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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS o\l\!R llLll-LrliR rlll ( ,\k,\'l l(r\
<br />I rE chy ar'ttrm unJcr P.nahy or !.riury lhlt I am crcmPr ln,m rhc C nlr.croF' l-i..n* Lf,w tar lnc rhllowi+ r.*)n (srJ70-1r 5e
<br />Ilus'n.\\ ,i'l PRrasi('n C, c): ny Ciy or County wh!.h rcqumi i t.rnir k, onsln'.r. alrcr' ihfruvc. dcmlish 'tr rFn mv
<br />nflcrurc. prnn n) ih i$trncc. d$ rcluncs rhc {'plicrnl lnrskh ncrmrt lt) rilc i sisncJ nrrcmnr lhir lror rhe ( lrco\cd Pusuanr
<br />r(' llr pn)vistr)n\ ot ih. Contm.ntr's Lire!*'i Lrw (chdflcr 9, C.mnrmins wirh Seli,'n ?Un oi Divnbn I ol lhc Busincs\ Md
<br />I'n,lisinr Cdlc)orlh iEo.\hc n.rcn,fl rhcft't'bnr ! d lhcbasis lnr rhc allc!&lercnrpron Any vn)[Ldnofse.ri{rn ]0'll 5 bv.ny
<br />nttlE.nr hra pcmir ul,j.ck rhc rmliu$l loa.irilp.nrlryol nor nrtrc lhan Iivc hundr.'ldourrs (5500).
<br />-1.,\
<br />dqn r.tthc pn'peny,(rn,ycnfloyc.s wrlh wrScsas lhet n,lc c.mFnsrlrn. *ill.lo ih.wo*d rh.srMrek*i
<br />inlcillcn or orjclcd lnr \dlc (s.c.'704!. Rusi,cs lnJ Proli*(n,\ Cotl.r Thc Corrracnr'r t-iccnsc Liw noc\ nor {plv b an ownc! oi
<br />ih. !,$r--ny who br J\ or in\s)rcs rh.R,n. a'xl *h des skh woi{ hin\clf or ltrcll or lhmugh hii or h$ own cnrflovccs
<br />on)vilctl rMr n'.h inrpn,lctunB iEfrn iN.ndcJ oroltcrcJ r,n sL. Ir, l$wcv.r, rlI huilJiry oriqm,vcm.r 'sa,Lj{irhmom p{
<br />ol onlPllil)n, lh. O*ncr Btil'l& wdl hlr thc blrdcn ol pn)ving rhd hc ot shc t]d nol huiu or i'1lltuE thc Ptrpc1v tot rh3 nurtxNc ol
<br />L {s owncr oi llr pop.ny, rn crclNivcly .onrm.turg siu l'&n{d . nr..t)F n' connrud rlE r}n'lcd isc. 1}t4 BNrcs
<br />aBl lrrni\sir C\d.r 'l hc Conlrarktr'1 Lic.ns. Law docs ndl apPly !r an owncr di !r.o.ny who huiU! ur Inli()vcs llrrcon,
<br />, wh..onkrcGlnrruchl)i,jc.Bwirh!6nrB.bns)h.cn\cdt'rrnunllorhcConkrdtrsLi.cn*Ln*)
<br />B & P(...{ rl,h n r! n
<br />l!1185!8,rgo![ENsarroN
<br />DECLARATTON
<br />I hcrcby arhrm undcr ncmlryoipcdu.y Dm oflhc hllowhs 'ieloarthil
<br />-l
<br />haE iJrl will n.i, ain a Ccn il-Erc of Cor{d ro Scllt.surc Iff worL6 oml'.nsdion. !s ln)viJcJ turbySciiotr l?0Oolrht
<br />bt r CoJ.. tu rlE pdro,r1e of lhe *,l* tor wh(h rhc lcmn s hsucd.
<br />k hdvcr d wrll nurnrarn workc^ .onrFnsili,n iDsuEnrc. rs rcquncJ byS.cri,r.l?(X)ol ihc t-rh.rOllc. tlr rhc l.rlDnnrt' dl
<br />*.rk I whrh rhh Fm tr My workcr r.mt o\arn'n insurMce crri.. rrl F,licy nunhcr dcl
<br />I{nilyrharnrh.Jlcrlornlkcl,lrhcworktuPh rrln\t'.irnrl N tsu.J.I nmllnoi cryloy any lcintn i6anv r ncr
<br />*J 6 b hc..nF subjccl n, rhc wo'k6 comlcnsrltrnr l.ws or Cal,l(nu. rnl ieac lhar { l \h,uld tE om nrh]c.l b rhc
<br />work.s omncn\aiion po!an,n\ ofS.llon !?00ol lhc Uhtr Crxlc,I slull,fl)nhwirn coq)ly qrth rhos [ovisions
<br />IyARNING: ,jrilurc k, wnr. wtrkcr( compcn\irnrn.ovc,!. N unh*tuL rnJ ddl suhj(l in cnrplov$ (' dimril Fmltls !n'l
<br />.ivil rines !p h on hunJrcd rhous0 ,lolla\ (51 or $ry,€nsaron. J,mag.a as F)vidcd l'or rhe
<br />!lrtri.l!d!!!ll
<br />I h.rhy anrhxnd.r n trillyol Frjury rld I m lRn{i unJcr lmvnfi ol Chaflcr 9 (.ommNirs wirhsccrion 7U)0) ol Divirnrn:l
<br />of th. Businc$and Prcrcskrn\ CDdc, and nry li.cnic r '. rulltuc rndcfncl.
<br />7+o+0
<br />1
<br />CONSTRUCTION LENDING AGENCY
<br />I hcrcbt ilttm tr.dcr !.nnlty ol pcrjury rhi rh.rc 6 a .onstruclion !:ftlin! a8..cy lor rhc lc.li,tucc of thc work ti)t rhich rh( lmir is
<br />is$c,l(Sc!..11197,C'v C )
<br />APPLICANT DECI,ARATION
<br />I lrtr{,y allm under Fnalry or I'criuy onc ol rh. nrbwn'8 d.clrat ions:
<br />DcBnnion PcrhirsArbc(os Norilicllion aed.r.l Rcpuhin,ns (Tillc 4l). Prr6)
<br />_Rcqu,eJ t cr olNoriliarbn
<br />I c.nilirld rhcl..leialrcsuhrbns E3{'lin3 3\hc{osrc rJvrl drc n.r aIPl'uhl. o rhrs !Nlccl
<br />E;,,yihr r r, .,.*t,hF,,1,rl i.rrrr nl {ir. rhxrrhc xlitrc ul,trnr (m,\.or1.er lilrc.hro'ntlys hrll((yrnJ(, y
<br />ordD!rc.s rn'l Srrr. Lnwr nl ir8 lo [uildir8 rctyaurhtrnc r.Fc\cnr.rvcs oirhk Ci(t a
<br />abvc rDnliqnl In,pcny ntr inrf.c
<br />I 1
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/lnsulation I
<br />Roof Sheathinq 1/20-R,waq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />/FINAL // )4//)-X-> r 'ldtlttY
<br />Certificate bf Occ(rpancy
<br />Notes, Remarks, Etc.
<br />Pool Fence
<br />Flood Zone Certif.
<br />0
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