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G. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.
<br />-ENTS
<br />?2./t.t-;Set Backs i//,1 // /,->-
<br />a->t,..;AForms/Steel/Holdowns b/D /,,t 7>-=>
<br />Erection Pads
<br />SLAB Eloor.I laht r.4//r'.?D-'5) -/
<br />Roof Sheathinq /th ht 1 '*rttrz.
<br />/(r-c .?ry_
<br />D wall
<br />Shear Wall
<br />Framin
<br />lnsulation/Ene
<br />Ext./lnt. Lath bf>-/)d enerl+bz- 12.ro1 ^.,1Brown Coat rn'/a'.1,*fr'lA*zrl-/Y
<br />lt/laso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />l^
<br />FINAL
<br />Notes, Remarks, Etc
<br />/
<br />-,
<br />OWNER IIUII,DI.]R DII-CARA'TIoN
<br />I hc.cby rlifln undcr lcn Lry (,f pcriury rhlr I Jn.\rmnr lro rhc Contr d(tr l,icrr\c lrs l(, rlt Lllowilr3 rra$n(S.cToll5
<br />Bu\i'Es rfl Pn,fcsio CGlc)r Aty Ciry or Cot ry lhich r.qui'c\ r lf! ,ir t) ..i{nd. rlrcr. imDorc. Jc hlNh or l.l)rt rty
<br />PnLssioDsCodc)orihirl[orrhci\cxc,prrhcr.rionrndrhchr\islarrltrllclclcrc'nnii,)n A !vi(,l nrolSccrin,7o.1l5htr y
<br />rlplicrtrr l{lr r p.nnir suhJ.(s rhc nptlrrtrrb x.ivilND.hyul rxn nnnc rhrn llv. hundr.d (lollrr\ (15(x))
<br />l. as ow.cr oldc prolrny, or myemDk,yar *irh w!!.\ r\ rh.n soh.onltnn\alion. willdo rh. wo* md lhc nBlurc is nn
<br />inlcndcd orofcrcd ttrsrlc (se.?O,ll. Busincs d Pn,fc\rionr C ic 'l hc (onkrcttr s Lic.nsc tjs docs nor lPlly i. .n osncr oi
<br />rhc Dotcny wh. ililds or inpmws rhcrarn. ld who dms such tr.d hi \clrorhcr{ll'orrhn,ulhhisorhcro$ncmpk,vccs.
<br />pn,vtlcd rhrrsu.h improvcoEnh rc mr inrc'xlcd or olILRrl tu {lc.lt h.$cv.r. rhc bui[inA or imProrenrnr k $ *ithi',onr ta{
<br />or.o !rLr'on. rhc owncr BuikLr tr ill hlrc thc h{dcn or pmviq thd lt or lh- dil nor build or nrydt r lmlsy for rhc purtn{ or
<br />I. d\ own.r ofrhc prc|xny..flcrclusivclyconl,4lin-s sirh lic.d\cd .o.t,.tn s !) con{tucr ihc rbl.cr (se. ?i}r4. tsuntrc$
<br />lnd PDfssionCodc: Thc Co.rra.tr\ Li..nsd Lnw dm. n.t rt,tly x) osncr of pn,Ndy sho builds or nnpn*l
<br />'hcr.oi.and who.onka.hLisuch!,ojccrswithrConhclff(r)liccnsdrursuutrrhrhcConrrrctn\l-iccn{t:r)
<br />I d.rc'nDt u.dcr Sanon I &Pr lcrthhrcorn
<br />D . orner
<br />]IAatr[IN:lQrlflNs Ia!
<br />DECIAXAIIAN
<br />I hcrby rflnm uidr p.ndryoloduryonc olrhc n)lloqins d(hrrn,n\:
<br />I harr and qillnuinrainaCcnifrarcoICnns.nrt, S.lr.lnsur. fd uorkc6 .oml'.n\arion. ,s lrcvidcd i(tr bySNrtunlTUrofrh(
<br />ttrb.r Codc. for thc l)crforrorcc ol rhc *ork tur whi.h rhe p.mir i\ n\ucd
<br />I turcrnd sillmainrain *orkcr\. cotrD.nsarltnr iNtrmn(c. x. rrlrncd hvS.crNn l7(xroIrl,c I]horG c. tu!rlE tcrfonnrrccol
<br />rhc *ork forwhichrhis pci,nir is nsu.{l My*orkc^ co
<br />LLI
<br />9 ,cl r1
<br />l.cdifyrh.rirlhcFrlonmn.rofrhcworkfdwlrichrhi\Fnnirtrisugl.I\hrlltrr.Dk,yrnyNsoninotry mnrr
<br />$ asro brsrE shjcd t, rhc workcrs conDctrsotion hss olCilirffnir. and,srcc rh,t ilI \lnuld t .onr \!hF.r h rtE
<br />workri onD.nsaiion pr.vi{ons.fSc.rbn l7U)olrhc Lahor Oxlc.l\hrll n,nh*irh.onlrly *irh rh,{ prcli\i.trr.
<br />WARNIN(;: Failurc lo scuic *orkcr Nmpcnerion.o!dr!c is unh(lul. trd shrll {,hl.cr an . rll,rytr b riminJl Pcnrhi\ md
<br />r, otrc hrrdrcd rhou\rDJ tlolIr\ lS]ix).(xrl)r, r, l'dd lirr !, rlr' ..{ ol ('!'rpoi\ rrn. ditrnlcs r\ p(rii ,nr r[r
<br />s.criofl ltr76 ofrhc Lih.r Codc
<br />.rppri.u*V-06-5q=\<-gcarJa{
<br />t)(.C
<br />...,*"'..t.SsJ ic EtZ-&
<br />coNs't'Rt( lroN I.ITND|N(; .\(;rN( \'
<br />nsu.d (S( 1097. Civ C )
<br />A-sIucAlfDllO,/laAII0N
<br />I tErct ) lrinn unJs I.mlrt .t t.rlury o c ol drc &llosins dclllrr i('n\:
<br />DcNniri.n Pcrnrih Arhcdos Norificrrnr Fcilctul RcSnhriotrs (Iillc 41).1'rn6)
<br />-Rcqutcd
<br />lJllcrof Norili.nri,.
<br />l..nrfyrh[rhcfcdcralrcgtrlorionsruIrdi'rg \lrio\rc iivrlrrrnoli]rPLi.!hlct)rhi\ln(+cr
<br />d*'*"'.'r::Hrt*,',"'lr"r**l slxtr rhxr nr xh)rr i',l,trnnitnr \t.ir.(r IrArNrii.or|ly$irIrllCIy
<br />con{rucrion. ud hcrcby nurlbnzc rqrc\cnrtivcs ofrhi\ City rnd C.unryl'
<br />ih.r. rrnri,!rt,l I'olldy lnr r\lt.r(rl
<br />.\pDli.onl o. Asctrl Si$.lurr
<br />\ ti'ett<*+ll+|ZL
<br />eX -o (.w
<br />UFER Ground
<br />Subf loor/Vent/l nsulalion
<br />Certilicate ol Occupancv
<br />Ihcrcbyarnrmund.rr.nrlryofpcrjurylhnrl0Dlicetrslurcrp't,viq'otrofChoptcrI($nnEn.in!siihs.crt'n7o(xj)olDi!isionl
<br />ot rh Brsituss and PofcsiorN Codc. ond nry ltcnsc is in iull tlrcc utd .rfctr
<br />,"",aif _ o
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