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BUILDING- INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS oWNER BIJILDER DELCARATION
<br />I hcicby rfl,nn undcr pcnilry ol Frlurr lhol I uncxcnpr fmmlhc Conlr.clui Liccnr uw lor rhc rohwirB rcason (Scc?0-11.5
<br />Businc$ ard Prolc$ion Codc): An, Cir, or Counry which rcqui,cs r p.mir k, .on.rfld. 0lra. nnt (,t. dcmoli\h o' qun nny
<br />{tocrnrc. dorlo ns h\rmcc. al\o tunuircs rh. rppli.dnr r{tr \x.hl.rnir ro nka lgncd slalcNnt lhll ncor fic n lic.itd |)unuml
<br />!. rhc pmvniotrr oi rh. Co mctois Liccnsd tis (Chorrcr 9. CommtuinE wirh s..rion 7fix) of Divnion I oI Ihc Busincs and
<br />PnnssionsCodc) orrhar hcorshc tcrctrDr rhcrcfr.o!!d rhc bdri\ ftnrhc ullcgcd cxcnrlrion An! violuriotr ol Ss1n,. 70:l I 5 brn.y
<br />appli.!trr r s pcrmir \rhjek rhc artlicrnr ro,civiltcnrkyornorrmrcrhr. fivc nundrcddolhr (3500)
<br />-1.
<br />!s osnc, oi rlrc !rcFny. or my enrlortc\ sirh wases N rhct solc cohp.ns n,n. sill do rlt N o* ond ihe stBlEc n fr,
<br />ilrcnded or ottcled ao! ul. (Sr 704.1, Bulincsr rtrd Pof.slbis Cdlc: Thc Cb.trrcrols Licen\c l-,w dorr nor sptly b trn.wmr ol
<br />rhc tmpcdy sh( t'uild\ or iDprou\ rlE(nr- uxl who des sEh Ro* himrcll or h. clforrhmuEh hNor h..owncmployccs.
<br />lrnvidol rh su.h impmvcmtrh arc mr intcdsl or orcrn for slc. It. howcq rh. huilding or inrFowrnr i\ sll *irhin otu }!r
<br />ofcomphri{[ rh. Oqrr Buillcr will hrvc th. htrd.. of nmvin8 rhnr tL o. $c did ml hoillor ia{trorc rhc F,prn, f(n th. purtF$ of
<br />I. a\ owNr or rh. pn,Ndr, ,n cr.lusirly conrmcrirB wir h liccn*d conlftcxns h .on(rucr rhc pn+d (sLt 70,14. Buvrcss
<br />utu IhlssionCodc:'lhcConrrsctnsl-ic.ns.l-trwdocs.orrflllyn,ri.wn$.rroncrlywlnhuildsornnprorcslhcro.
<br />nnd *ho cora.rsrdr su.h roirts sirh . Co.rrron9 ltun*d purunr ro rhc ConkKttr\ Li.cnic Ltrs)
<br />Y:::i|,]3ry orlcrjurr onc of rhc followirE dccl.mri,'ns
<br />lhalc rid sillmrinrrin wo*crs'conrEns.riotr insunncc. n( rcqutcd hyScction.l?(Xlolrhc ljborGdc. for rhc P$liirmncc ol
<br />lhc wdrk fd whih rhi! pcnnit is issucd M y sorkcn .onrpcnsliofl irsunncc cxnicr u poli.ynunh$dc
<br />-ExDiEr
<br />-,
<br />ccnirrhor in rhe perlortuncc ofthc work for shichrht pcidn is n{rd.l drll.ot cnrPl('yanytr6on inrnynrnicr
<br />si ,s t, bL..nr subjc.r lo rh. workcn omDcnqriotr lrws of Glilhmi0. $d llgmc rhrr ir I sh.u ld hi.orh $bad lo rhc
<br />workcr( .o f.nsarnr liovnions ol Sccr bn -U(x) o, thc titi, Cntc- I shrll- fonhsirh comfly Riih rhs Ptovhion!
<br />BARNIN(; frilurc k, R.urc workcF coN|xn\ lion.nlcuec is
<br />.ivil linr\ u! k, onc hundrcd rlFtrsrtrd dolnr (SIu).0UJ). irr ad
<br />cmtlo)rr ro cinrinrl lEnrlrics !nd
<br />rn,n. damScs r! providcd for rhcg::Xpil; ':
<br />/, n"*n,.r,r,, uuu", n"u"r,", *u*r,n,
<br />of rhc Busirc(sand Pmfc$iotrsCodc. onl
<br />I am li(n$drndrr ln,vi\nnrofChrprd 9(unnErcingwirh Sccri.n 70Ul
<br />my liccn\c is in lulllbEc rnd.lltcr
<br />V""btr'E
<br />t,.lP felY:t r(Wtg
<br />*ork lor shichlhk pcnnil irI hcrcb) lllrn, undcr pcnrlry orI.rjury rh r
<br />i$ucd (Sc..3l)97. Civ. C.)
<br />rc! xlJrlllrNt[Nul!(;iliEN0
<br />hcr n a $n{ddknr Lndirp rrcmv lor lhc pcriarromc ofrh.
<br />AIILIIJANI.DECI.AAAIIIIN
<br />I hcrct y.fiim undcr pcn0lry ot perju.y onc ofrhc rolloeins dcclarart'ns:
<br />DcnDlirnJ. Pcrnrils-Asb.nos Nolific ion l'cdcrrl RcBuhrnnN (Tirlc.l0. Pan6)
<br />-Rcqutcd
<br />Lcllcr oI Nolilicori,n
<br />l.cdity lhd rh. fcdcrnl rcguhrions rctnrdirg !sh.slos rcnn,vrlnrc nor !!plicnhlc k, rhs piidd
<br />lccnilyrh l hrvc md rhisnpllicir rh.rh,!. nr,{a,xrrI n.r' rL{ I gr\r,.oDrtlyw]rhxlL('itrrndCor ry
<br />oi(lirrnccs ind Slal. Lows rcLlling lo h.Eb, rorhot. rc[cantdrivcs olthk Ciry and Coury ro.nr$ uF,n rhc
<br />'\Uric.nr or.\!.nrSixn,lu
<br />'l
<br />tIP.mrile mn* lprinl):
<br />o{a,lra
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />ln su lation/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL b-5 -ts J)eSsf zfi\
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />rl
<br />t
<br />SITE-WORK
<br />I hrvc ,rxl will tuinhin a Ccnifi.a(c ol Cotrsnr h s.l trsurc i{tr wo.kcs' onncnslrio.- a\ pmvidcd lq by s..rbn lTul of lhc
<br />titx, Codc. ntr r hc lcdorrorc. .f ih. wo* for whi.h rhc ,$mir ii nsucd
<br />1fltQ7?9
<br />dh,v. nf,nrbdcd pn,lcdy tor
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