi ro oNrud. .lta, inFo\e &mlafi or EIstr ! rtuduiFh.ro r (iuffi., lko r.!un6 rh. .lplf,lnr for soch Fmir h lilc ! risn d srrffir rhn h. or 3h. 6 li.6s.n l,uBr.r lo thc lrovaioB or ltE (ioll!.1ois Li..ns{ t,u (( hapr6 9. Co6nd.r8 si'h s<rirn 7urc ol l)\irnn I ol tk Busi.B! ind PNLsiotu Cod.l or rhdr h. or .h. is .r.nfl rhd.6om Md rh. bai! aor ih! ill.ral .rmprion. Any violation of Scdion T0l l 5 hy tny rt plicdnl for r rErnil llhidB lh. lppliclnl ro r (iril n6rll y oa rcl ,noE lhs fiv. hudrcd dours I ttl)o ) l.6 NFolrt FoFny, or nr dqlh\6 tr nh r.s6 s rlEr $L con{Fario.. "ill d. rlE ssl rn dE rdE i! ml ddi.Ld dofia.d aor sL isd 7014. B6iK Dd Pmi*!68 Cod. ft.('odrdr'rLtret.*&Bd+llyloeouc.l rhcFoF!'} *lD hlill.r 8Fo\6dEFr rn nh aE shs! hrulf or h(xlror rktugh hir oi ha.*ndph)q rovid.d rhd Mh llp..lEBir E ml iidn d ot otu tu sl lt ho*-q. tlE txrldre or itrproffi i! rld $.hi..k ]d of mnpkiotr rlE ( xffi B{ihd "ill h.\r rlE hr&n of F$ms rl! lE q JE dd ml hlild or irFrD!. rh. FFry 6r ih. FlrFx of l. 6 osnr of rh. IroDâ‚¬lr. e .rcun .ly conlrrcr inr r irn licoFd co.rr!.lon lo co[nrud rh. t'oj<r (SR- 7l)1.1. BsmG .nd Pt!ftsir (-o& Tt. conta.(ois LiccN. I-ru do6 nol drDlv ro M or n6 ol n orElr s ho bu'ldr .r idn,orB ihdbn. ..d *ho s trlr[r $ch rmj.{ts trnh r( odEdorlsll(6E d p!runr (,rhc(-odrko.! l-k.M Ir{I I m.rofl uqi.r s(rFn l).t.: Oin6 ltatrKEBSt(AUruILrdIuIi DEClAEdttOX I ho.byamnnund6t$!ll) otFjurromollnâ‚¬l,n[Ninrd(lararion\ I h,r. rn v ill rui.rlin r C.niaKdc or( onfit lo S.lf-lBurc for $ orkd mmF<s.rion. 6 r'trrd.d lor hr Sdnon I70o (, i rh. Irnir c6d.. aor rh. pdfomm. of th. snt for rhkn llE Fnn is isu.d I h!\. !!d *ill m!'ntsr *oil6 .omFEdo. iBwftG. s ,.q!!d hq salFn 1700 of ln kth. cq,., for !h. pdf.ms. oa lh. lql for rnEh lhs Fnn i isr.d My *0.16' snp.dion iBudc.ffi nd FIi, .umir m I.di&rhd r rh. tEromft. oafi. uort aor rhf,n rhi F sh i isu.d. I 3hrllml dplor uv p<$n h tn) mmE v, B ro tdoE $tral to rlE N*6 onFnnio. k$ of C.lifon'a dd,sc rhd ill JFUId b<om stFr ro llE *n*d omFrinnn FtrtlsE oI S..! ian lTm or rlE l.td C.dc l cdL ldh* nh omd, $ nh rhos Fo\irioc WARNING: tiilu. ro K6. rort6 6nFuri,n cor6u. is ul&tu|, ud ltull subrcn d Enl,l.)s r. (miml Ftrhs ..d ctrrl fi.6 ut ro... hun&..ilh.osnd doll6 (tllx).0(x)1. i. rddnion ro t .Gl olcomrENrion, (hms6 6 Fo\il.n lor !h. sft!ion 1076 olrh.l.ahr(td.. i.t6d datrom.'. f6 rt lzo lzotr-T-r I Eea.llm ueLi Frlr'of Fj6 th, I m h.-B.n u.& F.rn5i of(luria e (6ffiin3 *irh sar Fn ?ul)) or Dn 'rnn l of th. BcK .rd PmfBFB Co&. t{ m} lr.@ B D tull torc irj .IT<r b '*" l\\zol2011 c0lsla!(rlaNtEBDtlc-acElcr I hdSy rfrm un& F x, of IEIlry rh, tlE. it..odMion kndhs .sdr for rh. Ffollft. ofrh. *n.I ft,r $nth rhn Fni i! '$u.d (s< 1097. (\r C) AITU(AILIECIAAAIIA! I h.+, rfrmn und6 pd.kr of Flury on. olrh.lollowinB ddtd.t6N: lrsmhion Pdn*ArtBro! ttur'f*dion F.ddrl R.tullrirtu (Tnkl0. Pd6, RcquE<t lnls nt tlorilrirn I cdifr rhd rh. ldld.l qula' ioN r.td'I.* nrtEn)s rmovd r. Br qTl'obk l. ltis prej.t1 Irolifyrharlh$.'cn(lrhtrRpthcarnrnaid(!r.rhdrh.atuc'ntuniN(,n,\.ord Ialrek'dnnIl,\[hall(ii]and((n \ otuhnam* and Srrr.liss RL 'qr ii, hildir! conn' n &i hq.b, a hori/r rrtiffirsii\6 of r hn ( itr and ('ou.r! k' ols !Ii,n rh. .hrv. m6xon d pNIEnv tu 'nq,rlre ,\tDlic.nl or 'rror \ixnrrtr,r 4 v(+o lpolwt't Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathi ng Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handica p Req De puty Final Report Engineer Final Report Flood Zone Certif. FINAL z-//lx \ Dr4 \l-di+ k Certificate of Occu pancy Notes, Remarks, Etc. ui|4)y136 If-