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BUILDING- INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS 0WNER NUII,DER ['I'I-CARA'I'ION
<br />I hflchy rffinn undcr p.Mlry()ffr]ury rhd I rcxcnln fr rhc Coolr dor'l,lcct\c LaN f{r rhc r{n[nvirt! rcr\ lsc.70]15
<br />ausircs\ rtrd Pnnis\i(r Cclc) Arr Ciry .r Counry Rhi(h rclutcs r p.rnir nr cointurl rlrcr, ir p!.vc. Gn{rlish nr Rt,rn
<br />'y(n'.rurc. priorro ih t$an.e- rho rcqun \ rh. lprlicr nn \uch Fnnn h tika (ilncd iarcDrnr thd hcor dr is li.citd N1{r trr
<br />b rhc F,vniuN of rh Conrn ttri l-iccnsi lnw (Chinrcr 9. Connncncn,g sirh S..ri{u ?(XD of Division 3 ol rhc Bu\inr\\ and
<br />Pnlcssi,rr\Codc)orlhrl hcorshc isdcnlPr rhcrrliomrtrd rhrlr\i\ tur rhcrlLgcdcxcnrprl.n. AnyviohlionofSc.iinrT0ll5hy0try
<br />rntlicstri turrpcnnir\uhjc.6rhc qrfli.dnri.icivilpcnilry.f.rtrFrrhrnIivchu rcddollxr(5500)
<br />-l.r\owncrolrhcDroFny.,nnrvcnTloyec\wirhwr!c\r\rh.nw,L.on[ctr\{rion.wrlldothc$r[nndrhcnMuru(nlrinrrftlcJ orofltrcd lar srlc (Sr.7014. ansircssnnd PmlcssidrCodc, llN(innrJch\l-i..n\dl-awdocsmraPnlyro,n.sDcrof
<br />rhc pn'rcny w]xl huilds or tlll,ni!$ rlrdnr. rid wh.de\n(lrw* hirnrLlorhcrcl, orrhrct€hhi\ or hcr owtr e.',r.yc.!.
<br />Drovidcd th rsu.h inuotrrmnh m mr inrcn&lorolfcmd f(trsak ll h.qc\( rh- hil(lir8 or iDl0trtr cmnr i\ qlkl wirhin.nc lsir
<br />oi.arnvlcri{)n. rlt O$ncr auikk will hrv. rhr bur dcn of F,vir! rhar hc n \hc di{l Rn }irilll or irtn rt rhc pmri.ny lor lh. nury){ ol
<br />l. N owncr of rh. lnrdy. rn crclusilely .onlmdins {ilI liccn*d contr.bn n) .otr(nrcr rlt or,lcd (Scc ?041, 8u\ifts
<br />d tunbs\im Cslc -l'hc Gntrra.ttr s Li.cns. tjw do$ nor r!|]ly io nn orNr ot l)n)pc y who l,uilds or inrP.orcs rhercon.
<br />trtrd who.onr.$idsuchpmlshwirh0ConrEdq(\rliccnscdprFutrrrJrhcconlflcloisl,iccn\cLr*)
<br />I rNcrcnvr utrdcr Scdl
<br />Dsle: Ov.€r
<br />woRxECs{()M Pri\isal IoN
<br />DUCLABTII!}!
<br />I hcrc$y rffirnuodcr pcnalry of p.rlury onc oflhc follo*irE d.cl$iln,n\
<br />lh.vcaMwillmtrnrhtrCcniliclrcolCon\cnrroSclllnsorcnrr*orkcr'.on|xnsmiqr.arrelidcdlor6ysccrbnr7molthc
<br />Lhtr codc, ror ihd Frrommncc oflhc work i.r {hich lh. nlilnil n h\ucd
<br />,lh0vcand*illmrinrrinworkc^.on[.n\nri,ninsxrn.r..rEquindhyS(ti.n]71)0ofrh.IihorC{dc.n)rrhcncrfonrnnccor
<br />rhc *olt far wnicn rnh pcmir ir isrkd My*orkc6 .onDcn\nrnr nNumrccc{tricr anJ F lky ntmh.rdc:
<br />lrflrili rh.r i'r rhc NrbrN.c olrhc suk lbr rhi.h rhi\ nrnnir i\ n\uc,l. I nrll tr.r cnlPkJt rny t,crs.n ir rnt
<br />'nrtr0rrv, rsri hc.oaE nrhjcci hthc s.rkcr\ conrpci{ i(nr hsl.l (-rlifonrir. irligrcc rhnr i,I\houl,ll{conrc \uhlc.r!,rh.
<br />s.rlc co'np.n{ri{mpnin\ii)n\ofsdcri( 1701)ofrhc Lnlytr Gdc.l\ ll. n
<br />wARNIN(; F.rlurc tr) {curc solkr^ innp.tr\dn,n corcn!. i\ trn ,fr r, oimioat Pctrrtic\ rnd
<br />xl,..l rhnxlrl (lolL)'\ lSllrol11xrr i,xL]!lr nB!r\ r\ fnridrd litr rh.
<br />Ci)dc. irrcrc( rnd nrloflrcy s
<br />v L a$
<br />I hcEby nflirm undcr nc.alryolpcrjury rhrr I D'n li.t.scd und.r rroririon ofCh.ptcr q (conrm!.ing Birh S..rion 7Ul0) ol llivi\ion:l
<br />.f rhc atrsiftss md Pmfcsions Code. ard nry ltcne n in iull iorcc dxr crk.r
<br />'a/*dt
<br />CATIiIBIIqII1)NIENDIIQI! l.(I
<br />I h.rchtrfiir nndrr Mlryorp.rrythlrhcrcis0con\Dcrbnhndirgrgci.y|nrrhoNdonMrrcol'rhcrorkforshi.hrhirNnni!(
<br />tsucd (Scc l09l-Civ C )
<br />L.ndcls Nrmc
<br />-APPLICANT DECLARAT!ON
<br />I hc,$y nltm u nncr pcntrlryofpdrjurv onc orlhc rallowin! d(l.r0lions
<br />o.rrniin Pcnnils.ArhcsIo\ Norilicarion Fcdcral Rcauhrion\ (Tirl..tl), Pid6)
<br />Rcqrncd Lcrlcr ol NolifEarion
<br />I rc'iifyrhrr ih.lrdcrrlr+nliiions rcainlir! i\h.n.\ rc[]vrlrrc n.r r|dic$lc n) rhi! Inrccl
<br />-l
<br />ccdiiyrhal I hlvc rcrd rhtrpr li. (nni rid {rr( rhdrhc rhtrc inlnnn i, r i\ fl,tr.rr lx gre k,.otrllllywirh trll Ciryand cou!ry
<br />.rdimrcsud Shrc Lrw\ rclalilgn) huildi'rB.{
<br />rtar\c nrtrri(ftd lnoNrryli,r iN
<br />\prliunl !tr lArnt \irnrlur.
<br />-"-':,|:;;zurz,
<br />Set Backs
<br />Forms/31eel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq 6h3/R 2t<-/
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />l\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 1/Kls ^YtlCertilicate ot Occupancy
<br />Notes, Remarks, Etc
<br />l,r, fl \ \,Ih.-
<br />tt
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