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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER AUILDER DELCAR TION
<br />I hcrcby rrltfl undcr p.nrlly ol p.rjlry rh l m excmpl lron thc Contacr)u Li.cnsc Llw lor lhc fdlo*in8 reaa,tr (scc 70:l l 5
<br />Blsinc$ rnd Prof.st,n C,du): ny Cny or Coxtrrt whi.h rquiN r lEnnil lo con(toct. ollcr. inrt rovc, dc'fr,|i\h or rcpan .nJ
<br />d crud, priorb irs is\udn.c, also rcqutcsihc llplic l lor such pcnnil ro liLa sisncd drrcm lh,rtror shc is liccnscd puBuanl
<br />ro rnc !'ovisn,ns or thc Cofiadori Li.cnsd tiw {Ch,ptr 9. (i,hmcncing wnh Sc.rion 7t{)i) oI l)ivisn,n I oa rhc Busincs rnd
<br />PmrcsnNCodc).rlhrlh.orshcis.xcmplthcrcliom.ndthcb.shlorrhcallcscdcicmprio. AnyvnrarionolSccliorT0ll5byary
<br />.mlicrdlorr.rnn$bjccBrhc.pplicanrroacirilDcnal',ofnormoErhr6fiv.hundrcddollitr(Ssur).
<br />-1.
<br />r\ owncr olrhc prcFrtt. d nlydrnpkr)e\ wirh wnScs ns Ih.n enc (onrticnsrlion. willdo lht sork arxl rh. {tuturc i{ nol
<br />inrcrncd or ofrcr.d nr $rlc (S.\ 7(|1ll. lttrsi,rss .nd Profcsnnr Cdc Th. Cofrutr'\ I -i.dr l:'s d.cs nol lpl,ly lo .n osncr ol
<br />rnc pqrny $l!, bnilds or irnpn)vcs rhcr6,i, triJ wh' (llrs srh $r tnnsclforhc clf.rrltroughhi(orhcro$ncnrphyc.\.
<br />tbvidcd rhrr \u.h i'nltroK rnk rrcmr i ctrdcil.roff.rd f.r *,L lt hoscEi. rh. huilling or irpD\ enrnt is v,ldtirhi''ik )tr
<br />ofcon{kri(,n,rhrOwcrBuitldwillhrvcrhburdcndfln,liiArh!hcorshcdjdn,hriklorinuolrrhcpn,IoiyforrhclurrNol
<br />l.,\.wcrorrr'c!n)pcny.ancxclusivclyconractins*ilhli..Dscdcn ricitr\h..iiru.r rh. Pmtc.l lScc.7Or4- Ru\inr\\
<br />,lhi!$iqrCodc'lhcConrrxctn\l-iccn\cl-rsdoc\frnapplyt,rno*tr.rorlnor--^rry$hobuildsorin,prolcsrh.ruoi.
<br />and wh. .onrNh lm s!.hpmlcFwirhnCo mcu(n lrcnsd lunuanr rolhc(irnk kr's t-iccn\r tiq)
<br />I r'ncrcnrpr undcr S.di
<br />Osner:
<br />1!:AB&;B.lrlDltr;M :UUN
<br />DECLAATIIAN
<br />I h.rrhy rllnN rtu1., Nnrlrt ofNrtrrt,tu.1r)r lr)lk)(ir! d(l rrri.tr\
<br />-lhrvcmdsillminllin!CcnifEarcotCon\cnrroSelrlosrrcrorwoikcdcorpctrsrtion.as[ovidcdf(trhysNrion]7mol'h.kh.r codc. lor
<br />'h. lcrfornEmc ofrhc wor* lor which th. pc,nrir n nrusl
<br />*hi.hrhn mnnn n nscJ Mv$or
<br />U"\rorrr,l tir rA,tt 6rcqr rc.riri.r ifr1,roli.ynun,hr rd
<br />a k,l ,'/0z5t q L
<br />Iccniftrhrt irrhcp. oiirrtuc.lrhc sork rd whi.h rhi\ tc' rir r\nsuci.Ishnllrcrcrployntrypcrsnhn! rrtrtrcr
<br />s sl,, tr.orr srh]cd lorhcsork. (nnnctr$ nn, hrsor Crlinnnir. tr d4rcclh ifIsh.uld h(onrc suhJc.r ri, rhc
<br />sukcr((nnll.n\ri,rF,risio\.fSd.rn]7mofrhctlhnCod..I\h{ll.(onhwilhc.nDlyririrho$!r,vnn,n\
<br />WARNIN(; Iirilurc ki {.urc w.rkc col\rnrdior .ov.m!c i( trnhslul. rtrd shrl jcd rtr ci'tluy.r !, criDirtr p.trrlri.\ rnd
<br />.nil rn r. rI] r L/ ,'. hrntjm,Ls-'"- rir.,,r'l. r-,h"li"r
<br />"",", -1 !/.C lt
<br />co,nJrn\rrnr,. a r!r\ rs fr^iicn T,r rh.
<br />uuNsurrQNra !l!.B
<br />DECLI&!]U!
<br />I hcrchy afi.m undcr pcNhyofnerjuy rhd I r liltnsd urdcr !ft)li\nrn ofCn |nd9(connrcncinsrnhsLtrk,r70(x))o,Divhion.l
<br />ol rh.Bu\in s{ nd Prurcssi{nN Codc..id nry liccn{c is h tulltuiryJcflccr
<br />q7ffi:%(-t
<br />v
<br />AIILICANfDIiOAAATION
<br />I lmhy lfiim undcr prtrilly.frErjury onc of lhc lollowin8 dclaBrions:
<br />Dc x,lirion Pcrnrnl Asb.sos Nolincation l'cdcrrlRcAulalions('iirh,r0, Pan6r
<br />Rcquncd blrcr olNonfi caliotr
<br />, ccdiririd rhl icdcralr.suhrnn,s rcsrlins a\h.no\ rc'R,ulrr. ror aplli.rhrc l.'lhi\ froi'cl
<br />-l.cniirlnrl
<br />I hlvc rcad rhir appli.ain,n ,nd darclh,rdrrhr nrfoflnnr irnr nc.tr(l l trgrN k, conrrly wirh rU c ya
<br />hy durrxtrizc,cDr$.nrdivc\ qIlln
<br />.bovc m.rioncd DtuDcny tu in
<br />,\ppliutrl ur AArnl SiAn.l
<br />'"':;tL'//t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/lasonry
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif
<br />FINAL lhtt/tx'H//n/>/0-
<br />Certilicate ol Occupancy /
<br />Notes, Remarks , EtC.
<br />SITE.WORK
<br />Pool Fence
<br />CAXSIBIJqII()NIENDING.6CENII
<br />! hcrcby.lftm undcr Fnrllyoipcrjlrrrhlr rhcrc ha.ondtucrion hndinsalcnct lnlnc PcrtotftrrEc ol rhc *ork n whnhrhisPcnnil is
<br />i\sucd (Sc..1097, Civ. C.)
<br />I ctr,t,- \ Nr ,.
<br />F
<br />I
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