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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE o\rN!]lr trI tt,Dt,:R l)lit,( AR'{'r't()N
<br />I hcrcby rfirn und.r Ftulry {,f pcrj!ry rhsr I !n crcmpr fFm rhc Contnckn{ l-ic.n\d tiw for rhc tullowr8 rcan (SN.7oll 5
<br />auriftss Md Pbrcrson Cul.) Any Cny or Counry which ftqu'Es n !.in t b .o.4ncl. rlrd. inrprorc. d.nmhh or rcp0n ,ny
<br />slru.lurc. pior to irs issunrcc. $o rcquncsrhcaplli.,nr ror su.h tri,n ro lilc. siSncd sr0rcnEnl Ihrl l.d or sh. h liccnsd pusu!tr1
<br />ro rh. psviiions ofrtr Conra.roa\ Lkrn\cd ttr* (Chalrcr 9. G,hmcncine wirh S..rion 7m0 of Divtion I oflh. Ausincss and
<br />Pmnsions Codc) or lhrr h.orshc iscrcnu rhcrclion,nd rh. tlNn f.r rhc alkScd cxcr.ption AnyviolrrionofSccrio.To.ll5hyrny
<br />lpplicanl forapcmir subjslslhc applicanl ro acivilpcnallyolnor morclhan lilc hundrcddoll-s (55m).
<br />{
<br />l.N oqrrrolrhcpmtEny.ornrycar oy$s *irhw.!csnsthcir hlc compctr\arn,n. will o rh. worl drd rh sMlure I nor
<br />inicndcd oroficrcd r'or sk (Sm?MJ. Brsincsmd Pturasids Codcr'rhc G, mcrn s l-i..nsc tiw &,cs or artly ro m osn$ of
<br />rh. lF|Eny wh builds or i lprov.s rhcrn. rxl who dmr \!ch k)rk himsdll or hciself or thmuBh his or hcr own cmployccs.
<br />pR,vnhd rhri such imtownf,nh m mr intcndcd or off.nl lar srlc ll hl'w.\u. rhc hoildire or inpmvcm is $ld wilhin onc )ur
<br />oI conrnLl hn, tlE Owncr Buil(ls will hovc llr bufthn of trcvir8 lhll k or shc diJ nol noild or i,ryro( rhc rmFny fn rlf, puqm{ or
<br />{h'
<br />_l.s\o{trcrolrhcrDpcny,r'nrcr.lu{v.ltcontacrinSwirhli.cn{d..funronroco.slrlcrrh.,rmjcd(S(7ol,l,Bunnc$
<br />nri Blfssion Codc lhcConrmcro.s Licctrsc Lrwtlocs nor anplylo rtrowncr ofro|t ywho builds or nnpmrcs rncrcon.
<br />ud sho conrmcrhrsuchrrejcchwirhoConrrucro(s)liccnscdDuNu,nrrorhcConrracroi\l-iccn{Il*)
<br />Lmcr. pr undr S..rbn .a & P.C. Lrrhi! rcrqrr
<br />ullBtrE8s:cauPilsAloN
<br />D&CIdX.trUO!
<br />I hclcbyaflt unncr lcnahrolpcrjo,yonc ofrhc hll)wins dshsri'rn\
<br />IhJv.r sillnuinrdntrCcnifKtrr.ofCon\cnrroScllln\ur.lnr*orksn compci\rri,r. rs pn,vilrd brbyS(tio l7(Dolrhc
<br />lixn Gxl.. tor rhc p.nbrroncc ofrht work ntr *hich rtc pcrmir k i\\ucd
<br />lhr\ca wrll [inrrni wo $r.o D.n\rri(,nin\ur nc.. r\ rcqutrcd lySc.rir ]7(n ul rhc l-$o. (inl.. &r rh. plrfon,utrr& ol
<br />rh wo.k lar qhrh rhn |xflnir is is{dl Ml \r.rkcrr rontrtr\ridr iNufln.c.aiiicr rlFrli.r_ntrmhsnrc
<br />-l
<br />ccniiy rlur h rlE ltrrt)luftc oirhc work li'r which rhi\ pcnnir i\ hlucd. I \hrll n.r .mtlr,y ,n, pcsotr in !try nmrmt
<br />s d k, h.onr rubjccl o
<br />'h.
