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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq t:5-13 J )affi5
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif
<br />FINAL '1,70,19 -It)cl*o4 /
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER BUII,DER DELCARATION
<br />I hcrcby olftm undcr pcnllry of p.rjlry rh,r I un .xcnrfl tiun lhc Conhdor' l,icrnse Lrw fu rh. nnhwir8 rcan)n (Scc.'7t):ll 5
<br />Blsnrs and Pnni\\i,, C.dc)r Any Cily or Cou.ty which icquncs ! rEnnir ro consrtu.r. nlr.r, inp()vc, dcnFlish or Fprt y
<br />srru.rxrc. rrbrb ils hsurfl... rl$ Rqut.silE ipllic0nr ior such pcmn b [hnsiSncd {nrcnrnt lh{l hcorrhe is lic.nscd luisulnl
<br />ro rhc pmviio.s olrhe Conrrac&tr\ LiLrns.d be (Chafl..9. Comnrncing wili Sccrion ?(xx) of Divkion.l ol rhc otrsine\! and
<br />Pnrrcsn,or Codc) or rhrr h. or rh. is .rc.rfl lh.rcfro a lhchush,trlh.lllcgcdcrcnPriotr. Atry viohtionoaSccrion 70.1I5 hyany
<br />.tilicanr r.r a p.rni subtc.krhc rpplicrnr to acivilpcnalryolnor nrto rha fivc hudrcd dollon (S500)
<br />-1.
<br />ar owncr ol rhc pn,Itnr. {n my c plorf,.s wnh s Gcs r\ rhct qrlc .o.rFn\d i,'n. will do rht sult md Ih. (Erm t frn
<br />inrcnJcd or ollcrcd f.r s0lc (Ss.70,+l- llusincs and t'rofcssnn,s C(ilcr Thc (nnrickn s l.i.cnsc t2e oc\ n.t 0mly ro ,n owncr ol
<br />rhcpDpcny $ho boild\ nr nnn('v6 rhd mn. ,rxl who dms skh w * hmsclfor hcrqlforrhR shhisnrhcrown.mPloy.c\.
<br />prcvidcdrh ech in,[ot'tunr\ nn nor i' cndcd .r orc(\l hr slc. lf- ho*tver. rh: huildinS or nNnno.trl is mll sirnin ',nc ttr
<br />ordnnnhri,n. rh. O*mr Buitd Nillhnrc rhc burdcnolOovin8lhllhe or \h. did d huin.r iliq,oR lhc tmpcny lbr rh. Px{s{ or
<br />-l.rs.wi.rolrhcfloltrny,trmcrclu\ivclyconlraclinEsilhlicc.scdconta.k,Nk)con(ru.rrl*In+d(S.c
<br />7rl14. Bu\irrcsr
<br />!,xl l'!trhsion Codc lhcConrracroisLiccnl.I-rwddrnor{r,lyro{oos'n.rolpmp.nywtu'buildsorimlrorsrhcrcon
<br />rnd uho onrh.r \ fttr sr.h tnorcis wirh r Conrradu(r) li.cnscd pursuntr( tu thc ConrNhis l,ien\c Liw)
<br />I rn.r.'nm und.r S..ri,n
<br />lIORXI'RS' 1:( ITITFNSATI(
<br />'NDEII^AAI]Q!
<br />I hcrchy ritlrtrr trndcr pcnrlly oipcrjuryon. olrhc f{ilk,si'r! dcclrr{n rl
<br />l hrlc rlwillrEn irnCcnificllcolconscnr(,SrltlNur.f(trworkc^ conDcns io!.as rn,vid.dforhrSccrionITOOoirhc
<br />l,a}xr Gxlc. rff rhc p.rroauncc of lhc w.rk for trhi.h rhcpcmir i\ ir\ucd
<br />rhc sork hr which lhi\lrcrmii is hsuGl [i, work.rL conrr.ns,ri({ iNut.ncc .rri{ :md E,li.yrutr$n ffc
<br />-l.cdiiyrhrri.ihcncrra
<br />ukc.lrh.workf rhrhrhispcirnil is issucd l shrll nor cnlPloy any |Er$n io 8ny ntrnncr
<br />v' n\k,ltuotu subj*! r.rhc workcis'comF sdion laws of Crlif{,hia. rn a8rc h.r ifl should hcc..t subj.trr.rtE
<br />worr.r{ .onlP.ns.r ion povhions oI Ssrion 3?00 ol rhc L3trn Gxlc, I rh.ll. Iiflhairh .ompl, sirh rho{ l]()!is ioni
<br />WARNINC Frilurc ro suN *orkcis'conDcnsarian c.vcrngc is onl tul. Md shlll s'brcr an cn,Iloyc. t'.rnnnrl FtrJlri.s od
<br />cnil finc\ up t' oi. hundrcd rhousand llx).1[x)). 'n Jdirrn] r, rh..,,!l .l.,trnlxrNrri,nr. r r!c\ ir nnni{i.d tur r[.
<br />1076 ofrh. tibo! Codc- intclcsl
<br />ulrllro
<br />![(liBtrlIUT
<br />ufdcr F)vlnnr ol Chrfl$ 9 (sm'rcncins wirh S.crk,n 7(xxr) olDivhion:l
<br />.f rhc Llusircs\ rnd l\olis\i,rN Cod., d ry lirc \c { lllllr) N r clli.r
<br />,"" \, I
<br />I r.n\c Nu'nb.r
<br />!40 -4qu*W
<br />I hceby !fltn undcr Fnlhyorp.rjury
<br />issucd(Scc. :lO97.Civ. C )
<br />grsctuy lar rhc pcfir me oflhc worr ft, whkh rhh licnlil n
<br />AIETANLDECIASAIION
<br />I M'y!fimlndcr pcnuhy.tp.rjury otrc of rhc folloNin8 d(larurbnrl
<br />lxmolilion Pcrnrir*Ashsros Norin.ari.n Fdcfl l Rcguln'io.\ lTitlc 40. 1'an6)
<br />Rcqutcd Lcltcr oI Nolincari{,n
<br />)
<br />Ih.rrhy rllirnrrmi.r |rmlry of t)rrlurr_ rlrr I n
<br />l.tulc, . Nx'hc
<br />-
<br />thJcr-s AJdrcs.:
<br />-
<br />tt
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