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BUILDIN^'i.IIjPECTOR RECOBD
<br />COMME OW ET BUTLDI,T DEI.C T TION
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<br />Ih,l.*on\ C{i].)orrtur ltorsh. F c(cnlPr (henon .fij rhc hrnr l,*rhc.lh!.i.r.m0i'n Any v!,hruol S&rDn 70:ll5 by
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<br />lr)!il.d rhd !x(h mI()Em s e mr d.flLJ or oddd fd lrk ll, lberwi rtr ho rlh3 or arn,Enrd R $L! *ihm or y.{
<br />or coq'btM, lh. owmr Bu &r will hlt llr hlnLn ol pmqs rh,r lr or th. diJ tur hux or unPn'w rh. PoFny lor rtE puqr,: of
<br />WORI(ERS' ('ITMPr'NSATION
<br />DECL TAAION
<br />I h.Ehy.fins lnlcr FElyofF lrlry ox ol rh. fr hwm8 &.Lr.ri)n(
<br />I hrv. .rl wrll mlnhn . Ccnlr*.lc d( (i'nr.r !' S.ltllsuE f!tr k'rl6' .ori{'cndr'.. r! FUvddl for hy Ssl$n 1700 ol rrE
<br />Iih* Cdt . for th. Fnolrl1f. oltl: qf,t n, wh.h rh. Fmn E Ftu&l
<br />_1..n'lyrhar 'h
<br />rhc Frtuimtuc ol rh. edrk ttr whtrh rhr lErnn 6 r\uo.l, I \hall ftn cnDl,'y.ny pcR,n r lny mdrr
<br />$ s lo hc$fl* \unjd 1,,lhc workrs .on,l,.n\inn uus ol ClLnnE, ,n,l ,!Rc rhar fI \h,uLt h.$m uhjcn n, rlE
<br />worlcn comlEnr tr)n Jlnrrtr$ns ol Sarin 17(X) ol r h. lillr Cni.. l rhlll, nfhrilh $mply sdh rhrc lnvtrBnr
<br />WARNNG: F,,lur. n' aur. ktrk.^ onFnerli $wns. ,\ uhl.wrul. .nd lhrll iuh}lr .n mllbrr' 6 ffml FMI.< .,ri
<br />.r lixr up !' nr hlllrJ rhour:fij & li^ rsl(U.tloo), r r!l'ri,n tr, rlx o! ol (.nyrn{r!'n. Lbm!.r r( F,vd.d fd rh.
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<br />{DClk nl:-
<br />UTENE!.LONIBASqA
<br />DECLARATI(JN
<br />I h.nhyrlltnunJ.ri^.nrhyol p.rruryrhi Irm lL.nqi und.rF'vrtr'i I (-h4cr I (!r
<br />'nnrrh-'mt * h Sd(rx 7(ltxr) ol DrvFion .l
<br />ol rh. Burnsurd Pnrcsr)n\Cul., r my lr.n{ tr m llll nnL: iitcllccr
<br />I)ak {i'nlrh(k'r
<br />Ia!$AU!:IIANIESIrING.ACEICI
<br />I tErby rflirm uftLr lEmly.l ncr,lry rh! rlsc !r (.rBii.n LrJb! rr.tuy fur ilE Fft'llle. olrtF ktl ad whrh rl r Frnn r
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<br />AfPUAINfDECIdSAIIO!
<br />I lRhy rltim unlcr pcnrlly dl p.rrury ok ol rh. !,nbwrn3 d{l,Iu,nt:
<br />l).m,I(.n P.rhnl^$.{dr Ndnr.iN'n li.!.al Rquldp (Iik s,. Pd6)
<br />R.qur.d Ir(.. ul N.rt.tr)n
<br />I r.n,lyrhlr rh.l.d.r.lr.Eulelx,n( E3!rdr! rrh.nos rcB'valdN ndr.pnlrabL n, rhB pnrF
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<br />rir,r mnrr)rJ nfl,Fdv ntr r\Fri,nturF,{\
<br />Appli.mlo.Ar.nl SirMlut
<br />SITE-WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Rool Sheathing t1 r6\ rq I t c(l\
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL 1 7/nylF /cz--'
<br />Certilicate ot Occu pancy
<br />Notes, Remarks, Etc
<br />tD/stG.
<br />Flood Zone Ceflif .
<br />_1, ar owkr of rl! |nltnr, m.kln1El, drddot *!h,Fa*l o rar,E b LTEr*i rlr i'trj.{ (S< 7044, a$UB
<br />.rn A.6ss. CqL: Th. Codrrrq . L(.nr be dEr mr .prly nr u od. or FoFn y *l$ boill! orur'tlmE! rh.ror
<br />&l vld .rHei ft, *h Foirt wnh r C..r rori, lrt.r.d l'tnM ro rlr Co'rralqi LEB tlw).
<br />-l
<br />uerehri u!.rS(rrh-. B. & PC ldrhnEron.
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