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BUILDING. INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.oWNER BUII-DER DELC E\AION
<br />I hcrchy arlnn undcr Nnrlly oi pcrjuy rhir I nr cxcnln io r rh. Co ncror'Liccnrc hw lorlhc lnlhwir8 rcnson lscc.7{):ll5
<br />Br\incn and Pnnisn,n Codc) Any City or Counry *nich rcqutcs ! IEnnir ro con{ocr. ahcr- i.rpoE- dcm,lnh or rcf^'n rny
<br />nru.rurc. pritrr' ir\ ,*u,n.c, rl\o rcqut rrhc ryplicrnr f{x uh pcmirk, filc r \igtud (rrcmnr rhar tr.r \hc k h.cn{d l[hurnr
<br />ro rhr p(,ri\ioN or rhc (:onr!.ttr\ l,iccn\cd ks (Charrq 9. Comnrencnr8 $irh Sccrirr ?0(x) ol Divhi{,n -l or rhc Busi',.$ rnd
<br />Pr.ttsidr Codc ) or rhd h.orshc h.r. rrrrhcr.liodr.dihchasi\larrh.rlLlcd.rcfipri,)n Anyvi(,hrionolSc.ri, 70ll.5byrn,
<br />rnplicanlnrrapcrnril$Ucctsrhc.!flicanlroa.rulpcn,kyornor'norcrhrtrftchundr.ddrtlir(S5(x))
<br />l. n\ o$n.r or rhc Jk,0.nr. orn,yrn,Ik,yBs +irhrvrgcsr\ rhcir slc conlncn\rn,n. qilllo ilEsorltr rlannf,rurunRtr
<br />ifctdL{ orollarcJnt{'lclsdT(xl.ausnrssnidPn't$i(nx(inlc:ThcContJcnn\l.'ccnyl-s ors nur aml)_ h it orrct of
<br />rhc nmFny sho htrild\ or irnpl.\c\ rhcto\nr. iD(lsln) doc\ {r[ *(trlr hnnsrllor hr^clfo' rhn)ugh hn or hcr own c.ll].)c.r.
<br />of.onplcri,,n. rlf,O*ncr Btrildcr *illhrrc rlf, htrrdcn olplovirB lh h:o!lhc did rn tdildor i'qrrovc rhc nn,J'xnl f(tr rhr purF)$of
<br />l.a\osmrofrh.pmpcnr.r'ncrclDsnclrconrracrine$irhliccnsdc.nrnbrt,.ondn'crrhcr(iccr(S..70:lt,Buni.s\
<br />rtri Pnna\sbn G)d.: Thc Conti.tr'r Li.cn\. tj* doN nor ipllr ro an orncr orpmFny *hi, build\ or nnprovcs rhurcon.
<br />anJ sho conklcl\ rhr suci rr+crr rilh ! C.tru{.tun, liLu{d lDrninr r, rh! Conrmtr\ Li.ctr\. trwi
<br />I rn ox.n,pi unJ.' S..ri,i
<br />-.
<br />B & PC lorl[i\ rctr{,n
<br />D.l. Oen.r "*ffiffi*
<br />I hcrcby rlfiflnundcr pemxyolp.riuryonc olfic rull.wins dNhr,rion\:
<br />Jhrvc fln wilL nminhin r Ccnili(orc .f C.nq r.Sclr-lNUrcrorwork.r'.ompcns0lion.ns pmvacdfort'ySslionl7(x)otlhc
<br />L4(l (h,lc. ro, hc n Nmrr"cllhrw.rl r.r trhi.hrhrFrrl i\ tr.dcJ
<br />E$Aclnd willmmh *ry1c6' . "n,!cn.rr Fn
<br />'n.umncc.
<br />r! icquircd by se.'l ion l70o ol thc Lil,r Codc. for lhc pcriorrucc ol
<br />ihc"qkfo."hthrhi,lormrra.urnvv*nrksitiFnrlr'otrrnlurRccorErlndIn'rynumtrrm./,..,",- fuz.m )lzzr,*lhrsq.sz/-cata2 /2-3/ ,/PU
<br />l rcnifr lht( in lh. p.rninn!n c.lrnc work ntr rhich rhis ncrnrir is 6Nc(l. l shnll nor cnrploy rtr) pcr{)n in $y firnNr
<br />s, rslotr.o.suhjc.rn,rh.workc co p.iMrt,n h*\olCrlili,rnir. rndtrlr.c(hrr ifl dhuld tf,c. r suhr,:.r rolhc
<br />wo*crr.o rlr $rn fR)vni.n( of Sc.rid lTlD ol rhc l;'hn (',x,r. I \lyll, lnn hlvnh c. ,Jny s ir h rlh{ f' oviuN
<br />\YARNIN(; Fainm ro $curc $ii,kcr' mmp.n\ariotr .ovfilc i{ nnl.cnrrlo)cr to qin nal Fnalries lnd
<br />ion. arogcs !\ polidcd fu ihccilil fincs ur lo onc hundrcd rhousnnd d.llars (
<br />S(1(nr.ll)la.llh.l.ilxtr(inlc. nr..nrndxn
<br />8.23-/Y
<br />Ih.rchy!lliorundcr |Enrllyolp(rjuryrhir I a licctr{d undcr |novisiotr ( hrlrr I) r..trtrn.ncir! \irh s..ri(n] Tlrl[)rol l)n r on ]
<br />oi rlE ltusinc$.trd Pmfcsion\Codc. and my liccnsc n nfulllar.cdtrdcllacr -,?4
<br />L -./
<br />I hetby Dflnmunncr pcndlry o t pcrjury (har rhcrc h & onsrNclion knding ascncy l'or rhc pcrlonEncc olric worr ror which lhi Frmil i\
<br />nsu.d (Src.109?. Civ C.).
<br />A!?UCA LDECLAMIIA!
<br />I tmbydlt rndrrncnalryof n(rjrry.nc.rrhcrbtlos,inrdc.hr!ri{nr:
<br />Demolirion Pcmirr Ash.srosN.rilicl ion fcdcBl RcEul i{n$(Iirlc4J.PM6)
<br />R.qtrncl lxrrcr ol Norincr!bn
<br />I.c'r'r) rl,xr rlr lc(lc.rl.c!L lnri,) \ r.g&lnr x\l{{o\ r.nntrrlrr tro( it,tlnrh[ k,1h \ tn,icrr
<br />l.cnil!rlrr I hd\cr. rhi\amli.rr( and rnn i\corNr I l8@ ro .onrlly snh rll Ciry ind Counry
<br />htri/crcprr*nrnnc\oirhi\CirrlndCo!trry!)c rduB rlr
<br />,^,"' E'g:E
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathing (d*lil- t Y?le /b,- -Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL ?l/oil f fvl/ln/ar / *-t
<br />Certilicate of Occupancy
<br />Notes, Remarks , Etc.
<br />COMMENTS
<br />w
<br />l.tr,lc' . \JJrcs
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