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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COIvIMEt{TS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />ngRoof Sheathi
<br />Shear Wall
<br />Fram in s
<br />lns u lation/E nerg y
<br />Drywall
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Qeputy Final Report
<br />Engineer Final Report
<br />-lNvFINAL/6/(/lB a\qc))
<br />Certificate ol Occu nc
<br />OWNER BU!!-DER UELCARA'II()N
<br />I &-r.hy aflinn und.r Fnnlry of pcrJury rhnr I nm cicmpr from rhc A'rracro^ l-iccn\e lnw nr thc followi.g r.r$n (Scc 70.115
<br />Businc$ and Proltssion airlc) Anv Ciry or cbunry *hi.h rcquiR\ r Frmn tu ..n{o.r, alrd. inrphrc. dcnti<h .r qrr Jtry
<br />{tucrtrrc. pri,r b irs issuincc. rho rcquncs rhc aJ,plicrd lnr \u.h p.rinirlo filc { riarcd nrlcnErr Ihal h."r shc is liccnrd puruir{
<br />ro rhc provnian\ ofrh. Conlraclols l-icctrsd tiw (Chlpr.r 9. comnrffinB lirh Scdi.n T(xn of Divnion 3 ollhc Burnrs and
<br />PnrrcsionsCodc)orrhlr lEorshc ncrcmpl rhcrcaromnnd lhcbasis lor rhe.llc3cd excryrion. A.yvioltrlionofSNri)n?0ll.5byrny
<br />nffli.rnt ro,aFmlir subjccG rh. rtplic,.l ro !cililpen!lllot.or morerhln filc hudrcddollur (S5(x))
<br />_1. rs owrcrolthc lrrolEny. or my.n[loyccs sith wag * rhct !ft oilpcnuior, willdo rlr ulf* orl rhe (81urc n mr
<br />inrc lul ordficrcd li,r qlc (Srr 704{. Bu\imssand lhfelsion\ Codc: lhc Gntrky r l-ic.f\c b*tucsmr rmltt,an.wrcrol
<br />rh.Pmrdy *ho huilds or i'nDn,rc! rh{]mn- dshodo.s$.hwofthnnscllorhcn.llorrhmuAhhkorhcrowncmnbyc.\.
<br />provnhd rh,r suc[ inDmvenEnh .rc nor inrcnd.d o ol]aEd for \rh lt hoscrer. r,r bliHing or innmEnrnr is skl s irl,in om ru
<br />oi conltlhthn. rh. OwNi auits will hrv. rll t ri.nofpovingrharhcordrdi] n huild or ifp.n\r rhc pr,p.ny for rh. tury)r.r
<br />Lrso$ncrofrlrnmpcny..nlck.lu\nTlyconkr.ri',9!irhlic.n\.Jcotua.brbcon{ru.rtlf,pmJc.r(SN7Or4,Bu\i"cs
<br />and h)lcssionCodc:lhcConxrcloisl-icc"rcLawdocsnorrn0lyrornowncrorn.oFny*nonuilds.rnnprcvc\rhcrcon.
<br />,nd who conrncr\ror ruchlrn+.* wirh rConrra.k(s)liccnsedpu^llnr rorhc(ronrrcrois l-kcn\c li,s)u\J t,t&
<br />DIa( t..Ut,\t t()\
<br />I hcrchy rlltm uidcr lcitrlrroi lf,rjur! oic ofrh tulk)sinE d.rhnri{in\:
<br />I hrlc ddsill mii nin!CcnifiqrcolcoisctrrroSclfln{mnIworkcfonpcnsrrion.$proeidcdfortryS.crn:17{X)o,rh.
<br />libor Codc- for lhc DerfolntrNc olrhc wolt ior which Ih. p.rnir is hsucd.
<br />rhc $.rk lnr trhichrlnr $n f rl rsucd l\Itr trork(r.. rt^-.nsrri(r in{trnir..nm.r r txni(yiu $crrr.
<br />-,ccniryrhll
<br />irlhcrcr,ornEnccolthc$oiklorwhichrhi(n nn is i$ucd. I shrll nor cDlnoy rtry p.r(nr inanynrnmr
<br />so rsn, h..onic \rhrc.r b rh. ktrkcn o rrcNrrii,n lawsol'Crlirornir. rn.llsrcc rhlrirl sl.i ld hcco,h \uhjd.r t, rh.
<br />woik${ ..mp.nv i,)n fR,vili,)nr .r Sccrn,n .17(X) of rhc hhr C{}dc. I sh3ll. Ln hsirh Rnnplr" with rk,{ povhio.\
<br />WARNINC foinrc r. scurc workcn' .onlllcn{r i(nr ovcher ir unlnwful. aml shrll hjer ur cn'nloycr ro 6imio pcMIri.s ond
<br />ciril lnrcs DI b.trc huodrcd rhotrsrfd S10(|.(DO). r tuldiliotr n) rhc co{ ot c.Drncns.rior donrg.s ,'\ pmvid.d kn rhc
<br />n,"' -08 Prlb
<br />CONIiIBIJCIIONIDIIIAIi]ICIAI:I
<br />I hcrcny afiiirnn cr Fnallyol ncrjuryrharIhc.ci..onsrtu.rion lcnding.Scncy tulhc pcrionnrrcc olrhcwork hr *hichlhn pcfl.i n
<br />ksucd (Sc.. 1097, Civ. C )
<br />d.S[Ul:ANIl)f,{:LABAI1a!
<br />llxr$ydtru cr Ftrihy oipcrju, onc ofthc n)llowire dcclrmrions
<br />Dcnk irn Pcrmir*Asb.n.s Norificrri,)n Fcd.hl Rcgrbrn,ns (Tirlc.l0, Pd6)
<br />Rcqxird Lcrlm orN.rlii.rrio.
<br />-l
<br />ccnilyrhar thc ltdcral.qulalions rcB{diry rsbrslos rcnrvrltrc nor lJrtlE.hh lo lhh pr*c!
<br />I r.'ilv rhrr I lhvc 'cdd rhn rt,tlrrridrud nrrcrl rrlrrnh,v. tr,lofln iol
<br />onlrrkc\ rtrd Srd.l.ns\rl ii! ri hu,l,lln! ..r{nLrri(nr. rRl h.rchyxunn,rc
<br />h .orc.i. I rFe ro .omlly e h all City rnd Outrly
<br />rEcan'd,cs olthr Orvnnd C.unry rn cntcr,unon rhc
<br />-,",,.olzzllea rrra.. nrlz
<br />ahivc k-. ncd pruIi.ny ntr ir\
<br />Applic nl or AxMt Si,:nx
<br />LCA I
<br />I
<br />Ext./lnt. Lath
<br />Flood Zone Certif .
<br />Notes, Remarks, Etc.I hcrhy nfirnondcr prnrlryofl.rjury rhnr I a'n li.{.r.d undcr rovhi.n ofChrnrcr I krmtuncin!
<br />.f rhc B!\i'rcs u{l Profrsi{r$C.dc. r d my liccnsc is ir ti'lltlrcc kBlcficcr
<br />Lic€trsc Clas:-Ltcns Numhcr:
<br />Dalq ConlEclo.
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