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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE I IDiSIG.COMMENTS OWNER BUILDER T}ELCARATION
<br />I hclcby ailrnr undcr pcnrh, ol pcdury rhlr I m excmpl from rh. C{,ntado^' Ltcnsc tiw f(tr rhc rbllo*ing rcasnr (s(?l):1115
<br />Busincs flrn Pmfcssion Codc): Any Ciry or Cou', which r.qxirc\ r ,.rnril lo .onsIrucl. altcr. inrprxt. dcnoli{h nr rqhn uiy
<br />dtu.rric. lritr ro irs i\sua(o. dl$ squircsthc applicr lbr su.h pcnnirto iih u \igrcJ e c,tutrr rhai h..r sh. is liccnsd Duisu0nl
<br />ro rhc pmvi\hns ofrhc Conrr.roa\ l-i.cnsd tiw (Chrrrd 9, Comrnctrcins wnh Sc.lio! ?OOO ol Dili\ion I of lh. Au$ncrs and
<br />Pofcs\i.nsCodc)orlhrrh.orshcncxemalrhcrcfromandrhcb!\hforrh.Jks.dcxonprnr!.AntriolalionofSccli,,tr?0.ll5hyany
<br />ltplic rfttrrpcn.irsibj(*rh.amli..nrroacivilp.n.lryorormorclhatrlivchundrcddollnrs5m)
<br />l.$.wncrrirlrl]n),)crty.ortrrycnrpl(Dccs*irhsrscs!slhcirv,h.onlldistrtr .Billdorhcrvork d llEnMlurc i\ nor
<br />trcndcd oro0crcd li)r $lc (S( 71!.,r. Bxri.cs hd Pnnasi('n\ Codcr Thc Conna.tois l,iccnse l,a* do.\ norlmly b !n.qkrol
<br />rhc lrnJFny wh. t{ilds or iirrre\q rh.rcn.ond who dfts such work hinrcllor hcrclror rltrotsh hn or hrr owfl cnrth}t$.
<br />nrovidcd rhrr such irnprovcnEnr\ uc ft,r i.rctrdcd or olltEd lor rrlc Il hosclci rh. tDikliis or i'1v'ovcnEN t nild wirhi', otrc )utr
<br />of..trDldir,. rh Oumr BuilJcr qillhavc lh. tilrdcn ol'florir8 (llln hc or \hc Jid nor hxild or i'nProvc rhc nmtisly lor rhc Pu'Ix,eol'
<br />-1. "\oNncr ofrhc ptuI4ny. ar.rclusivcly.otuaclirle wirh li.cn$d conrmclon b con{ru.r rhc floFr lSc.. ?Ol-1. Bu\i'Er\
<br />.M Pnrssrn Codc: Thc Conlrdois Liccnsc La* docs.olaDnly b !no*ncr or l()r.dy who huilds or inl)ro\ct rhqcon,
<br />ind ,ho conrrudi nn such roj.{h snh ! Conrtoct,(s) liccnsd fuNurtrl torhc ('onlnrlo s Liccnsc hw)
<br />-l
<br />ancxenrpr uoder Secrion
<br />iraB(!x5tcoM8[Nsa.r]o!
<br />I hcrcby,riirm uktcr pcmltyolp"'j,.y on" nrrh" rntl,*hglffiil*3s
<br />lfr r"* ,nu *, rr n*.t, u C"nr licorc ol Concnr h S.lt l.surc lor wortm .!mptn$rn,n. as ,mvidcd lor by Sccrn,n :r7u, ur rhc
<br />hbor Gxlc, ror r hc p.rformncc ol lhc wort for which lhc n rorit h isslcd.
<br />,l hivcn"du'illnuinrain *o.kcF cnmtf,.\ tun i.rnr!i.., r\ 6qxnL{ hy sccr iM l70o of rhc l-Itn{ Gde, ntr rhc P.rrormrcc of
<br />rhc work lor whth thhFnnir is is{cd Myworkc^ co'nP.trqdnnr nrurnn c cndcr ffdt'olty nnm$..m.
<br />Iua Cn )n0r>
<br />I.cnifyrlrrir,trpcrloflMtrrc.lrhcw.rklorshichlhnNrmir i\ i\!ocd.I nrlltror cqtoy.ny Pct\on h!n,nBnncr
<br />s s r() hcconrc \'hrcr r,) rhc *ork.B'..'nruis lio lasofCrlinrtria.rM.8rccrhoriiIsh.uldtrc.nrsubj..rrorlk
<br />sork.6 oDr|Itrs3r ion pn)vir ni of Sd nnr :1700 ol rh. tjtxtr Codc. I (hr ll. lbrrh* irh conDl, wirh rh.{ ,n)visds
<br />W\nNlNG I'rilurc Io krurc Boricr conrpcnsdnu covcrlgc is tnh\efol. rnd shxll subi..r ,r) cnrllorr n' mnii'rl If,Dlri\ r d
<br />.ivil inr.sunn)Dmlrndrcdlhousinddollnn($|U)-UX))-i.rddiri.nk,rhcc.nof.omFn\nli(.d0nrlcsa\FrvnhJturrh.";:;::,{#ri:.
<br />L](INI!LS]}! ts]]-I1]!!
<br />DECIASAIION
<br />I hcrchy dmrfl und.r p.nllryofrcrjurylhar I om liensn undcr pmvnio. ofChaFlcr 9 (commftinE sith Se-'rhn 7m0).rDivhioi l
<br />ol rhc Brsincs rnd Phf.$ions Cod...Jld my licnsc ( nr tull ior.c nxlcflccl
<br />Z c/-c)
<br />con(redor )<
<br />CAX,SIBIJCIIOI{I.EIDIIC.ACENCI
<br />Ihcrchyoffinnundcr!€nlltyofpcrj!ryrh rhdeirrcoNr crion Lnding r8cncy lor lns p€riotmn corrhcw.rkrilrahichlhhpcntr[ n
<br />issucd (sN.l09r.ci!. c ).
<br />AIILICANLDEIIIAAIION
<br />I [EEL, afllm ututrr Fnnky of pcqury oN ol rhc followinB dcclnr ions
<br />Dcn'lin,n lcrmik Ashcit.s N.rin.rrion F.d.nl RcBUl ions lTnlc40, Pan6)
<br />-Req!tcd
<br />llrrer.t Norif@ri,,o
<br />I cc'rifyrlrrrh.fcdchlrceulrliors rc3fldin3!sb!\r.srcmovrl!r. ror rp!licrhlc ro rhi\ t)tuiNr
<br />ff*:lrl**r;;l*r;yr:
<br />rt !c truind tn,pcnylor iNpcct
<br />Appliclnl or AA.nl SiSnolnre:L
<br />i(rnrr {rrc rharrltr ihnc rJorunri,{ ir c.trccr I!!rsro
<br />b0ildin! con{ru.rn,n. nnd hcRbtrlrnnzc rcDr$c ilir.\ oi r
<br />comdy wirh rU Cnrand Coutrry
<br />hn Ciry rftl (nunry ricnr$ uF,n rhc
<br />,^,".11ty
<br />Set Backs ,
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorvenVlnsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt- Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL
<br />Cerlif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />z-lL
<br />,r,"', g:q ,,l./Ll-
<br />tJn'j.''\ Addrs'-
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