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BUILDING. INSPECTOR RECORD
<br />DATE tD/slG.COMMENTS OIVNER BUtI,DOR DEI-(]ARATION
<br />I h.rcby dfftrm tr, cr tcniry ol pcrjury rhar I d .r.hrr rn,m rhrtont..ro,ilNn{ litr nr rhc tollowmS E.nxr.(S( r0]I 5 '
<br />Bunncss inl Pn,{asn,n C{i]c): Atry c(y Dr Counry whth rcqnrrcs a p.rmir i, cunndd. dlrcr. imt'flrrc. dcmoli\h 'r rI'Jn ,ny
<br />srNcrurc. prut' r '$uancc,.ho rcqurcs lhc appli.anr tu. surh p.mnr k) l,h d \ilncd n.lcmnr rhal lro, \h. r Ii..n*J Naulnr.
<br />k, thc p&vnn,ns of rhc Co.kr(kt r Li..nwl Lrw lch. cr 1). Commcnuine wirh S&rtun 7tlo0 nf Oivision I ol rhc Brtrtuss anJ
<br />Pru&\sn,ns CdL)orrhd lr orshc is cxcmpl llrrcltufl aftl rhcl'ain nn rh.,llcscd.rcm bn Anyviohlinulseroh7011.5by,ny
<br />amhca tur r lcrmil nrhjals lM aprli.atrl lo acilrl|fnrlryornol nucrhan lilc hundre'l doll&s (S50o)
<br />-1.
<br />$ ow.cr orrhc t'()tf,ny, or mycmploy.ci wirh warcl rs rhcn n c oml]€nsaln4 *ill Jo ttE wGk.nd rlE *BrN is Bn
<br />inrc cd or oliiL{ ior elc (S(,7t}44, Buiincs md Pof.ss$ns CL{c: Th. Conkrcror's La.ns ljw J{rs nor ipFlv n' an owmr of
<br />rhe pruFny wh) bdills or in\srrcs rlrmm. aJrl *k! &xs seh mrl hinscll or hct*lf or rhruueh hn or ncr o*n .nplovccs,
<br />I(rvid.J thar such inpovcmm e d [lcnlcl ororLEl lor srlc ll hoErc., rh. ttrilmSor iqnlvcm s$ldY hinorcyce
<br />of compLri4 rhc owncr Bxilkr wdl hrw th. bur&D of poving lhrl k or \b. diit nor buili or iryrovc lhc l)nllary fdr th. ttu{rJs of
<br />-1.
<br />ns dwncrordr popcny. rnc\clu\ivcly.onlractog wirh l i.cnse!.1 conl r&ros k, mnirucr lh. lolc.l (Sec.1044, BusiM<
<br />and PnncsihAdc:'llt Co.krcrors Ltcnsc L.w
<br />'l@s
<br />nol lplly ro d.wn.r orr.P.(y qki tuilds or inptuv* rhcrcor'
<br />lnd wlrJ urnra.h inr ]u.h l,()jc.h wnh.6nrEclo(r) lic.n{d pusu l lo the G'nrradois l-a.n{ h* )
<br />l,m.r.mhrunJc.Scllbn .B & P.C k{rhtsrc,tnn
<br />WOR(FLS' (-'OI\IPENSATION
<br />ASEL^XAIION
<br />I hcrc$y 3ffff1u dcr pcnalry ot Frjury.nc.lrh. f(nn,wr18 Jc.larrlins:
<br />-!
<br />hrvr anJ w'll nuinrr rCcnrlicrrcolConsenrbS.llrlnsrrc ntr workcr'conrncneton, as Pn,vdcJ ii,rt'ySccrion 1700ofrhc
<br />lrnltr C.xk. ntrrhc pcrfdm.,f,e.l rhc wori r{, *hf,h rhe p.mir r $kJ
<br />[:hav. rtrdwill maitrrsin vod.6' on'p..s.oon rsutafrc..s
<br />work ror which lhisl}.mirh i$ucJ. My wolkcr' oml*trsrr
<br />rcquircJ by S.d ion l70O .l rhc Labor G),1c. fttr rbc J)crfome! ol
<br />a'ltrt'o'tryNmt.rm:"*,", Slatc !^fl l/A
<br />aLa +q 7a z)
<br />-l
<br />c.dity rhd o ihc p.rLrrmnuc oirhc work lor vh'.h rhN rcnnir rs i$u.,1. I shrll nor cnploy rny Pcron n rn, nan..r
<br />s) N to h.d,m s,bisr lo ric wolkcs' comrcnsaron hws ol Calibrnil an,t lg(c rh{ il l slDull tr$nc bl.dbrlf,
<br />workcri .omocnsar ion !('!ir$N of Sccnon 1?00 oi rhc lihtr C&lc. I \h l, lorlhrilh confly qirh rMr lln)viurs
<br />WARNING: Iidrltrr. r) r.ur. w(trkcr'conrcnsartr'n rovchlc N unlrw !ftl shdl suhier m cBploy., to dmin.l FEli.r r.d
<br />.ivrl ftrcs up.ro onc hun'lEd rnou\M't doll&s (S,00.00O). itr adJiri,,.on of comFnsarbo, natuscs as |rovidql for rhc
<br />s..L.n 1o7n ll rh. [hur cuic
<br />,",..dlt"/zo
<br />lnl.sn"ndrt.flrv.sl,c.s
<br />,,'".Jm trhdcr Nn.lly oi pcrjury I har I an lic r tn'vrlk)n orChrflcr I (commncing *irh S.clir 7{{D) ol Divnn'n l
<br />of rhc Bosircss and Porcrsions C]lrdc, &n my li.cnsc n in [ill rd( ,nl cilEt.
<br />[oZtz y.
<br />7<)
<br />I hcrc$y altirmutulcr p.nalry orFrjfiy rrtd rl'crc t i cotr
<br />'s\u.J
<br />(S.c. 1097. Crv C.l.
<br />irn bndinr lSctr y tur thc ncrtomaE-^c oirh. work hr qhrh rhk lEmrir !!
<br />AIIUCAILIECIAf,AIION
<br />I tlrc6, .llim undcr pcnall, ol pcrjury oft of rh. lnllowtn8 dcclirrl nns
<br />Dcnknniotr Pcirnih-Ashcslos Norilicarioi F.d.r.l Rc8ulll6rs (Txle 41, Pd6)
<br />Rcquirc,j l,il{oi Mnific,rir.
<br />-l
<br />c.nrfy rhdr th. fcJ.rrl r+ulariur rcSadioS rsl*ior d.$val a. dr amlrihlc t rhl prujd
<br />S .cn,iy rh l lmvc ErJ rh,\ xprl'utoi dtul nrrc I ih)vc irltnmti,,n rcoftccr I rlrcc t, uo,nply wirh dl C[ydtrd Counry
<br />onlrnnucsanl Stalc Laws rckriry 6bu'ldiq con{
<br />,lsvc mnl tr)N.d ,rn'pcny nx irspccrion purp*s
<br />,\oDln.{nl or Arcnr Sim{tur 'a hec,"a
<br />rcFrcscnr ivcsolrl'nCnyand
<br />13 d
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\4ason ry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />,17- I
<br />FINAL 2ldlzo Dk{l)n.ilsq
<br />Certif icate of Occupancy lr
<br />Noteq, RBmarks, Etc. I2l*24rl I
<br />SITE.WORK
<br />Forms/Steel/Holdowns
<br />T-Bar
<br />Lrklr''r Nanc
<br />-
<br />tin,l.i. ,4 lJrc*'
<br />-
<br />f--r
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