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BUILDING- INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR{'IION <br />I hcrcby aftilN nMcr pc.aky of pcdury rhit I nN cxcrn,)l norn thc Conrrrcrorr l,iccnsc La* f{r rtu lolbain! rcN,i (s.. r0:ll s <br />Businc$ md Prolc$ior Codc) Any Cily or C.unly which rcquirc\ a pcnnir b c.n{dcr. alrcr. nnfiovc. dcnmlnh or rcj'Jir JDy <br />nnrfurc. nrior ro ils hsulncc- lho rcqlncsrhc applica for such pemrit h l]lo r sign.d {d.ncnr rhar hcor shc is li.cn{d pursurnl <br />b rhc FJvisiotrs offi. Cont dols Licctrscd L.w (Chrfrcr 9. Conmcn.ins wilh Scclion 7(xX).r Dilhi.n I ofrhc ausinc$ and <br />Pfttt$iotrs Codd or lh0l h.orshc iscxcnDr thcrcrionrand rlreblsh lor llrc rllcs.n.xttrll,i.. Atrlviol,rionoiSccrion?0.ll.5byany <br />rrpli.flnr r'or. pcfl.il subjccrslhc smlicor l. !civilpcMlryoln.' morcrrhn llvc hutrdrcddollitr (5500). <br />l. as oqmrofrhc proFny.or nrycnrtloyes pirh w{-!csrsrhcir v'lc compenrarnnr. *illdo ihc $.rkd rhc sinrlurc is rol <br />i cndcd or oitcrcd f.r $lc (Sa.?0,14. Blsincrs aod Pnltsions Adc: Th. C()nltktr s Li.c.sc La$ docs nor lpDly n) rn osmror <br />rhcntupcdy {ho buildsor i,nprovcs thcE .aftlwhodocsNclrlorkiim\cllorhcEclforrhk)ughhi\orh.rowncmployccc. <br />pruvidcd rhd srch n nrov.mnr r. ml h cndcd or of.ft{ hr srlc li hoscw rhc ttrildin8 or imlnvcmnr is {nd virhin oic )td <br />ofcon\rhriotr- Ihc Owncr Duidcr will harc lhc burdcn oil]r.vins rhar he o' \hc did nor build or i'nprolt fic fmp.ny ior rlrc PUIPEot <br />_1,aso$D.rolrheirop.ny-amcrclu\ivcltcomrucrlng(irhlicrtr{d.oikr.t s lo cotrslrml Ihe pmicd (S.c 7r)44, Bx\i',")\ <br />dnd PolassrD Codc lhcCotrr.ctot s LiccDsc Laq docs nor lr,plylo 3nosncr offn)pcny who huilds.r rrlrir orcs I hcrc.r <br />rnd who .1'nrd{ f(n su.h tn.jcckwirha Clrnri&ror (, liccr*d Nrn.nrrorhcConrracroir I.iccnsc l-aa) <br />I rDcxcnrt, undcr Sc.tio <br />D.l.: . _ Ovn€r <br />w( rRKlrr- c{I\l Pr:vs,1Jrl(rN <br />DIiCIA.SAIION <br />I h.r.by aflirnondcr p.nrlr, or r.rjuiy onc orrhc fdbwiis dc.l.mrnnN <br />I l !c mJ qilliui'nriirC. ii.drcul Coisctrr r' Scll.ltrsurc lo, work.n conrNn{'li{rr- rs trovidcd fd byScctnnrlT00olrhc <br />rtrd will hinhltrsorkcn.onrNtrsariotrnruramc.as rcquncd hySc.lion.ITOOolrhc l-rborCodc. turrlt NrhflnrNcol <br />y *o*cs co.rFne[ion insumrNc caricrlndFnicy iu'nbdr r.] <br />?tAlaor <br />l.c(firl[tnrrhcr.rloirninccofuhcsorkior*hichrhispcrnririsissncd-I\hallnorcDli,yrtrytcsotrir{ny'nxnncr <br />sor!nrbcromsuhJccrt,rhcw(trkc^'.onipcnsarnnrh*\ofcalifimir.rtrdrsrccrhjlillrhouldhcconr\uhjc.rrorhc <br />rorkcrs con!.nsariontovirn,isorS.dtunST00orrhc LnbrCodc.l rlull. ihnhsir[.annpl] *irh rho\c F)visio s <br />IIARNINC F{ilurc ro wurc workcs' cornpcrslltnr covcra8c is unhwful. d shrll $hjccr nrr cmplortr ro criminal Ftuhics rnd <br />cilil litrcs uD lo.nc hutrd'ld rhouMn{l dollrrs ($1(x}.(IX)). in rddiriotr ro rhc.o{of compcnsarion- drmrs.\ rs j,.vided r.r rhd <br />V" <br />I hcmbyafllrDn.dd pcnaltyofpciurythat I am liensdutrdcr pmvhion olChrprcr9(co nltmingNirhScction?OO0).1Divisi,,n:l <br />of rhc Bo\in.ssnnd Prufcsions Codc. d trryliccnsc is ir full lorarndcflc.l <br />'"'*v' <br />CONEIBIJSIIONIIIDIIIJ.A{jENCI <br />I hcrcby rlhrn uMcr p.nilry o l'pcrj$y lh0l rhcrc h ! con(rcli.r lcrdins rE.n.y nr lhc pcrlinl.ncc ofthc sork iu shichr[n Filnir i\ <br />hsuedls.c .1097- Civ C ) <br />AIIUCAXIDUCLAAAUON <br />I trrby afllm undci F-MlryofD.rjury orc ofrhc rbllo$in8 dlrl.rrlion\: <br />O.rinnior Pcnnir+Asb.slos Nolilic.rion Fcdcr0l Rqularions (Iille 4l), Pan6) <br />_Rcquncd Lcrrcr ol N.rifi uriotr <br />Iccnilyrhd rhc ltdcralrcgu[ri.ns rc8a'di'rg a\h.{o\'. n)v3l]rcior t,t,ltr rlcrorhtJnolc.r <br />l,.$J[,,,,,",lhrvc rcad rl,is afpicrrin,and \rrr.rharrhcrh'$ i'nn'rurion h.onccl liSrericonrply*irhallCnyandCourly <br />rrc !-r*sr.hriry kr hxildinaconid.rnn,. n hcrcby.urlDrizc rcnrcsc rliv$olrhisCiryr.d Coutrry ro cnrcr ulmn Ihc( \t ltrt((a Fox <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Roof Sheathinq <br />Shear Wall <br />Framino <br />lnsu lation/Energy <br />Drywall <br />Brown Coat <br />Ivlasonry <br />Pool Fence <br />\ <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />A <br />WAGU Pt t4tL g-7-lv Y.ILI iL <br />U\ <br />FINAL t'-7-tv \7Certif icate of Occupancy <br />Notes, Remarks, Etc. <br />L <br />SITE-WORK <br />UFER Ground <br />Subf loor/VenUlnsulation <br />Ext./lnt. Lath <br />T-Bar <br />t <br />Flood Zone Certil. <br />Cotlc. i{n (h. I}.rtunnanr ofrh. w.rk tur which drc Fnnir i tsucd <br />L.nd., \ Addrc.. <br />tt <br />tt