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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OlYNER BtII I,DER DELCARATI('N
<br />I h.rcby lllirm undcr p..Jlry of p.rjrry rhar I dckdnipi fmn, rhc C.nrr.ttr\'l-i.cnq bw for rhc Lln'wire rcrson lsccTollS
<br />Bu\nrss r l I'}rofcssn,n C.dc): Any Ciry or Counry wh{h rL\luncs i Frnil ro <'n{ruc1. alrcr. improvc. defr,li\h .r rpdn My
<br />srtu.rur., jnktr&r irs issrdn.c. rls. rcquncs lhcnptlr! lnr such Frnrir !o l]ler sisncd \rarcncnr rharhcor dr $ Ii..n\cd tunurnl
<br />ro rhc F.vi\i{ns of rhc Conrra.ror's l.i.c.i.d l-a* (Ch ptcr 9. Co nnrn irS wirh Scctir TUJO ol'Division I .f ihc Bu\i'rds rid
<br />Pdi\si,nrCodc) orru lrorshc iscxcmfl rhcrcfronr rhc hrsk lbr rhc rllcgcd cxcqnn'n Anyvi,'ltrri ofscrio.TlJ:ll5hyiny
<br />rptlicr tu i r.rni snhjslslhc apnlicrnl lo acivilrcnrllyol'nola!rcrhrr firc hndrtd doll,rs(S5(xr)
<br />_l-ar o*mrotrhcpn,pcny,or y r rb]tcs wirh w Ec\ rs rlrir $lc snr!.flsrr ion. will no rh. work ur dE nturm i. fr{
<br />nnc Ld or offcrcd fd slc I SN 7(}],{, Busircs 0nd I'rofc(\iotrs C.dc l hc Conlrirrois Liccnr ll* d{{s nor {trly ki r. owocr oi
<br />rhc Imncdy sho h{ilds or inrl,{,ks rhcNn. anl *ho drc\ skh Norl( him\clfor hcr*lfor rhNu8h his or hq ostr cnpk)tccs,
<br />p0vtlL{ rhnt such inpFv.nrnr\ r. ror inlcndd oftRl f.r *& ti ho*.rcr. rh. huihti.8 .r i,qlorc.EN s[1*ihi.om )tr
<br />ol c.tr\rcridr. thc Owtrcr Bnifus willlllvc tlrc hurd$ oilToviu rh4 hc or shc did tror huild or inpmvc rh.IniFny tur rhc purrN oi
<br />-l-0solncrolrhcptr'Ilcny.(rcxclusivelyconrr!.rin!siri,liccn\ed.ont(rrsr,.otrnrucrlhcnmicllsccT{}r:l.Bt\itu$Md h.its\i,nCodc Thc Conkd.lM\ Licensc L1E do.s not lptlylo !nowncrofp(,p(nyqho buildror improlts rircrc.n.
<br />itul sho.ortmdsforsuchpreiclswirh!CodBcknri)liccnsedpusranrrorh.(hntacroasLiccn*tj*)
<br />I.'nr.knrd undcr Sccurn .t &PC f"rr'ri.rrL.n
<br />D.lcr O*ner: -wonxFraiaoMPF.Ns rmN
<br />I}&CLASAIION
<br />I hcrchy,flirm undcr pcnaltyoln rju.y ore ofihc loln,wirB dNlarart,ns:
<br />Ihnvrmdwillr inrlincCcnifrcorcofconscnthSclltNurcfor$ortc^ lanrp.i\ario!as pnrvklcd fd by Sd ion l7(x) ol rhc
<br />lalxr C{i.. lu rhc p.rf.rmncc or lhc work lor uhi.h rhc !.rnn is issucd
<br />rhc sor k lir shi.[ lhir ll.mir i\ i$!cd Mt *qkcrr .omtrtr\ri id iNurM( . Eicr r k] Nlry nunrhs { c:
<br />l.rnify rhrr ii rh. |[fonu..c ofrhc *ork Lr which rhis t rnrir is i\u.d. I \hxll nor c'nph! dtry fc^on nr any nrntrn.r
<br />\J 11 b tf,nrrc suhjccr ro rhc *orkc6 .o'npcnsri i{nr hs\ .l Crliftmir. rid +ru. ihrr i, l s[iukl B<o t uhjld k, rh.
<br />workcr\ conrp..snrl.n Ircvi\i{)ns ol Sccriotr.17(xlolrhc l.rhn Codc.l shrll. tunhNirh ...l.ly wiri rhortrcvi\i{nrs
<br />sc.rnr 1076oflhc Latrn O,lc. irlcrcn lndlllonEy \ l'.c\G-^--l*?-/-tt no,,,-,,W,,
<br />I hcrcb, alirm undcr ncoahyofpcrjxry rhnr Lm lie.{n undcr l"o}ision ofChoprcr q (odrceins wnh s..rion ?uJO) ofDivni$ 3
<br />ol' rhc BusirEss and Pmlcssions Codc. ad my liccnsc h in alll rucd md cfter
<br />&-/-tt ,""rr".r., kl//r-G,"*--/r.-
<br />(ANSIBI]CIIONIENDIN(;rIIiIJN.(I
<br />lsucd (S.. .1097. Civ C )
<br />t trd.i\ Addrcss
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<br />_l ccnirr rhrr rh. rcdcal icBularions egaxtinB rshcskx rcmv.larc nor rpplicairlc ro ihir Pn&.r.
<br />-l
<br />ccniattharI h.rc rcad lhisuppli.arionsrxlitrr.rhd rhcah,vc inbnn tun i\ conccr. I ngrc ro cotrDly wirh rllCiry.nd Counry
<br />ordinuccs!M Sraret ws Elaring t, building ..trifl.r i([ rx] hcrby.uthorizc rclrc{nrarivc\ ofrhn Ciry dnd counry ro etrrcr uF).lhc^i*I"i:"Tri,ilYW u.," I -, - t t
<br />pemr,e Mm.,p.in,l: uJ-[/ rlo '-, le Ba A-.t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venl/lnsulation
<br />Roof Sheathino Y $\rQ /(l4nPt .{b)
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL ;b6x
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />Pool Fence
<br />Flood Zone Certil.
<br />AIELII;ANLDECLAEAtrA!
<br />I hcr.$y onim undcr penalry Drpcrjxry onc orrhc rollowin8 dd.lnnrions:
<br />DcDnnirion Pcnnirs Ashcios Norifi.rrion Fcd.rnlR.suldrtrn\ lTirlc 40. Prn6r
<br />-Rcqund
<br />L.tts ol Noril-rcari{tr'
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