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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNET BUILDTIR DEL(ARAIION
<br />I Lrcby rfln'r nMcr J)cndry of pcrlury rh0t I dn cxcryr liom llE Conlrld.F l,kcnsc Ljs f(t rlt aollo*ing rce\on. S.. 70.1 1.5
<br />Bunm$ anl Pmrcsion Odc) AD, Ciry .r O,unry which rcqunr\ r Fm lo .usln.r, dr.r. improvc. dcmlkh or EFn My
<br />stMlurq Drior to s h$rda, alw rcquircs lhc otplicanl tor \uch IErmir ro lilc a \i8n.il nddtu.r rhnr hc Dr shc is liccntd pu*uMr
<br />lo rhc F.vnnns o{ ltE Contmcloas t,iccns.{ tjw lchaflcr 9. Con,mnci',g wirh Strtun rulo or Dvision 3 oirh. Busimss md
<br />PbrcrsionsCod.)orrturthdrshciscr.ml,trhcrcronandrhchastro!th.nll.scdcxcnrflion.AnyvioldrionofSclilnT0.rl5l,yany
<br />flSqll-rr,-r,*t,.,-,rr
<br />sPrrrdr h sc,Lirl,fturrt' n, tur rhs ri,. humrcJd"llJ. '150ur
<br />--Erl ,{."*.,'r ,r," n ,p"r. ur f,} cnpl,,yd\ utrh ualcs as rh.tr $k onrFns ion. will& rirc work un rhc srnxlG i\ R,r
<br />inrcid.n or olTclc{j lor slc (SE ?044. Burines lnd t otc$ion\ Codc: Tie G'nlollori Li.en* bw &s mr {ply lo 0n osmr of
<br />rh.FmFny wh. huild{ or inpolcs iltm[ dk] qlF das such slk hi'rl$lior hcBelfor rhFugh his or hcrosn cq,lorecs,
<br />tirolidcd rld \uch i'ntrolu'rnls m nor id.nddi d oft,rl tur sL ll h.$rE- th. hoiriina or inpmE Enr is $ld wiliin orc F{
<br />ofco pLrirn,rhcOwrrB ldLr willhrw thc burd.n oa lh,vinB $d hc or shc dil tnt hoild or rnlrow ilE nn\f,ny for th. Plryos of
<br />I, r\ o$nd ot rhc pmllny. rd.r.lusivdlyrotrta.rinS wnh li.cnsd.o rados lo con(Nci rtE prejsr(SeL 701.,1. Bn'rs
<br />md Pmt$i[ C{ilc]'lhc O'nrrrroir l-iccn\c t-rw dors nor,prly k, rnosi.r.rttuFdy who hurlds or irl)rovcs lhcrLln.
<br />rtrtl *ho.onr.chlorsuchpnrdr*irhnContrero(9lncnqlpumu"dn)rlrCotrtnt,\Li..nscL!w).
<br />I aNcxcDrpr utrLicr Sdri(tri-/a-
<br />t",. D4!
<br />DI.CLASAITA!
<br />I h.rchy ifln undcr !cnaltyol[trjuryonc oirhc folhqnrs dcclarllionr
<br />IhrrcJrnwillnEi nin r Ccnifir,lc oiConcnr lo Scltln\u,e ior worltrl. .onp.n\dioi, .\ lnvidcdlorbys..lio.l
<br />hh.r Ciod.. nr rhc F.rfoinDncc of rk wo* Ior whi.h rhc n€rn r n nsued
<br />-l
<br />hlvc ntrd wilL aEinllin workcrr co'nrEnsari'n, n$un'x-c. a\ rqutcd hy sl\r ion :l?tn .r rhc tib.r Codc. lnr thc l]crl'ormmc ol
<br />rhe wo,k ri), whrch rhi\ Frmi n is$dl My worksa co'r{risn nuramc.Mff nnl I.lit numbtr (c:
<br />ry5;;;rn nr pcrbnDrc ol lhc rork lor whi(h rhk r--onr t i\\ucd. I \hf,ll mr crrl,,yrny [rcA.tr i'i rny nuin r
<br />Nhjcr rorhcw. cr'.onDcn{rion lr*sofcrlif(mu. d 4rc rhnrirl rh uld B*om suhlr\t !'rh.
<br />workc'\ ro lr srrn,rln,vnon\.lSc.lonl70U.l rhc htFr(odc.l \h!ll- lonh*irhmmllt *irh rho*pn,v,nohs.
<br />W^RNINC liilurc h {.urc wor]{cn comP.nvri{,, .ovcrg. '\ unlawtul. and shnll suhl.cl m oDlo}cr h sininal pctrrl,ic\ rnd
<br />rivil lincs up n,o'E hundEd r)x,usrDd dollrrr (sllD.oql). i', ddirn to rh. co{ oi.onlcnslion. drrugcs !\ pruvidrd Irrt
<br />::4"1;irfri;I n]1,/
<br />DEET,ASAtrQ!
<br />I trrcbyalfir und.rlxn ry of lrrjury lhii I m licened unnd pmvision ol Chrlrs 9 (omnEncins wirh sori.n 70{})) or Divishn 1
<br />ol rhc Burincsr rnd Pmlessi.nsCodc. arn rny liccN i\ in rullforcc urcfli{r.
<br />I-i.enscCla$:-
<br />toltrf,!(uoN.rralAlidtiENcr
<br />I tErchy rninn u cr Fnrlry ot p.rjury rhrr rh.rc is 0 mnsldction Lndilr8 o8cmy ld lhc Frl'ornuncc oi rhc work fd whi.h rhis Frnii is
<br />is$cd lsc. :1047, Civ C )
<br />AIELICANIDECLABAIIQX
<br />I d,y tt undcryctrllty ol p.ljury onc of lhc nrh* ins dcclullion\
<br />Dc rnn,n Purni\ Ash.qos Norinc nn lcdcrul Rc8ulari.ns rTirlc.r0. Pin6r
<br />Rc!UPt
<br />z(*u,'n
<br />Elx,**l
<br />lhc lcdcr0l rcrululion\ rcguding x\t{ los rcm,vrl JIxn rpfltablc k, rhrt pr'n\l
<br />lhlrcr.rJ rhi\ rlrnliuri,nr a'kl (at ihrr dr trh,vc rnnu nn i\ codc(t lngrcc k,
<br />rrc lr'*\rlrrtr,gti hdilJ ,x co n'x..,tr'.
<br />,:h.vc '(nrinrcd pr,ncd! r.r insn .ri n ndrri\G
<br />n,,,n-,*n*-,r**'- f./.ItQ.rL.
<br />o"^r*,-",,n",, J U TLfyNd,,
<br />I
<br />cFrllysirh rll Cir, rnd C.unry
<br />rir Cu lo! counry ro drcr DF,n r)h
<br />l.(Qelur
<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 />Framing
<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 />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL a
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />Fov.0B 07 2015
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