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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDEII DELCARATION
<br />I hercby amnn undcr F.rully ol pcrjury rtur I am cxcnpr rir rhc Conrrlckns Liccnrc trw fttr rhc dlo*ini i..$n (scc lr)ll 5
<br />Businc$ anl Pnfc$i,n Cqlc)r Any Ciry or Counry shich rcqutcs ! Icrni ro .dn{dcr, 1116. in[ov.. dcmlish nr Elon lni
<br />{ru.rurc. prkr ro n\ isuunc.. rho 6qun s rhc rpplicrnr rd ru.h pcrnrn b ilc tr siBrcd shrcnEnt lhol lEor shc h licenrd pu^lonr
<br />ro rhc tmvisions of th. Contactols Liccn\ed L.* (Ch{'rer 9. Conncrcins snh sc.rioo 7m0 of oivisio.I ofrhc Busincs and
<br />Profc$ions Codc) or rhlr hc or !h. n eicdpr rhc.crom lod rh. hlsis in rh. a ltcgcd .x.np(io n. An, vmlllion ofScclion ?031.5 by ony
<br />appliclnr aon pcrnil suiicctsrhc lrpli.a.t ro a.ivilpcnaxrolnot nFrc lhln file hDndaddollDr (S5($)
<br />-1.
<br />!s oNmr of rhc !m!cny. or m, cnrrloFcs wirh wrscs 0\ rh.t hlc .onrpcnurion. aill do lnc work dd rhc trrmi' nor
<br />in(cirl8l or olttrcd nn {k (Se.. 7(X.1, Businc\s and Aolt*ion\ Cods Thc Cotuaclofs Li.cnsc tis locs nor apDly r. an osncrol'
<br />rhcpmFny who build{ or inprovcs thcetr. md sho d.c\ \uch r(,lk hiDrll or hcrsc ll.r rhrtn'Ch hh or hcr oa. c lllloycs.
<br />F)vid.d Ihar su.h i'nprt{r'mnr(dftn inrctucd orofittud f(tr\ c ll. h.$crcr. rhc buildin8 or iNrmrcrnnr is sold vilhin onc ,tu
<br />ofcompbrn,n. rhc Owm, Euilds will hlvc rhe hurdcn of F,vins lhar tu o, \hc did ftn btild or nrpnrc lnc pm,rn! lor lhc lrur?oe ol
<br />Lrsowncroirhcpmpcnr.sncrclu\ilelyconrEcringwirhliccn{dconkrcrorsroconstdcrllxphj.rr(Sc.7Lu,{.BusiEs
<br />rtu PFf6sinn Codc: fic Contlcror's Licensc tjw do$ mrnldy rn rtr owncr ofrmp.ny {h. boildi or imrrovcs rhcrcon.
<br />trnd who conkrchitrru.h [n,jc.n *nh, conta.tr (,licci{d porxrnrro thc Cont0clfl Liccns ljs,
<br />-l
<br />anrcrcnrpr uldcrsccri,B & I'C trrhl' rcxso .
<br />l)!( O*ner
<br />ulltrtrur.sluuu,NlrrloNu:(I, I!]tlrQ!
<br />I h.ruht !l1i'r utrd.' ruDrlryolpriu.yonc orrh.lnlbtri',8 Jc.lrrrrnn\
<br />I havc and *ill minuin *orkcrc conwns.rion iflsutumc, ,s rcquncd hy Scction 1700 of
<br />'h€
<br />Lllxrr Codc, ror rh. pslornEnLr ol
<br />$c aork for which rhis l.nnn is issrn. Myworker .onEnsorion insuiaEc canier sd rxnicy nxnh.i m:
<br />I ccnilr rhrr in rhc pcrtormrfrc {)lthc work for which rhi\ lci,nir n issucd.l \h.ll nol cmploy ury pcr\on in rny manif
<br />$ ns ro bc.rm subjN[o rhc trorkos conp.ns.rion hws ofcrlir(ffir- rtrd lsrcc rh]rirI {$rlJ h.( r{bjcdlothc
<br />qorkds LlnDctrsrrin pnivisio s ol Sction 3?uJ of rhc ltrhtr Codc. l snall. ri,n hwirh conpl, wirh rhr* p' rhn,.s
<br />WARNIN(;, Flilrm i6 {curc sorkcri.ompcnsaln,d.ovrftEc is unhwlol. and shrll suhj.lt {n cmploycr lo criminrl pcndrh\ and
<br />civil lin.\ up t, onc hondrd rhousrnd dolh6 (slln,OD), nr rddiin ro rhc.os olcompctrsarion. dinn8c\ as Imvidcd f{r rh.
<br />IECIASAUgN
<br />I hcnby,rfinn undd,r rhyorncijury rhar Lm liccn*d uMcr thvisi of Chrptcr 9 (commmin8 wirhsmri,.70ur) otD,visio.1
<br />ol rhc Blsiress and Pntsnrns C.de, and my ltc.* ir in tull f{nc Md .fi:.cr
<br />t6 *"*... K
<br />caNsraucrlotrMDlNti_&aE cI
<br />I hcrchy rflirn undcr Fnohyo{pcrjurr rhar rh6c h: onsltuction bndiis rsc*y ror rhc p.rlornlmc ol thc uotk for *hth rhi\ Frmir is
<br />issucd {Scc. 109r, Civ. C.)
<br />AITLIIANfTEII.AMIIAN
<br />I hel,ylllrnDrdcr pitrrhy oip-rjury om ofrhc followinS dLrluorior:
<br />Dcd,lirio. Pdrnitr Ash.do\ Norin.arion F.dfial R.gularion\ (lirlc 40. Pd6)
<br />_R.qnirdd tltr.r ol Norifrdi.n
<br />-l
<br />ccn ify lhar thc fed€ral .csularions cg din8 astcsros rcnsulm nor applic,blc ro rhis pmj.cr
<br />I ccdifyrhrr I hrvc rcrd rhn drpli.arion iid sl.rc lhot thc abovc inl'ormlhn tcorar I ogr ro comply *irh rll Cily ond Couniy
<br />odimn cs Md Stdrc tjws rchtlrx k,tuildinscotrntudion.
<br />.lnvc mnlionM lnp.ny ! irspcdiontullo
<br /> pt,lir0l trr n[rnl Si,]ntrlu h
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/E nerq y
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL -?-tn \.l,v}lr
<br />Certilicate of Occupancy
<br />Notes Remarks. Etc.
<br />T-Bar
<br />Flood Zone Certif.
<br />-lhalcudwillnEinrainaCcniaEarcoiCon*nrroSclrlnsurri,rwork.A'.onqrnsarion.rr,rcvid.tlorbySccrion3?00oarh.kbo! Codc. lor thc pqf.n'urcc ot rhe wolk lor whicfi rhc pcnnil i\ issued
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<br />"r11;Jt*'':J"j'I 4? --TIIEISTII-IOAIAAUI)f,
<br />rxndcrs Add.cs
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