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SITE.WORK DATE ID/SIG.COMMENTS OWNEf, BUILDER DEI-CANATlON
<br />I hcrcr,y rfirn u&,.r Fdny or Frr,, rh, I m .r.,pr rnrn tlE Co da tiw uv ro. rlt folh*iry E $n (Sa 70ll J
<br />Bulrn.rs $n ProL{shn Codr) Any Cn, or Counry shtt r.rluicr i rmn r{, o rd.t, 1116, rmpnE, d.mrlish ot EFtr oy
<br />{ructurc. Fh, ro irr irffi. rls r.qlidx rh. +lltdi n, ru.h p.mi '. fik i {8Ed srllcmtrr rh.l lE or {E is lic.trEd pllser
<br />ro rlE F,nrxE or dt Conr.xlq r LEned Ll rchafld 9. C.dmrin8 wnh seri,, 7m0 or Divnrrn I or rE Bu.iErs rnd
<br />PrDtcssi r C.d.) dr rh{ tE n rh. L .r.trpr ttEcfNn un E h{sn for rhc rllcs.d.tnqrioi Any vhhriin of Sdi,n 7Ol1.5 by ..,
<br />ulpliclnlnn!pcn.il subj(l\ rh. lprlic!trllo r civil p.mlry or rer .sR rhrn fiv. hu ndrdl .lorl&s ($Jm)
<br />-1.
<br />.! owEr orrE rrDFnr. G my cnnloFi wirh *lrs 8 rlEn $E $np.Mi,.. wil d, llE est an E(erE; ml
<br />inr.rd.d or ofi.Fd lor el. ( SE 7044, Bulirc3s and Pmf.ssi'nr Cod. Th. Co, r..h\ Licc.E ljw &B Nr 6pply b 4 owftr or
<br />rh. l'rld, *h, hrililr or irfhB tlEun ,n wl!) d.B sh po* himlf or hc.sll or ltmuth his ft lEr os flr{lhycd.
<br />Fovii.n lh.l tuh ltqDwnl. G rd irrsrd.d qofiqld,q xl. lt lbew, ttE hinin8 d inprelld i! qrrl *irhin m Fr
<br />or @tpbri{ 0r Owk, ButLr DiU llE 0E hE c. of FDving ltu h s nE dn d hi! or inIrcE 0! Fr{6y ror rh. FlFt ot
<br />-1.
<br />G o* E of r,x F,rEry. cn crclurirlr.o,trrlins *itn lilrnrd .odrd6 ro snlrM rh. FoFl (SN ?o+4, a6fts
<br />rrn PtDG(in Cod.: Th. C.nterols Li..nr L5v dca mr lptlylo MowM ofltoFriy *ho build. oI impmv.r rh.ron,
<br />rnd whi' 6 tuk aor su.h ,ioif r eirh r co Mor(r la.n€d puru.rrr b llE Conlrerolr Ltctrr llw|
<br />I m.kmli undrr Sftri)n
<br />Drl. ()rn..
<br />rvoRxrrl\. L'0\rpi-\s,rrll rl!
<br />I]}:TLAAAII!)!
<br />I lRrcby rlTtr uirlcr ltnlhyolNrjuryo corrhc tulk)wiritdcclnr inr!
<br />,/
<br />-l
<br />h.E Id *il! m.hin . C.nifd..r CoMd h S.l rom fm $rt6' onFN.lb'r D Fotit.n fd by sttb,17@ 6rrlE
<br />tibor Codc, tu ih. tEfoffic ol rlr * l for which rlE Fmr i{ kurd.
<br />f-1, "*.a
<br />*,,,^un-n *"*E ConicBrriri inllJre.. ( Rgr, by scrsn r?m ot $. bbo( c!dc. r.r lh Frm or\ ir hrt f uhrh rhir Fmr r EEd. M, w-I6 mmFndbn mutrm ffir rn Flry nu F E
<br />/.*, Sl4t tztv,Y" ,rgA}rr {rnc,l
<br />\,n,n,,*. 4?4r i1( '.p*., '9) l'/r\
<br />-l
<br />clnif, rh.r in rlE Frfo,ru. of th. ro* fq ehtn thir Frmir s 6 .d.I rn mrcir?tyqFsnh.ryIuE
<br />s B b h.or NbFr lo tlE wmt6 onp.Mirn Lrs otc.lifdi. rd.rrE lh.i al I tlblU b...r .ubF ro rrE
<br />,o es' ompcrsrion provtionr of Serion 1700 ot rlE L$or Cod., I ltull, lonhvirh 6nrly wilh thos povi'sionr.
<br />WAnNtl{G: Fdle 16 ift hl6'on$..diin oE t i. unlrrtuL rn lh.I $blxt D .rploFr b qnnind FrIi6 rn
<br />civil fcr up to oB lldrd lnoueln dolB (lt@.m), 6 .ddnbn b ilE 6r of o,FNlioll rL, 3t! s lfDtiLd aq llE
<br />S6rion 1076 of UE Llhn Co<!., hr6!r lid .trory r f.es
<br />(,."v tzql? \tr+e\rn c
<br />DECIjAAIOB
<br />Ih.E-6ydnmunj..rFBxyorFrlnyrhdIMlRri.du.rFovirhnorchrrls9{@mrEingwnhSdrbn?(m)ofoivartnl
<br />of lh. Burirs rn P,Dr.rsaoN C.d., ,i Dy ltdE ir h tull roN sd .fid.
<br />.o"*.,.., ( 21
<br />(,", ,.rrzq /:r
<br />-LEB
<br />Numbr r()t, 1+l 3
<br />c*i..d* UL( eobhr..J)
<br />catrrf,lcr1lnit[N]ac-a1illc]
<br />l hcrchy xliirnr unn r nlnslry ol trrJtrrr rhr r hcr. n tr d,n{ru.t $n k.dirg r8cmy ftr rh! !.rllr numc ol rtu work ntr whi.h rhi\ Irmir i\
<br />irsEd (s(.1097, civ. c )
<br />l..d.r's NrnEl
<br />ITTIIIANI.IIECIJBAIrc!
<br />I My unimundq ncnih y ol pcrFry orc of dt lolL*ios d(Lririon.:
<br />I}mhnn P.rdik-Alh.sro. Norif..rio. knl R.luhrionr(Tnh {. Prn6)
<br />_Rcqutun Larcr of Noriauri.n
<br />I dil, rhd 'lr lc{hri E&brionr ESadiu BlErlo3 m,vrl e r, {,nltrr,k ro fin |,nFl
<br />**xify rhtrr I hrv. tal rhn lmli.rt ion $rl rl{rrhit rh..hrr inforndion i\ coNt I !s,a ro onlj y *irh rll Ciiy lnd Couniy
<br />rcFcerrr.rircs ol rht Ciry lid Counry 16.nr6 uF,n rtEI rrd srur.l4rEhr S k, boiLlin8 .odtud$n rn h.r.by rd h,,
<br />rtin.rnrL,f,Jl]n,p(n) n'n\p!.rnn!urtx'{\
<br />vl71l2l
<br />6-"€ ttn c,I
<br />Aeplcsl or A!6r SkElu
<br />\ P.mllR Dd tprinl,:t \)z -
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Boof Sheathino 1-3-z r i ra.f {a-tl*rp Our G rwr.r
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL 7-lg'zt t Etr(.{a
<br />Certif icate of Occupancv
<br />Notes, Remarks, Etc
<br />f
<br />BUILDING. INSPECTOR RECORD
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