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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNDT AUILDER DEI,CA RATION
<br />Ihcrcbyrinru cr pcndry ()l perjury rhul I a cxcnrprtmmrhcConk,cttr{Licctr*ljwlorlhcli'|I,,$irsrcrRnr(scc70:ll5
<br />Iiusincs lnn lhfc$ion Codc): Any Ciry or Counry which rcqunct , l},irnir ro .otrNn(, rhcr. nnPiovc. dcnml$ or rcPrt M,
<br />{ncru.. prnr tu i( i\\xrh.c. rlso rcquncs rhc dprli.! lnr su.h pcnnit ro lile! siSncd {rrc,h r rhd hcor shc n liccnscd iUFUML
<br />ro lhc pnlnn)ns oi lhc Conlracxtr s l-i...*d ljw (Chrpr$ 9. Co.nndminE wirh Scction ?UX, oi Di!ti(,n .l ofrhc ausi|rss .nd
<br />Pnra\\i(,r\ Co.L) orrhar h.or\hc i(cxcmpr rhcrclmrrkl rhe hr\k l'or rlrc nllcgcd crcnDrion Any vt,hrnr ol sario ?tr:ll5hy!ny
<br />rpplic.d lorrlcann suhjcchlhc rprlicanr ro acivilrcnallyolnolnxrcrhrn fivc lru.drcd dollrs (S5uD
<br />-1.
<br />as osDcr ol rhe popcdy, or m, c Dk,yc.s sirh srSc\ N rhcir sk cm|rnsalion. *ill do lhc sork rxl $. stMIur i{ nol
<br />nr.ndcd or oficicd ror elc (s(.7(}14. ausircss a hons ,ns Co{c: 'llc Qn r.cr.r'r l-(nsc ti$ dds n.l 4l,ly ro an o*mr or
<br />rtu popcny shn l,uild\ or irryrows rhcd,n. rJxl who dds such wort hrnrclfor hcrslfor rhou8h hn ot hcr o*ncdpk'rccs.
<br />,iovidcd rhd rh inpnrvcrEnls aa nor i cndcd oroficrcd aor sb. ll n.wcru, rh. buikli4 or nr$olc .trr is $ll wirh ca. )[{
<br />olc.Dplcrion- rhc Osrc! Builds willhrv. rl[ burd.n ol pNvirS rhd h. or shc did rct hrild or irrjrmw rh. tbpcny for rhc l)u.I.t ol
<br />l.asosn.rofrhepft,tdy.inrcr.lusivcly.ontrrri,rtswirhliccnscdc.nrrrtorbcon{tucrrhcproj..r(Se701-1.Busincs
<br />rnd thlcsir (.odc: Thc Ginrracror's l-ic.nsc kw d..s tr6r aprly ro rtr oqnrr olpmpcny wio huilds or impmvcs rhc.con.
<br />J d Ih o rn.,(.'su(nn.F(r\lnh. (.n,,,d.,'.i lihrr.crr nl'yqr r,],lq.,,nL.. tr, '1trctr'ct-'s'
<br />,n,.\c nI undcr\N nn t orlz ut [;,1,!-',it,,P
<br />,,","8,tp- r6 -2.">roBrE&rraMurNlallltN
<br />I'ECIAXAIIQN
<br />I lrrcbyrflir utrdcr pcMltyollcrjuryom olrh. nnhwi',s dc.lurrrnn'r
<br />-l
<br />harc ul will nEinrli'r a Ccdifrnrc .f ctnrk r b S.ll li\ur. for so.ken .onDen\ltion- N pmlid.d r(t bySccrion]?0Ool'rhc
<br />tntn Cqlc.lar rhc pcdornurncc oirhc work lit *hi.hrhct nnn t issucd
<br />r hc *orl li,r *hich rhis p.rn,ir i\ nsuL{ M y w.rklJi (nnFi\rr i(nr muriNc .rir icr aRl }i li.y numhLr ec:
<br />l.cn'fyrhrr nrrhc trcrli)[mNcol rhc trork lor *h]chthn t^-nnir n i\stcd,I \h3ll orcnll,loi_ rnyp!rvr in any nrr rcr
<br />v) sroh.qnrE Nhjccl h lhc $orkcr( mn,r.nvri{'n h*\ of CJlif{triii, rn r!ruc rlrrill lh'trl(lhcluf, \uhad rorl{
<br />$orkerl conrnctrlirtr pn)isn,ns ofScclnni.lT(X) olrhc tjtrr C.dc.l arll.l,)nh$irh.dmnly { h rho\. pr.r$ions.
<br />WARNIN(;: Frilu'. t, {.nrc w.rkc6 .nnDcrsrridr co\crU. is utrhstul. rnd \hrll lir.i r| c'nfbycr io cri'niDrlP. lric\ rnd
<br />civil fitrc\ uf n) onc humlrcd rlnrus0nd do
<br />Sern,n 1076 ofrh. Lrbor Codc. imeEsl {od
<br />,,,,"t $ - Q-o .18 n
<br />in sldirtrn n) rh .o{ .f.otrrrrnsirioo. da uEcs !\ pr'lidcd for rh.r'+6.fnVLo
<br />I tclrNstr) (rt\1ttA( 'll)tt
<br />Dltcrtltttl()r
<br />Incrcbyafiirrundcrpcnlllyolri.rju.yrhar I rn li.{ kllidcrprovisio!oICh.prct9(connEncinB*irhsc.riotr?fix))olDivisirrl
<br />oi rhc aurnc$.nd Pmlcsions Codc,,J nylicen* n ii roll nn(,xlcrc.r.
<br />IONIIB!!:UONIENDINIi.ICENI1
<br />I hcnh, amrtu undcr FMlty of p.rlury rhlr rhcrc is a.onnddi('n b ing llAcNy lnr rh. r.rLnrun.. of rhc work for shth rhis Il.rrir i\
<br />nrued lscc -l0r)7,Cir. C )
<br />APPI I(:ANT DTCI \IIAI-ION
<br />t hcrct y rnn,n uRlcr p.nrlrt ol I{rlury onc.frlrc hllo*irE d..liririotrs
<br />l)cn{'lirion Pcrnrirs Arbcdo\ Norifi.dnnr lrcdcrdl Rcguhror (1ir|c,10. P.n6)
<br />Rcquncd lf, rrcr of Norill.rri,n
<br />l.cnilirhd rh. lidcnl rcSuIrioN 'rSirJing r\]f,nos rcnnivrl xrc or itPLi.xhlc h rht tr.lttr
<br />idnrnnli,n, i\.omrr lrsrccn).onuy{irhrllCiryrnJ(-,,unry
<br />hy rh.rizc.crrcscnr ri!c\.f rhtrtyLnd Counlyx,c cruFrrrhL
<br />I ccnilyrhri I hale r.adrht ppli.drir did $rc rhdrhc dtxtrc
<br />,{Jn ac. JnJSrr.ljvUcL'rirEr.thdiUi'rs,'{ri,d.':..$Jh c
<br />rh*c 'tun,r{rd lnn n\ rn tr'.r@- n,,n"*.J{|lpli.onl or
<br />^s.nl
<br />sismlumzz.
<br />"*-u* ^ ",nn^,.4 Lor ,, t o E7,^/ -'g-ro , t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\rlason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />.A\
<br />FINAL X-22-lK ytt6u
<br />Certif icate ol Occupancy U
<br />Notes, Remarks, Etc.
<br />SITE.WOBK
<br />tJndcr'. \onrc
<br />lxr.L''' \ lIL -
<br />SLAB Floor
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