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BUILDING. INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUII,T'ER DEI-CARATION
<br />I lrcrchy rilirm u cr pcnllty ('I p€rjury rhm l in crclllpi lb,n rhc Co.r{rntrr l-ictr* l-aw r,tr rhc tullowtr8 rcas,r (Scc?o:ll.t
<br />alsincs lnJ Pnna*ion Cc{c): Any Ciry or Coutrry whi(h rcqtircs a tcrn,ir t) c.nslrucr, allc!. imor'vc. J.molilh or r.Prtr ,ny
<br />slfl.turc. prFr L irs issunc.. ako rcqut s rh. .mlr i ldr nrch tErmir r' ilc r \i3nil nakmnr th h. or shc n lt{n\cJ N4uur
<br />b rhc tmvisions oi lh. Co.rractr's Liccn(d tiw (Chrrr.r 9, Connncfrin! wirh S&rion '7(Xx) ot Divrhn I ol rhc Bucincss and
<br />Pn)icsn,ns Cone)orrhar h.orshc $.rcq)r th.rclRrMd lhcbNi ltr rMallcEcJ.rc lFton. Any viul.lionofSccrion 70rl 5 hy,ny
<br />aptl'cMr rrtr dl).rnn subjcch lhc appli{anl lo a.ivil p.mlry oa frn m)ft rfidn livc hundrcridoll6 (S500),
<br />I. as owncr.frhc proFny. or nrycnfloyes wrlh wrlcs Js rhci, vrlc.omprtr!tuon, *dl(]ll lhc wttrt u rh.(ermsnor
<br />inrcdlel or uff.rud tnr srL ( Se ?04,1, Busincs lnd Prctesnrns CoJ.: Th. ai)nkn roa s Liccnse Law doc\ nor apoly o an owrcr.1
<br />rhcpllFny who t'uil'ls or trnprcvG th.rdn. arxl wtx) J(B $rch etk himscll o, l[ncll or rhr -{h hs or hcr o*n cnrpn,yccs.
<br />provdcdrh.r $ich mllDrcnrnh rc rtn dcRlcJ o.oli.R{ h,r{h.lt, k)w.kl tlI hu lnS o mPR,hn.nr is dd wirh orc )ef
<br />ofdnylcrx)n, tE(Owncr Aurucr will hlvc rhc lNrdcn of nmrin-s rh, hc or sh. Jrl nor htrild or inll]n)w l]rc pn,Fny tttr rlr Puqx'c.f
<br />I. {s owrFrofthc Dopcny. !m.xclusiklyronrr.rin8 wih lun\cJ (onr&us h)llndru.r rhc lmr.r (Sc..'7(x4. 8u$Ns
<br />rnn Pn,is\rn Co'lc: Th. ContrNloas Liccnsc Law l,rs ool ipoly b rnown.r ottlfi)Pcny who hurl,ls o! imprcv.s rh.r.otr,
<br />.tu1 whr r.nrrach lbr su.h Ilfl,tccr wirh a conkx.ldn I'ccn\cJ Pusuanr 6 rh. (irnrrrcntr's L(.h. tiq)
<br />I dn c\cnr unlcr Sceri.
<br />Dil.' O*n.r:
<br />uaatra8s:l9rltElsar&!DE$ atrUo!
<br />I h.rcby arlirm uidd p.nrlry of gc,jury om or lhc Intu*in8 Jelmrn,ns
<br />'-I hrvc dJri will minrain . C.nilrarc of Cotrsnr lo Scu:ln\urc for work 6- conr!.ns{ b.. trs tnlvtlcJ lor br S.crbn J'700 .f lhc
<br />trhlr CoJc, ,or rh. ttrlomc ol thc poi( for whtt rhc Fmi n i\ucd
<br />{r U," on,l *itt.ninoin *"rlcE conl.nsdion insnnc., as rcquird hy Sccrn,n l7m oi
<br />'h.
<br />hbor G)dc, Ior rh. rnom4. oI
<br />th. w{rk nx whNh lhi\ Fmit ii i*udi. My *orlrcB .oma..sarion inslanc. ttri.. aJrl Flicy ntrsb.r el
<br />(..""Cnu,rgcrr-tr.rr l,r c-c)
<br />I lz-o,"*,*, 56.GfS tt-'l t - ol - 1 6 ?I
<br />-llrnifyrhd
<br />inrh.lcrfonmN.f rhcwork li)rwhch rht pcrh,\ t{Ed. I drll nol
<br />$ s N hcom suhjcd nr rh. wortrc^ d,n{.nsaion Ilqs otCnlihnn!. d ryrcc rhrr 'tl \
<br />w.r*cr u,Fnnir rnr n('n\ .l S(hon ]7m ol r hc I ]lrtr (ndc. l \hrll. linn,wnlr
<br />cnq,n,r.r ro cnm'nll |)cDlrs l
<br />ion, .lahr8cs !s F,vilcd ll'r rtu
<br />IVARNING: Farhrc ki ecurc workcn !-mFnsr(ion rov.rrlc is trnhwlnl. r n'!ll
<br />crvil lscr ut l. onc lNndrcd llmusrnd Jollr\ (Sl{D.(x1o). m a'tJ'lknr o rhc co( ol
<br />s.(rrr:t07601rh. Lrhtr (if,tc. urrcrc( rnd
<br />i
<br />PECIAEAIION
<br />I hcrcby atftn und.r Fnalry oI perjury rhar I d li&n*r unLt r l,ovlbn or Chiplq 9 (@mnEdia8 wllh seto. 7uD) ol Divnion .l
<br />of th. ausift$ Nnd Pofesions CGie, lnj ay liccn{ ir in {ull for. ,nd cffer
<br />K**".n
<br />K,,","
<br />ArILI.LANLIEELAIAIXTN
<br />I trrcl'y {riim unncr pcnrlry orprijuryotrc ot lhc LlLwine dcclarrri'n\:
<br />Dcmohnrn Permirs-Asknos Noriticdtin Fcdcral Rc8ulatnns Oirlc 40. Pan6)
<br />Req!iEd Lxrl.r of Nor1n.{iun
<br />4-,;;
<br />ny rhrlrhc lcdcDl rcgtrhrn,n\ rcgrdn,g d\hc(* r.ntr
<br />!har Ihrvcr.<hsnpplarrnnr.nilnrrcnur0Bih,vc ( i( cdrc.l. I rgre b mmlly w h rU C(y nnl Courly
<br />huillms. n(ru.ri(r tL.,l xurhoru. rc[csnr{rivcs ol lhh C y dd Counrt to cntcr up,n rhc
<br />rlx)vc nrtrri,rEJ pol)cny i, nst^-(hon tu
<br />/t'emire narne Oant:\7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erectron Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lns u lation/ Energ y
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL // 16/JtD- r .UTL/ UY
<br />Certificate df Occupancy
<br />Notes, Remarks, Etc
<br />/)J Adao
<br />)
<br />UFER Ground
<br />v I,.N)n in rny nmNr
<br />Lt?t
<br />c.**""", k<rr r..a t? 6>--54 . \n.-
<br />CONSTRUCTION LENDIN(; AGENCY
<br />I hcEby a[irm un,icr Frolryofp.rjury rhdr rh.rc Ls a.on(ruclbn lc ins a3cncy br rh. ,.dnrMtc of lhc worl it *hi.h rhn ltmil is
<br />issucd (se. Jo9?.civ. c )
<br />I inJ -'. Nrir
<br />t nJ.is A rcsr:_
<br />m( r|]l'l'(a61c k] rhs |'n,rrrr
<br />** ) lr* lz-,
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