<br />woiksa conr ns u: hws.rc,lihnrir. Md l8N rhd irI should hccom subjcd brrt
<br />workcn .omNNition [ovGions ol Scdiotr ]7ID ol Ihc ht r C-odc. I shnll- fonh$i
<br />WARNIN(;: F hrc b r.uft aorkcr'ompctrqrn $rsatjc is ntrl.wful. rnd {'hJcl m cnrfloycr h rinnml jxirlrics rtrd
<br />civil fin.s up l. onc hundrcd lhous0trd dolhr ($1(x).o(x)r. in .ddition I conDrnsrrn,n. drrl'gc! s |](rnlcd lar rhr
<br />Scdi l{176ofrhc litnr Cqlc- inrcrcn and arromr's les
<br />DECLAAAJ:III!
<br />I hctby amflnundcr pcnahyofpcrjury lnd I !n liccncd lndcr pnvnion ofChatw 9(conmncing wnh Scction ?uro) ofDivhnnr 3
<br />of lhc susircss and Pmrc$ions Cde, anl my liccnsc Ls tu tull forc dt crd
<br />CgN,tIf,lCIlANl.IilDIlIi.AG.ENcI
<br />I fiercl,y rmrm und.. Ilenalirolperjrry rh,r rh.ft i\,.onsrrudk,n LndinS ngcmy for rhc p.tronMnc. oirhc Nork in shich rhi\ pcnnir i\
<br />hsucd (S( :1ir97. Civ. C ).
<br /><'kklci,t)
<br />ATTLU;ANI.DECLAAAIPN
<br />I lrd,y r,nm trnd.r l.naht of Frjurt onc ol rhc f.lk,wiD! Jr.l.rdnr$l
<br />l)cmolirion Pcnnih Arhc\ro\ Norificari,n Fcdcrrl RcEUlaiions (TirIt 40. Pnn6)
<br />-Rcqunc
<br />blrcrof N.rificrrion
<br />l.Lnnirh th. fiJ.nlrcSuliri()ns rcerdrA rsb.{os rc bvrl rc nor {'pli.$lc ro lhis preFdr
<br />l..ailylhrr lhavcrrtrhi\rtplicnnn,rnddncrhrrrl[i(,n n.omcr.I.Ee ro cotrIly rirh all Cirydnd Cou y
<br />onli' n..\rtrJ Srxrc lf,qsftLriig k, htrikln!.r {ru.r aurhorizc rcr,rcs ivcs olrhh Ciry ond Counry k' c cr trB,n rtf,
<br />$ovc nsrrnnL\l propcny for insp.cti{nr purFs\
<br />lpprlconror,l*enrsknrlurc D\
<br />Pr-t * rr-r rlrt^", 0g4rz
<br />Set Ba9!S--
<br />Form tee oldowns )
<br />Erectio)rf7ds
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Roof Sheathinq
<br />Shear Wall A\
<br />Framin [-VXKI\
<br />lnsu lation/EnqGy rt
<br />Drywall fhAf,-
<br />Ext./lnl. Lath
<br />Brown Coat U I
<br />Ir/lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL ll -2 -tY
<br />Certif icate ol Occu anc
<br />Notes, Remarks , Etc.
<br />Ll-''r.'.ut
<br />to)
<br />Yr-2 t+(
<br />1t*p Elr6 f
<br />ID/SIG.COMMENTS
<br />t/v.\tl\d
<br />)nT
<br />$."vudt
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<br />Y
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