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BUILDING- INSPECTOR HECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER Bt'ILDI'R DELCARATION
<br />I hcrcby rflinn lndcr pcnllty of Nrjtrr, rhrr I an cicmpr lmn rhc Conkac(r' t-iccns Lrw ror lhc rollowin8 rcrson (Scc.7)11.5
<br />Bu{ir.\s nd ftolas\ion C.rl.): Any Ciry .r Garmy whi.h rdqunc\ | Fanir lo mNrrucl. alrcr. inEovc. dcmohh or rprir rny
<br />{fl.htrr, rr.r lo irs hsun..c. rko rcqutcs rhc amlic,nr f.r su.h!.nhn io filca signed slalcm ln hcor sh. n li..n\cd,rxrsuMr
<br />b rhc pnrvnions of rhc Conrractn s l-i.{ns€d ljw (Chrpr.! 9. C.mmE-in! sirh S..riotr 70dl .f DNtion I ol lhc Busincr lnd
<br />Pnrlc\si,rrs Codc) or rhd hor\lr iscrcnDt rturcfron0nd lhc bNs for rhc rlle8cd cxcmplion AnyliollrionotSscri(,n70:ll5 hy rny
<br />opplir!.rforrpcnnirsubjatsthclprlic!trrloacivilpcnlhyofnornnxthanfilchundr.ddollan($5m)
<br />-1,
<br />rs owncr oi rhc foacny. or my cmplorcs wilh wlgcs as lhcir solc ompcn$rion. sill do rhc work &rl rh. dndurc h ml
<br />inrcM.d or oflcrcd for sL (Sa 704J. Btrsines and Aofesionr Codc Thc G)htact,\ Li..n* tis dms rct ot,,ly ro an osncr ol
<br />rh. tDFny who build\ or inpfr)Ks rh.asn. oftt wh() drrs such qrrk hnnsclaor hr6.llor rhrough his or h.r own c'nPloycc\.
<br />pn,vid.d rh,r such irpmrcmft m nor i,ncnddi o' .fltrtd for skr Il t()*lvtr, rh. hurklm8 or in!)ovcmnr h vrld *irhin onc Fr
<br />olcompldion.lhc Oqncr Buil&r willhlE rhc tordcn olrmvins lhlr hc.r she did nor build or inpow rhc tmFny for lhc Nrtrs ol
<br />l.r\owncrofrhcpmr.ny. r cr.lusivcly .ont..ring wirh liccned .oNi.roh h con{ ru.l lh( pojNr I Scc ?(U:1. B!\inr$
<br />r Ertr\rhncodc: Thc Conlrdois Liccnsc Law Jocs not applyb ano$ncr orpi{'rc ywho huildsot nnPr.vcrlhcrcor.
<br />trnd eho conrr(rs in such In,rc.h snh a Gn tuck,nn licenscJ r\urnr Iorhc(in rrctols Liccnsc Ii$)
<br />I rrcr.mpl und.r Sr.ii,nr
<br />]taaK[&::(aufl]Ntarlo!
<br />UUELA.BAIION
<br />I hcrchyrflnnr!n crncirlry.rf.rluryoncofrhcfi)lk)sirgdc.lrfuridr(:
<br />Ihrtunlaill DinrninrCcdifi.rrcorCon\ctrrr'Sclf.lnsrrrfttrtr.rkcr'c.nD!trrdi.n.!s nroviJ.d fttrl'yS ion 1100olrh.
<br />ljhrC{!c.lorrh. n rror@nccol rhc Rork for*hi.h rhc pcrnrir i\ i\\u.d.
<br />I hrvc.nd willnrn rir workcr{ comncrslln'n io\ftncc. !s rcqutcdhySccri{,r.17fi).frhclrhdrCodc.lorrhcpcrinmanceol
<br />rhc work lorwhich rlris t flnir is isncd Myworkcs .omlcnsrtiur irNunncccaricr dd tx,li.y iumbcr d.:
<br />-l.cnllyrh[
<br />in rh. pcrtu.rnr.cc ol rhc wort hr w
<br />{) rsk, h.c.nrc \ubJ..r t,rhr workcr\ .omlcNnri,,n
<br />mr cmtl.y rny Pc*on in any Nnncr
<br />if I should hccom \ubj.rr ro rlr
<br />comply eiih rtn{ pn,vhnnrl*orkd( ..dp.isari.n fiovisio.\ olScdion ]lmolrhc t
<br />ItARN,NC l,rilrtrc l{, \ccurc *orkcri c.n,p.n\rri{)n co\c
<br />civil fircs u! k) onc hun,|!d lhou\rtrJ d.llrrs ($l(X).01[,
<br />and drll \u$Jccl rn cnDloycr t. clilnin,l Fn.ki\ and
<br />,r o( rl.o rmn\rlidr. dnruc\ n!,(,vnl tur rh'
<br />l)htr 1_,x1.. d.r.n xn xr
<br />,,",", oJ:6afo$^
<br />I hcrchy firmun c.lcnrhyorfrrjuryrh l nnr li.cr{d rtrdcr rnJv'\n olchr
<br />ol rh.llNinc\s rnl t'roicsions (ixlc. J n,t li.rnsc i\ i', fullnr.cxnd.ffN
<br />ncina wirh S..ri.i 7(XX)) oiDiviridr.l
<br />oVoz-?$,,.,,,
<br />I hcrch! rffirm undcr lEnshy oi ,.rj!ry lhal rhcrc h a consrrucrbn lcndinB asenc, ror thc l).rromncc of lhc rork for shi.h rhh Frnn !q
<br />issucd lsec. 3097. Civ. C.).
<br />AIIucrrNlJroAtrAIIaN
<br />onc otrhc tutk,snra d.ctrrrrir)ns
<br />rion [edcr!lRccuhrtN ('lirlc ]l). Prn6r
<br />n\ruEtnln,! a\hliosrenxtrrlJr nor 4tliehlc [, rhis D(]-tr
<br />lrcnirylrmr I hrr. r.a 'rti,raid rrcrhdrhcat v. iflnnluion isc.trccr lagreroonrplrwirhrllCiryandCoutrrt
<br />icrc*nrarives otrnh Cirylnd Counrt k, cnrcru|ntr rhc
<br />"*'oe-oz:?o$
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />D rywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL t0-il -ly It-W)t)
<br />Certif icate of Occu anc
<br />Notes, Remarks , Etc.
<br />T-Bar
<br />tt
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