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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BtTILDI,R DDLCARA'IION
<br />I h.rcby llnrnr utul.r penalry of Frjury rhat I am.x.mI fiDm rh. croltB..ro$ I-ic.B. ta* for lh. folloeinS ra$n (s4.7031.5
<br />BNincs d Profcsion Codc): Any Ciry.r Cnu y *hrh rcquires a lErmir r. connDcr, thq. i'npr.vc. dcmlish or tup.n ..y
<br />snrour.. nrior ro irs nsulnE. lth r.qut6 rh. ap!'li6ni fo! sucn p.mi ro 6E a sign.d ,ar.dnr rlBr lr or sh. is lic.Ds! pur$.d
<br />ro rh. pmvisions of rtu C.nk&roas l,iccn$d lr, (ChaA..9. C.mmrci.f $nh Ssrion 7(XXr ol Divnion l olrh. Busi(s and
<br />Ptuf.ssrns Codc) orrhor h. or she is ex.nDr rher.non and rh. hasis lor rh.llleged exery)(nn AnydnrrionorSecrion?0ll.5byiny
<br />0oplicMr fo. r p.anir bj{rs rh. .pplicior ro r cr il O.Mhy of rct m.c rhsn nv. hwdr.d dollM (t5m).
<br />l. a\ oener olrhc pnrEny, o. mycmployccs $nh wa8cs 6 rhct sh mmp(n\dion. willd. iE krl di rL iM@ ir mr
<br />ini.nd.rl or olT.r.d for sL (S*.7O1-4. Busin s hnJ PrcLsions CoJ€, Th. Conrodor's Lic.ns lf,* do6 nor aroly ro dn owncr ol
<br />rhe pnEny wh. huildr o, !r!oE rhemG !!rl w& d8 x$h *Dd hiB.li or hcGell or itmush his or h.r own.mploles.
<br />providcd rhal such improrcrdr e. nor inreded nr o ind r., sl€ l[ howcw. 'lr buibinS ofuneosm n sou *irhin oE ]r{
<br />o, conubior fi. OwE Buill.r will hdw tlE bu,&n ol pmvinr lhal lE or sh. dil sr build or i,+tut rtE pnpd, for rtl pu.Dos of
<br />_1. $owkrofth. pmp.dy, mrxclusiv.lyco toc(i$ *ith lic.nsal cont*ur ro.untuo rlE pmrrl (S4.7044. Busim$
<br />a l Pbf.sin Codcr Th. Codn ro. s Lic€n.. bw dds nor rpply ro m orNr of nii'p.dy wt() builrh or iopnv.e rh.Eor.
<br />and who .o.k .6 ror such pmi.cls wi'h a C.nrEdo(O liccr*n puFur o (he Co.udols Ltes. tr*).
<br />l!9af,E8E.CA!4!!iNEAIXIN
<br />DLCIASAIIOE
<br />I hercby atltm lndcr pcnalq of pcrjury orc of rhe followi.g dccla.ar ions:
<br />_l hav. aftl will roidin a Ccnincar. ofco'Lqnr ro S.lllnsua for ,o*.8' smpldariD", .r pmvid.d fDr hy S..rion 1700 oirh.
<br />L.br Codc. lbr thc ,e.formrc of rhc wol* lnr *hrh rhc ,smn b ssu
<br />-.,{*,andwillminrainvork.6coflp.nsriioninlurstr..,,\RqtrirnhySdiionlT00ofih.LlYtrCod.,fo h.ErfomE,f,.of
<br />lorqhrurhi!Fmi BNucd M!Bortqr'mmrDrrn,n\u, ...rm1 dalIUli, nlhhc, !.5*a.t c f.w.al
<br />I 'tLLt ol o I o,1\"z{,
<br />_l rdilyrld in rhc l.rfo'I:rG. of th3 eort tu w6ich rhir FrnJr is ircu.d,I rlull nor.nDloyany t rsr in My m E
<br />$ a\ ro b.$m s$i.cr ro rhc wo.ldJ comp.nrliion Lws ofc.lilo.n.. lnd agec rhd ii I slnuld tEcoE subrd ti rh.
<br />sork.is.on\tnsriirnpovirDnsofS.crionl?0Oufth.bb.rOod.,Ishlll.tonhwnnrcmplywirhrhoepovGios.
<br />WARNItG: Failurc ro scuc wo.keB eqEtudion cov.n8c ir ula*tuI, d shall suhj.c! .nlplotr! io dnind Fdhi6 rrd
<br />civil Iin s up to oE hundr.d rho!$nd doll.s ($lfii,Ut)). in addnio. ro rhc co{ ol conrt ns.tion, damg.s a phv]dcd for llE
<br />Secrion 10?6 of rlF IilrtrGkl., inr.r.s,.,"21*a 2o
<br />!.tr-:Lr-8n]1.!^
<br />I ndnby altkn undd p.Mliyofp.rjury rhlr I i6lienr.d rnd.. rmvisi.nolChllier 9 (comEEioA wiihScc.i,n ?000) oaOivishn l
<br />oI rhc Burinc$ und Prolc$ionr Ccylc, ard my lic.nsc n in tull nne d .ffcct.
<br />,t,,t"z +Lv
<br />(oN$Btl1I!]NInNpllclcE
<br />I h.rty alTm uinld p.nalry of F.rjury rhd rh6 i! a coBrndbn L lir8 rg.my fo. th. Ffol]rlm. of rlE *o* tot ehtt lllis pdnn ir
<br />($cd(Sec 109?, Civ. C).
<br />rhh.ppli.riio. 'Jrl {!r. rhar rh..bo!. infomrion h c6ar I aB@ro@mplywnh allCnylDd Counry
<br />ri{n\ rxl h.Ehyauthtrir rpr.rnrarivcs ofrtus Cnyold C.utrryro.dq ul'onrhe
<br /> pDliclrt or 3or Skn'tu
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathino z/zq/z.o ,&yr /
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL /zilz)lccz
<br />Certiticate ot Occu an
<br />Notes, Remarks, Etc-
<br />Rev. 08-07-2015
<br />UFER Ground
<br />trndclr AJ:lrs
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<br />AI8IICSLDESLAB{IION
<br />I lEtby lflm uid.r p6.hy ofp.rjuryon. ofrh. followirBdeldroriols:
<br />Dcmlirion P.rmic'Asbenos Ndrificarion F.d.!al RcBUldions (Titl..l0, P3n6)
<br />Rcqut.d trn.r oi Nouf&:rion
<br />t d.ral r.gxhtnm E8qlin3 rstE(os EnEral @ rct rpplicabl. ro rhis pml..t.
<br />*,,1:iL4--@
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