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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG,COMMENTS
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />ngRoof Sheathi
<br />Shear Wall
<br />Framing
<br />lnsu lation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL 4t 'tqlt
<br />Certilicate of Occupancy
<br />Noles, Remarks, Etc
<br />OWNER BU I LDDR DEI,CARATI(}N
<br />I hcrct'y !flim undcr pcn0lry oa pcrjury ihar I !m crc'ry,r tmn rhc Conkrct)^- Lic.n{ Ijw fo. rhc lillowir8 rra$n (Sr.- 7011 s
<br />Bu\nr\\ ,nd Pmfclsion Cud.) Any Ciry or Coumy whi.h rcqun s r IE rir lo connrucl. ahcr. improvc. dc'mli$ or q*n xtt
<br />nd.turc. rrir t, i( i\sunn c.llso rcqtrncs rhcappli.nnr ior such lcnnit Io lilc a signed slaicnrnr lh"r hcorshc is liccnscd turflanr
<br />t' rhc prcvnn,n\ ol rlf, Conrracrorr l-iccn{d lrw (Chrpr.r 9. C.m'ncn.in8 wirh Scctiotr 7(x)0 of Divnion :} ol rhe Bu\incs ud
<br />Ptulcsli.ns C.d.) or rhar h..isht is.x.npr rhcrcrr.ntrnd rh. b,ns for lhc {llcecd cicmtlion Anyliolart,nolsd.ri,n' 7011.5 hymy
<br />,mli.a lnr aFrnri' suhjerslhc aplliconrro !civil pcElryoftror.nrcrhln fivc hlnd,cd dolldlS5(xr)
<br />llltl. ar owmr oa rtu nmpcny, or my.mpby..s wirh wasc\ r\ rhc r,lc .onrt nsdrion. pill d. lhc sork ffil rlE n nh@ i\ or
<br />idcndcd orofici.d lbr salc (Se ?O14. Busincs rnd Pr.icssions Codc lhcConB.t{tr\Liccn{liwdo.\n.rtprlyloano* cr.l
<br />rh. ImFny *ho hlil.h or i$imv6 rhcrmn. and who dms \uch $od hnns.lf or hcr\.ll or rhmuth hs or hs osn cnployce\.
<br />pn,vidcd rh0r such nnpmrn.nh $c nor inrcnldl or oilcrcd tu nrlc. ,t Msvcr. rhc hu illirB or inrpmrcrcn( is vrld wirhin om )t r
<br />ofcumtlcrion. rltO$nm Buiuj. willh]rc rh.l rd$ ol provin8rhlrh.or\hcdn frn hui&l or ioDm( rh.Ix,Fi, n, fi. pulitof
<br />-l.
<br />rsouftrofthc nolcny..ncx.lusntlyconrrclir8 with liccnrcdco racl.Fb.on\rrucr rhc pmF.r (Sc.. ?0.1,1. Busncs
<br />rnd Pft,r*sk n Codc TheContr{cr.acLicc.sdLtrsdo.s.orrpplyt,Mowkrofpror.rry*hobuildsorimprov€srhcrcon.
<br />and rho conlmch rbr such pr+ds sirh ! Conrrcr.(, liccnscd puruanr 6 rhc Cont&tr'\ Lk.n{ trr)
<br />-l
<br />hrvc 6nlwill nrn oin!CcnificorcofConsctrrroSclllNUrclor*ort6\crmncntlnrtr.fl\ pr.vid.d f(trbyScc.otr lTlrool thc
<br />bbd c.dr. ror rhc p$fornBn.. of lh. mrt for which r h! p.rnn is issucd.
<br />,lhrvcutrdwillnrn ain wortcm conDcn\ ion iflsurarcc. trs lcquircdhtSccri()n:l7lx)ofrh.LihorCodc,,orIh€Pcrfornumcot
<br />rhe Bork lor whichlhispen.il is nsucd. Mywo.kcn compcnslrion insuzncccrir mJ polky nunrh.rdc:
<br />C!ric,
<br />Policy Nnnlbcr:-Expins
<br />tf4cniry rrrar irr rrrc ncrrrnrR. ofrh. w ,t h, whi.h rhis Nflnir N isued. I shurrnoi cn,rro, rny |rc*on n dny nmnc,
<br />$ a!ro hlrom slb]c( ro rhe *o.lcF .-mFnsrioo laos.rCllilomh. dd rarc. rhrr irl \hiuld h..onE iubj.rl ro llx
<br />*orkcr'c.mtr.n\lrionIln,vhion\oiSccrio.]TllOofrhclrhrCodc,lshl.ldnhwilh.onrllywirhlhost'rorisnnF
<br />WARNING: Failuit h *.urc workcrr oryrn{rion .ovcagc i\ utrhwiil. lnd snrll lrn,ccl an cmrhrtr ro 6innn,l rf,n,lrir.nd
<br />.ivil lincs up kr onc hutrdrcd rhousrtrd dollss ($ltXJ.L$0). in addirio.lo tlrc co( ol com!.nsarnn,. dr rgcs !r proridcd li)r lhc
<br />SA1rl lrr?6oi rhc Lrh.r ( Glc.
<br />'n(crcn
<br />an,l Jnoirf,! " lN.;;",:\diiis - -' ;-;:*,W
<br />DECI,AXAIION
<br />I h.Nby oiltm undcr n nrlly of pcrjur) lhrr I dm ln-_n{d undcr lr()rision orCh pkr I (L\nmf,ncin8 qilh Sccrior 7uD) ofl)ivnnnl:l
<br />of rh. Busircssrnd Pmlcssions Codc. orxl my licc.sc n in tullntra d effsr
<br />gN$AUlUgllIENUNliJtliENlI
<br />! hcrcb, liround&Fnaxyorp.rjuryrharrh.rcis..o.sfl.Ii,.hndin8aEcncyrb,thcpcdbrmrnccofrhcwotkiirrwhichlhisJ).flniis
<br />isucd lsc. 1097,Civ. C )
<br />AIIIICAII.DECLANAIIQX
<br />I tmtry.rlinn undcr pcn.hy ofp.rjory ond ol rh. nllbwing de.'l,Bri,,ns
<br />D.mlilion Pcirnits.Ashcslos Nolilicoriotr Fcdcml Rcsuhliotrs (Tillc40, Pnn6)
<br />Rcquircd lxtr$of Notifi carhn
<br />_lc.nifyrhrr rhc fcd.fu I rcgu lnr ions rcBtrdin8 .lbcsos rcnrrv{l nrc nor Vplicnhlc Io lhh pmJccr.
<br />yll ccnityrhd I hove rcad rhis apdicarn,ned s[r har rhcuh)le i'rrorturio. is.orc.r In8lcchconrplytr h allc rrnd(irnry
<br />orlinanccslndSr!r.LlesEbrilsrohildinBcon{tocrn,n.e h.rchy srrhni2. rcpmcnr,rivcs ofrhh City md C.unryro cnrcr qron rlt
<br />$.1. rc trrd nr.Nr! r.r I , -
<br />appri.*r*,rs"n,si**,,* Yfil"k /V/d&J ^*.*-tuld
<br />P,m,,*mn.,prin,,: V-Ucfn /4aqJ
<br />15'211
<br />a
<br />Pool Fence
<br />I trnrc\cn'nr urdcr SRr'"n .B &PC tryt\i.'.rr,n
<br />o,'"' F- I 1 -t?,**,, ffi*(^$
<br />DICUAAIIgN
<br />I h.ruby rfllrm undcr Enalry ol Dcrjury orc oi dc ro owir8 dNlaftrio.s
<br />It--
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