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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS O\INIiR BUILDf, R DELCASATION I hd.!'y rmrm undn Fnah, olFjury lhal I m cx.'ryt tum lhc Conlra.h6 l-i..N l,w lot tk tollosina @$n ls(70r1 t Irusi.6! sn Prof6ri'n Cod.): Ary ( y or Coudy $hrh r.qun6 a Fnir b coNruci. dh6. dF$., 4,mlth or .qur et strucru.. FDr ro !s !sle., rt4 '<tuG ilE +dad for kh Fnn lo lik ! t'rn d nrffir ihd lE o. 3lE b licss.d lreql ro rh. FrvBhB olfi. comdm 3 l,rcoscd Lls (()sr'(6 9, (imntrior $nn Sdhn 70(x) ol lrr'txJn I of rh. Burio* and PmfNi,,.s Cod.) or Ihar tE or sic is crorpr lhr.noh &d rhc b6rii lor rh. allq.d â‚¬rmpliofl. Any vioh n1n of Se1io. ?01 I 5 by ar) .pplicdnr ln o p.mn sohjds th. ,prli.dr ro ! civil !.mhy oa nn nD.. lhM filc hundr.d (l1rll&. (5500 ) I. s .{ffi of rh. I'ord}. or ny @plt}6 $nh $.a6 a ih!tr $L.onqEMM. uill dr ll! *dt Dd rlE rdrc 6 n, dndai or ofiddl lor $L (se 70a4, BcilB dd lrorsioG (!d. Tlt ConrBlors Lt@ Itq do6 ml q{,lt to s o\M.f rhc IrDlEly who biL! or improv6 rh@n. od *b &6sh knl himsclf or h6*llor rhiotrTh hi! ot hs (wo cmpLlt6. p.ovid.d rh.r such inFuffrs e mr irdn d o olb.r tx sk lf. hos*a. E lliBnl* or nnFortFd 6 $E {nhin "nc !d ofco@lin( !Oqd lk&ld $ilh.\r tlE hr&t.fForirB tht lEd3h. dd dn hin d nq.r. EF.FttrdtFrFeoa I. Er o* M of fi. Frp6ly. m cr(lusiv.ly cootrd ins silh licakn codtu()6 ro coiedd tlE Fojcd (Sd 7041, Bd$s ad FnEircod.:'r'h. conrdo.r Lic.e L.* tiE mt.rrlr lo 6o*ns olproFry*tu b{ilds or nnprov6 ih-d,n, &d wh. codBl! f{ ruch Flj.rl' *nh !Codaro(,lkaEl p6u,r h 'h.Cootr*rort lI.e r,$) I mcrmo undd Sdion ]ll)lli[Bt-(aufrlsarar DES.AAAIIA! I hd.br.ltrm und6 Fn.hy oa psr!ry nn. oalhc rolk,s ins ddlds'trr6: I h!\. sri will @inbl. ! Cdili!.I. ot CoMr u S.ll-lBUr. lor *o,k6 conFMon, s FlviLd tot hy s.n{n um o f rh. tjex Cdj.. tn rh. Flollm. of rlE {o forrhrhrh.Fmn ! e.d I hrr. and will n.inr!i. worl6 compcNxon rNuranc.. N r6lur.d url sd tun l7O0 of th. libo, Cod., for $. pdfomrcc ol thâ‚¬ wort aor which lhir psdit i! suqi My *orkd comp.n$riin iBurNc .eis dd policy nu'nbd e.: I cdiflrh.r Dlh.Fforrre.6f tlr so.t f $hkhrnnFmn is isu.d.I nalltul onpkr) dyF$. rlnyhffi $ a ro bdom st'r<r ro rh. sirr6'snFdion b*! of Cllfomr.. ind tsG rhd if I rl$oll taoE tuba-l lo ll! *oirf, rdn:FsrNn ro\ isbB of sdron lT0o of lh. lihor (in . l sldl, n nh$nh comply $ rfi lhos pto\ s'o6 $ RNIN(: l:rilLn( ri {tu'r \f'1.'s \otrrN,!,irn' .r\r'dr A r l. d \l'rll suhEr tri on civil line up ro onc hun&.J rhou$nd dou6 Sdi.n 1076 of llE ljtrr CB!. t- I h6ct ' amn! ud6 rEDl'r olFrrury rh, I m DECII8AIION uda Fvtion otcr'.fls I (@@i.B silh Salion 7000) or lr\Bon l of rh. ttcilB md PrcfsG Cod.. xd dy lrdg a in tull lorc.,ri.lld ts -11 6+*og 1') r I ha$y .lTm un& Fa.t' of Flu r.- t iaq!.d (sc. 1007, cir ( ). fid. ir i odtudi.n krlins lscr tu ih. Fr('lrle. of 'h. N od fo. * hih rhu Fni i! ATEl(:ANfD&gA8dIlqts I ndd'y afrin' uid6 t n.lry of Fjury on.ollhc lollowins d6la.lions: Oaiolilio. FmileArtrsror Norifi.d 6. I'.d.ral R.ruldion! ITn k 10. Pd6 ) R.qurqj llrq ol !*,i6.d$ hc findi r.sulhltuN rcs di.s trsttsku ronoral s. nol oppli..bl. ro rhir rorc.l hlE iftj !h6 appl'c.rx'n d I saia n' conpl) l'ih illch) a i(i,onr) Sr.!.l,ss EldnE ro b{'ld'ns i.rl.ddn6 orlnB Cn! rnd (-oumy ro dra upon dr obe (*E a-J,-h't Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathinq Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL l/n//ot ),\b5 Certificate of Occupancy r II Noles, Remarks, Etc :::'"[ff'" I I I I