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BUILDING- INSPECTOH RECORD <br />SITE-WORK DATE tD/stG.COMMENTS OWNCR BU!LDER DELCARATION <br />I hcr.by aflnn unld rmhy of pcrjury lhd I m cxcnrtl irom rhl Contrcbn Li.cns. bN lnr t[c foll{,sin3 rea$n (s.c 70.]l 5 <br />Btrsinc$ $d Prnfession Co<lcl Any Cir, or Counry which rcquncs a !.iinit b connrucl- alr.r- intl)rolc. dcflnirh or ml{n any <br />dtucrrrc. !*'r b ic i$urn.c. Jk rcquncsrhc f,,lic.nr lor such pcrmir ro lilca \i8 dd s.rc'ftni rhar trorsh. n liccn\cd nuNut < <br />ro rhc prcvisions ol rhe Contacntr\ Li..is.d L'u (Ch,rrcr 9. Co,nmcncitrs *irh Sc.lin 70fi) of Divi\bn I oi rhc Busincss rnd <br />Pnnas\ionsC.dc)orlhrrh.orrhcncrcnrflthcrclionrandrhehlsi\lorrh.allc!.d.rcnlplnnr.AnyviolorionoiSccri(n,71)-ll5byrny <br />atplic r l.ra p.rnrir suhjcchrhc applicam ro acivilr.nrlry.rnor Drnrh fivciundtcidollars($5(x, <br />-1.alowmrorthcEoFny.rnmycmplorrcssnhwrscsaslhcnv,kconrr.nrarion.siudorhcro.ndrhc{trlwi\nori c.dLrd oruficrcdftrsi[(Ss?(]+4.ausincssondPnnasn NC{ cTh.Coiri.crotsLiicr\cliwilocsnorsrllyt,mo*ncror <br />rhcpmpcny *lxll ild\ .r imlnrv$ rtr6n. ilxl who des srch r.!t hinNcll'or hcrrclr ot rhn,u8h hh or hcr own c Un,yccs. <br />D.ovidql rhd such iqrorctunh mfln inr.d.n offml f(tr slc. ll lbwcrcr. ltr huildin! or inptuErEnr k eH wilhinom )c{ <br />or L$mplcrirn. tl$ ot nd Euiklq $ill ha'r lh€ hrdcn ol pmvins rhd h. .r \h. did nor huird or iryrorc lhc Impcny fi, lhc !u{rM or <br />I- nsown rorrh. pn)!.n!, rm.x.nNivclyconlr0crirs wilh licco\cd cor r(kn\ t, co0$flcr rhc pdcd ls(. 70+r. Bunncs <br />n Plrni*\ Codc ThcConlructn \ Liccn\c l-rwd.c\ n.r rmlyto anowtrcrolpropcny*ho buildsor nnpn,vcsth$con. <br />trtrJ who contr.rs n, ruch pmrc.ls *irh ! Con!do(r) licenscd IrAUUr h rh. A)nh.hr\ Li.ctrt ti$) <br />-l <br />!flcxcmlr undcr Sccl <br />lla8.6ErlLll]I]trNsAr()! <br />DECIAAAUAN <br />Ihcr.hy rllirmn s penrlry ofp.tury onc ofrhc nnL,*i'rt dNlrrrri.ns: <br />lnlxn (i(1.- lirrfu pcrlnam .c ofrh. s.rk Lr shi.h rtu ltnn I is i\{'cd <br />_l hrrc a {ill nui'nni'r workcs ...rpctrs.lii inatrrn.c. as rcquircd bySccrn,i.1700 ofrhc L.hor d,Jc.lor lhc pcrt{nnEiccof <br />rhc *sk tu $hichrhtFrmi( i\ i\\ucd Myw.r*.s .onlt)cnsrliur iNurm.c cnricr rnd Frli.y nu rhcr m] <br />-l <br />ccniiy rhol in rhc perrorrom. orrh. woik r.r ahi.h rhi\ l)c.nir n ksucd- I shau to cnPk,yanyrfisotr in trnymanrct <br />$ s t, hc.um \uq&i tu rhc sorkcs conrr.ns.rion liw\ ofcllinnrh. rnd ssN lh{ irl .hould hccom subjccr ro rh. <br />wo'krn.a,mp.isrri.nptuvhioNofSalionl?molthcl-ihtrC.dc-Ishrll.nflhwirh.{NrlywirntbtPori\ior\ <br />wA|NING Frilurc to B_urc *(trkc6 .ompcnsdiinr me.Egc ir unherur. a.d dmll suhjccr rtr cnDloltr r. dinirrl t frrlti:s a <br />ro om hnnd.cd thousond dolh.s (l|fi),qD), in sddin k, rhc.o{ oi .onucnsrrii,n, dor€cs ts Providcd l'or lhc <br />scctio 10T6ofrh. tjbor (iic. irrere( md a onry \ rr.\ <br />IlErchyaft uktcr Fnrlry or Frrury rh l anr li(cNcd unncr i!ni{tr,,n('hrfrr' 9t.onucn inE$irhS.crion7([D)otDn*n,i ] <br />oi rh. Bu\incs x'!t Pnltl\ioi\Cod.. d my li.cn\c i( ir fullhrce aul cllLcr <br />l-i.cns.Clrs:- <br />I hcchyntlir u.d.r Fnrlryorpcrluryihd rhcrc n a con(rucrion <br />h$.n (S€.:1097- Civ C ) <br />odiog qcn.y frtr rb. Frlolmmc ofrhc aork fttr which rhh Fmir is <br />AITLICANIIICLdIAII!}N <br />, hcmt y atfim undcr FnllryorFjrjury onc orihc rollo*irs dcclffolinns <br />DcmlirnnrPcflnih Altt{osN.rifi.art,n Fcdcr.l RCBUhriur(Tirlc4). P!rl6) <br />-Reqnncd <br />txllcr ol Norifi cari,n <br />IrdrilyrhrrlheLd.rlrcguhlionrEgrrtlin!xnx{.\rcN)vlJc ornmlnxb[hlh]slrlrcr <br />-l <br />cerlilyihd I luvcrc rhis lmli.r n i and sar. th, th. ,hr\t nrformrtion h corer I agre e, co.rrly qnh t0 Cny and Counr] <br />dtrrn.c\ rnd Srorc Lnws rcl inE ro huildinE.nn{tu tr,n Mdh.mbyaulhorizcrcprcscntarivcsofrhhCiryaddCounlrlocnlcrulnlnrhc <br />Il::.:i,,jl ]-#44 ',,"'4* <br />Set Backs <br />Fo rm s/Stee l/ H o ldown s <br />Erection Pads <br />SLAB Floor <br />Subf loor/Vent/lnsulation <br />Rool Sheathinq <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coal <br />lVasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certil <br />FINAL /ll\l7-"N^rr6)^21) <br />Certiticate ot Occu nc <br />Notes, Remarks, Etc <br />trndci, NrDc <br />- <br />tJrdcr'c Addrc*: _ <br />UFER Ground