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BUILDING- INSPECTOR RECOBD
<br />SITE-WORK ID/SIG.COMMENTS OWNER IIUILI'ER DEI-('ARNTIo\
<br />I hc,chy dfllr,n untlc, rEnalry or n"lu,y rr,u, r ,n ".",,pr r,ll"li. o-",.,"^:i,.",* 1"" io! rhc rorh,lms rcrl (sdc?o.r|5
<br />Bu\inc$ ind ttoic$iur Co,lc) ny ciry or Coufly q hi.h rcqunc\ | Ntnril ro cor(rucr. rlrcr. i'npiuv.. d..$li\h or rqxn $ri
<br />srru.rutu, pri,tr r. irs i\ru,trcc.olso rqlunes lhc oi,Dlic. lorsu.h pcrmir h fih tr sisncd ndcnE r rhd hcor shc k liccn\.d lr!.q3nr
<br />ro rhc r.vnions olrhc Conracro.\ Li..nscd tf,w lchnrr$ 9, aomncncins sirh Sccri()n ?U.x) or Divhn,n I ofrhc ausincs! ond
<br />Pmr.ssi,,nsCodc)o'lhrth.orshc$excnDllhcrclromandlhcbnsislurhc{llcEc,lcrcnl|nrn!.Anyviol0lionolSccrbnT0.llSbyrny
<br />aprli..nrlorrpcnnirsubjccFrhc.I)pliclnihrcivilpcnrllyolnormncrhi0llvchutrdrcddollds(SslDr
<br />_1.r\ o*ncrofrh. lr.Fny.or mycnr ot$r wirh B.scs rs rhct $lc cotrrp.trsarion. *ill do rh] $r)* dd rhc sndurc h n,
<br />i .id.d orollcrcd lor srlc (Sa ?(}44.llusincs lnd Profcsi{,ns C.ds Thc C.trhn t s Li.cnsc ljwlocs nollPply t,,i oqmror
<br />rhc pmf.nl *hl bxilJs or inpmvcs rlrh'i. md stx, dd\ rxch k)rk hinscllor h.Kellor rnrough hk or hcr orvn cntfloycc\.
<br />Dovidcd rhrr such inunn$Ed s ar. ml i.rcn,lcJ or otti' ci Lr sl. lll howcv( tll. l,tildi'r! d i'nPovc rrr is nnd wirhirr oDc Jsr
<br />olror{lLriJn. il.O*trdr Bu, d willh0E rnchrdctrofpmri.Blhd h.orshcdil nor buiklorimpok Lt pmldy fitr rh. nuqnc.i
<br />_1.aso*ncrol'rhcFrcny.,.\.hsiv.ly..nta..ngsnhli.crscdconrrlcronrocon\rrucrrtf,pf,*.r1S...7(x-,1.Ilu{n$
<br />rkl Pmllrsi Codc Thc Conrrrcloi s l,iccnsc Low doc( nor amlr b rn o$ncr or n(,lc y wh. bunds or imfr)ves ihcrcon,
<br />and $ho.ontscr\f{trsuchpn,FC(wirhaL]t n.lo(srl,.crscd ftrnurnr torhc(i)!tr.r{n \ l-ic.n\d bw).
<br />I a crcnrrr x d.r Sc.hotr
<br />lrcaxJi&trauP[Nsi:IlaN
<br />DE(I.AA rIO!
<br />I hcrciy iliiro trndcr |EDrlry olpcrjury om olrhc i,llowin8 dc.hrrri(f,s:
<br />-lhnvconlwillnrainiaintrCcnificrrcorCon\cDrhSclfln\xrcfortr.rtcFcomEtrsrriur.$prcviJ.dturbySccriotr:17(X)oirhcttrhor O)dc.lir rh. pcrionrEnccoilhc *olt n, trhichrhc pcrnrir is t\u.d
<br />I lr\r rtr(l tr'lLn'ridxi', "rrlor $y Sccr bn l7ll0 of rh. l.rhor (.odc. lor thc pcrfomHE ol
<br />r.ccrtrir xlFlicyiunrh.rdc:
<br />.i.,"::-uu y'-uiiiul x^i;;u'"'t c 4lt/ttl^)Lloo i?
