|
BUILDING- INSPECTOR RECORD
<br />OWNI'R AUILDER DEI,CARATION
<br />I hcrch! trlrn r rnd( !.ully oi pc.juy tlDl I !m c\cml lnn rhc Cnnih.ntri l-iccN. I-.w tur rlr ,ollr*in8 r.av (s.c 7011 5
<br />Bu{ c\s iltJ Pr li\si'r Ctl.)r Any Ciry or Cornry wh'ch r.q!trct r Pcnnn tu ()n(rucr, ilrcr, iq,ov.. drfr)lish 'tr toltir rv
<br />slrucrulc. pi,trn' ils hsuancc,3l$ Equnc\ rh. dmlicMr tursu.h p.mnr t,liLn ngncJ nrl.nEnr rhal hcor shc s li(.n\cd Punurnr
<br />b rh. p(,!si,ri\ of rhc Ci)nlri.ktr s l-Nns'l lr* (Chatr.r 9, GlnntRmS wirh S..ton 7t[lo ol Divnion ] f rh. Bu\incs ,nJ
<br />Pftnasri(sC,.)or(halhcor\ndi\ctnPrth.r.iiond lhchlshiltrihcalL8cdcrcnDhon Anyrnllnnots&ri'o7l).ll5bvrtrY
<br />anplE, r l(tr a p.rnrr sohjcr\ rhc .mlcarr l,, . .ivrl I'.mlr y o, nor nrft rh.n lrvc hunJR'll Jollm lS50O)
<br />l,a\owncrolrh.pn)0cnv.ortrlycnfhy.crwirhwa8.s]rrh.rv,h(nnt'ctrsotion.wilnorh(wd.kd r1rciturmtr n
<br />inr. rd orolfcrcdLrq.(Scc7044,Bunnc$anJPn,lislotr\C,il. llrConrrcttr'sLi..n\.t;rw'loc\norr|Ilvlo{owncrol
<br />rh. l lp.dt who hu Js oi rr{n\Jrr tlrr(nr. ul whll 'lu\ \'ch k)t{ hlntll o' nrr{ ll ! r r hr ough htr or hcr own cmfl')v.cs
<br />lrov cd rhir s'.h nnpnN.nrn( m n i, .nlcd nr oflsJ tur etr Il, la'ecrcr. rlE hu lin! or ml,l'rcnEnr s h wirhn!'n v.ir
<br />ol $hplcoon. nf, owNr Buildcr willhxvc rlrc l$dcn.l JllrvDg lhil hc.r \hc JiJ ior huild or nnp!,t rhc lfirJrnv l(tr lhc puqit ol
<br />l. r\ own.r oI r hd fln|F_dy rnr q.lusivcly .onkNr
<br />'ns
<br />wi l, I lE P!+.r ls.c r(}l4, nu\ms
<br />rnl }l.tcs!)n(-,)dc: thcConk ktr \ L(ctrsc L.*noc\ tror rprl,L) rn.wner oi p!'|rn! wh,) burldsor inlpovd\ rhcrt'D.
<br />rnJ wh, co d.Flnr su.httr()j.rrr wirhrConrnen'n!) liccnsc't Pur\ui orlt C trkr*)r\ I-iccnsc lrw)
<br />l..6.r.hnr trn.i.?scrrtr,. 3 &P( ldrhi.I"r,,i
<br />lra8f,uBs:routENsalq!
