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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE It!8.1,COMMENTS
<br />Set Backs a
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL ?-lo.l1 VllLil
<br />Certificate of Occupancy \_,/
<br />Notes, Remarks, Etc.
<br />I
<br />OWNER BU!T,DER DET,('ARATION
<br />I hd.t! .frm undct FEh) ol Fjur: lhi I m ddlpi fiom llE Colrr*16' La@ rr$ aor rlE folh*in3 r@n (SR 70ll 5
<br />It6u6! d ProfBnn C.<1, any Cn, or Cou.ny $ith r.qunB . Fni ro oldrud. rhc. inF.\e &tulah or EFir d) '
<br />ltodue Frnr ro irt i.!mc., .ho rcquiBlh. rppli.er for och Fnh lo lilc a sur.d nd.tel lhd h. or th. i! lic4.d puurd .
<br />ro rh. Folirr6 ot dE Corrrcr 's Licosd L,* (Ch4,rs 9. Conlffinr wnh S<rion ?0m ol Dn irion I of rlf Buin< od ' '
<br />t oldrnr Co<l.) or rhn lE or !E il.ranF lhG.fom,id !h. tEs lor rh. nks.d dopri,n AtryrbLlionofs..!n.70115 t'y D'
<br />.rpli@r aor ! Fmit ubjdlr rhr lpplicul to a ov il p.n.hy o I no! mo.. rhe ,iv. hu.tltcd d.llm (t500)
<br />6- "** r,*
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<br />d Bt 6phlG trnh *'.a6 s rlEit sk comFE&i'n. trnl d, dE *aI rd rrMEirmr
<br />'dod.d.rofrEdrtruk(S(7ol.4.Bu'BudP'nfdirs('od.:TrE('otrdortl-k.Mliwd.6rorprlyrosostuof
<br />th. rmpdy wlD tlildr o. inrFo!6 ttEo., 8rd whn drq 3u.h *nd himr.lr or h.Mlf or lhmqt tis or nr oM .dPloyc.
<br />F.\id..l rhd e.h mFrffts cmr had.d o.olEd [rik.lf. hon*s- tlE h'gnE d ot.rt,ffi ir $ld sirhin oE s
<br />ol corpkri4 rh.(\E E{itis *nl hn rl! hd6 otFri{ rhi t d th. dil d h{ild or rp.orr dE FlFl,v fu llt ti,F*6l
<br />l- 6.$6 orrE FFty. m dchln.b c6 r-rr8 $nh [.dE6l.odre6 to $ldrucl llE FojG! {s( 704.1. tkIs
<br />. Pi!ftss Cod.: Th. Co.kdoir Lico$ l,w dE nor qrl,y ro o .u6 or FoFrt * h. hdil& or ihpmvg lhEon.
<br />rnd sho .o rodr lo. $.h F.jds *hfi ! co 6.10(3) li.d.d puBur to lh. (\nrrtrloii U.oc l$)
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<br />I h(.by lmrn und( poahy of Fjury onE ofrh. n'llosinS d<lirarions
<br />I hrE td q,ill min.ia i C.n'a.r . ot Coen lo s.lf-lM. f- $dt6- 6nEdE ion. ! Fori,.d 16r!ysdrhn17mof'h.
<br />llbor Code for llE pdfoffi. of Oc srt ft, {t-h llt pann i t Ed
<br />I h*. ..d *ill Mini.i. *o 6 corF.Nlhn iNurffiG. s Equircd by S.clFn u00 olrrE tlb.r ( od., for lh. Ffolllle. ol
<br />rh. trGl for *nkh rtir Fni it &Ld My uortd o,p.rE hn i6utu. ffi nn pok, numbs r.
<br />tolict Nrmh.r r.!piB:
<br />.L!1.-,1 ,r', .,r,. p.r"@. orrh. *oll ro, *hkh rhn Fmr n isu.d. I ltdlnor nphy..yF$n m dny in@d
<br />l- $ 6ro b.roft tutld to th. (116'mmFMFn tl$ ofc.lifofria r.d isG rhd ill rlhuld hcom stlcl b llE
<br />| " 6' compdrqFn pm'inN ors.dnn tlOOorth. l.t$ C.d.. l !hn, f.nhl h mnplt srh thox rmrs'o6
<br />WARNIN(I lr.il[. h s- c (orkda compdion rovd*. k unlawful. dd shau 3ubjd o dpl.tr ro 6imi.!l Fmhi6 and
<br />&llc (llo0.0(x)). in lddhh. ro rh. cott of c.dFdion, .LN*6 a F.\idal ,o. lh.
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<br />I hftby rfltn und6 p€nolly o i psJury
<br />of rh.Irurffi dxl Profsn,N (od.-rd mr lkru ir n tull ({ft ed.ffd
<br />collralJCIlal.LEUDBGIG[Ncx
<br />I hqtUy .tfm urld Frxy ol Fpry thl lhs. i . mdMbn lEdin* isdl tor lh. Ft,lr1e. ottlE *dt ft't $ni{ lti! Frl ir
<br />isucd {56 1097.Civ. C ).
<br />APPLICAN T DECI-/IIATION
<br />I h!rb, lmm unnd pdrlr, of pdjlry on. of lh. aolb$ in8 dftlrd ionr
<br />l).noh nrn PoInlArtEl!, Notifiotion ll.<!aar R.suh i.n] ( I (1. .10. P.n6)
<br />R.q!trqj llrq otfxilifi.don
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<br />rEnc trE i,n d prop.ny fq i,EFlion
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<br />I
<br />Brown Coat
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