<br />I ccnily rhrr in rhc p.rfonmrc oithc work for q'hich rhn tcrnrir i\ i\\ucJ. I \h.ll tror.mPloy rny Dcron in !n, nMn.r
<br />$ Nti hcqnm subjed b lnc $orftcs.onT.isari.n lds\ of c,lif.nri{ ind 33reclhar ii Ishould tEcotu suhrdr h rhc
<br />*orkcn conlP.n\lri.ntmlkbn\ ofS(riotr 3700olrhc Litxtr Codc.lshtrll. fonh*irh conlply airhrhut lhvni(ins
<br />W RNINC: Ftulurc ro sure workcn compctrsarn,n covcBlc n dnL*rul. ,nd shrll subjcd otr cnlrlorcr t' di rinrl ltn.lrics.|d
<br />.ivil nms uf Io onc hu.drcd rhousa dDlhr\ (Slm.(XJO)- tr' rd'1trtrn' r, rhc ron nlcunrDcnrrln,n. drn'r!c\ rs lmvidcd ior lhc
<br />o.l
<br />,",", - 1L!4 ^0n,,,-,7/!/r Llcl \sflr ( (rNrR^( T(rR
<br />D!T(:t ARATION
<br />I lrrhyumrn uklcr F-.nrlr, ol r,.rjury rhar I !D li..nwl undc! provisii ofChrtrcr q l.onnmmin8 rnh Sccri,h 7fix) ) .l Division :1
<br />of rhc Bu\incs ud Pn,rdsi.rsCodc. d nyliccne h ir tirlllnrcc oBtr,r.cr
<br />(.). qqlGLI
<br />ilL
<br />CONS RUCTION I FNDIN(; (;ENCI
<br />Ih.rchyrlfinnunncrr.nrlryorpcrjuDrlrrrhcrcisao(tucrionknli.!rsen.yl.rrhcr^-rroraum.corrh.sork(tr!hichrhi\Pcnni(i\
<br />issucd isc. 1097. Ci\ C ).
<br />l-rndcr: N nr
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<br />AIfUlAlfDliCLirXAIIllN
<br />,hftyrmnnun.rl)e aktorFluryoNolrhcn bEinsdahrnrionr
<br />Dcmliriotr Pcrnrits A$cnos Norilicarn,n F.dcril Rdguhrn N (Titlc4tr, tim6)
<br />-Rcquncd
<br />t,ller of Norifi cdbn
<br />_ l,d'l)rhJrrh'h'Jflalr4ulJrin.rccdJ'nSr.hor.\rcni'!Jlo'cn,.'It'k.'hl.r.rhhtr.lcrr
<br />V lccnriyrhdrlh0\crcndrhi\drrnlrr,,nrnJ{rrrrhrrrhcrh*ci'rfonrnrl{{hcotrccl loarccroco,nflysirhallCilyandCo!nly
<br />orditunccsand st{rc Lawsrelarinak' huildinc.oi\rfl.rbn. xnd hcrclryrurllnircrcrrcsc arilcsollhhCiryrndCountytucnrsutnrlhc
<br />hrc if,nr'otuJ !n)fc{t,or iNpNri0
<br />Applicxnt orAa.nl SiAtr urc
<br />I'rntrile( nan,c(Drinl): K 6,9 ,r)U"r/r1A
<br />7/"-/u
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Cenif
<br />1
<br />FINAL I ?lnhv F "/Ylnfh-finr-
<br />Certif icate ol Occupancy vLL't' -
<br />Notes, Remarks, Etc
<br />DATE
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