<br />I,,ECT,AR,\TION
<br />I hcr.$y.lltrm unic! |Eulry ol li.rjury onc olrhc Llhwin! d.clrrriion(:
<br />-l
<br />hrv. Mdwill mnn un,Ccnificxr.oiaonsctrrhSclLlnsurcntrso.k.r!(rnt^_trriliur.as Pn,vidcd nrhvSccrbn 1700oi rhc
<br />htxtr Crxlc,lor(h. p.rinrtr(c slrhc worl,d whih rhc Brn h r\str.'l
<br />I hrtr rnl wrllnUirrxi', work.rs rnmpcnsirnn inrnn(c. rs rcqtrlr'J hySc.lrr l7l$rlrhc l-$.! ( Ddc. ltr rhc P.dnrminec '1
<br />r hc work ttr wht h r his Ftrnit '\ tnrcd My $.*cs (omli n\rhntr r{rrEc .rtri.r 3nJ lrrliry numb.! arc:
<br />_Er0rcs:
<br />-
<br />I uc.lilirh!rinrhc Ir.r$rhrncc,'frh. votk ti)r whi.I rl'isr.rn,ir
<br />'s
<br />r\rcd l \l[ll not cn{'n'vrrrv P.s.n in rny nBnncr
<br />$ r\ b lrco.rc subl.urr) rhc sorkcri $m!.ns$.n h*\olCrl'lomir, r rgN. rhrrn I sFi,tl'l h&onr uhi&r t,d{
<br />workcs'.onr.n\rrionon,vi\i',n(ofSc.honl?0O.lrhclrhtrCorlc.l{trll.l,)nh*irh.omnltwrthlhoscP!}visdn\
<br />TVARNIN(;| F,'lur. h $ctrrc *oic3 .omr.n\nron (,vcrrSc r\ unli{tuI. rnd shall nrhi.lr an cn{loyn tr' dminrl Pcmlr.\ ed
<br />S..r(m 1076ol ilr tihn C*1.. mr.rc( ud rxoiNy ( L.s
<br />)
<br />Date:- APPI
<br />LICENSED t'oNTRA(jTOR
<br />OECLANATION
<br />I h.rhy rllth undcr i.nrkyol pcrtur y rh, I rn, hth{d tridcr lK)vni,r ol ChrPr.r, (Lo$nEnui!3 *irh S..rirn ?(m) oIDilisnrn l
<br />ot lhc Bn\incs rnd Prnc\norsC.dc. and my li.cnsc is io lllltur.c iu cllc.r
<br />lhl€
<br />-
<br />Conlrtul
<br />CONSTRUCTION I-ENDING AGENCT
<br />I hcrhy al lirm u.dcr Ftrrlty ol tE I'ryrh,r !ltr. nrcotrirucl nhndinga8cn.yturrhcpcrlirrmoc.ofrhcw.rklntwhiehrhr'!crm((
<br />i\$c! (Scc 1097. Civ C )
<br />AIIUIAILDEIIAETUq!
<br />I hrNhy ,n nndcrltnlllyor pcrjryon. ol rhc nnhwtrrelcchrJri,n,\:
<br />Dcm.l(totr Pcrhirs sb.{or Norilrlrn,n li.dcral R.!trldn,nr (1[lc 'l(r. Pr.i6)
<br />R.qum'i Ir(.rol Nohli(in.D
<br />I.rn'ltth rhclil.nlr.Strlrrr)tr1rt!.rJ rerlhcd.\rcnkrrlrrc or r|,'h(ih1L' ni (hL\ lxi{r
<br />I (nifyrh l h.vc rrd rlri\ r|th(dl i()n ul slar. il r dE rlh!. ,nl,tnrrun r!.om( I rtrc rI (omI'lv wiih all C(v rnit (iury
<br />oilornecs lntl Slar. Liss (lf,riis b hudling .onsrruuron, !n]h.r.hy ruthtr,c rcltrc{nuh\$ ollhtr Cnv d Counrv !' cntcr ornr nt
<br />ove n,cnrlnf,d B,Ndy ktr i,rcfr.rbn Puqxxcs
<br />Appll.rnl or Ae€tri SiAn{lure: t}.le:-
<br />IDiSIG.COMMENTSSITE-WOBK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenVlnsu lation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 4 -zt'za A 4t sr\t€ftts *47
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Icntriri e nhtr'.iDri l':
<br />SLAB Floor
<br />Pool Fence
<br />--------r------
<br />tt
|