|
BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDAR DET,CARATION
<br />I hcr.by r0nnr uNlcr pcMltyolFrjury lhlr I am cxcnrpl fronr rhe Conrr!.t,. Li.cnrc tjw r.r rhc r'ollowiry rc{en (Sa?0.11.5
<br />Br\incs\ r l Prcfcssn,n Codc): Any Cny or Curnry shi.h rcquncj , lrnnt lo construct. ahcr. inDrovc. dc.x,[\h or ftPrn nny
<br />srru.rurc, prbr h ns k\umcc. oho rcauircs thc omlica hr such [tmir lo filc r sisncd duretunr rhai r. .r sh. i\ li.cn{d Pursuonr
<br />b rhc pn,vi\tuls ol rh. Conrra.ktr s Li.c.*d u* (Chnt'dr 9, Co,nmcminS with Scclion 70(x).f Divhion I orrhc au\i".* md
<br />PmrcsidN codc)orrhrr hcorshc iscrempt rhcr.linrand rhc hasn ior ihc ullcscdcicnDridl Anyvi.l ionors(lim?0315hy0try
<br />antl'!Jnrlor!p.rnrir.uhj(r.thcanlrdnrrnrc\rlncndhy.lnnrni".rhadl^rhdtul'rdJcJr\'(\tro'
<br />'ft!.'',"**,"r,*,.*,ry.orn,ycnplorrcs*hsrg.\ssrhcnebcotr,pctrstion.w,ud.rh€wortu{,rhcsrrd@r,
<br />"
<br />irtcndcd oroflarcd lor $lc{Se.7014. Businc$ and lt ltssions Codc lhc(irrracroisl,icensctisdocsn.ril,tlyro,nownfiof
<br />rhc pmlf,ny who huild\ or impro*s rlrmn. ud wtx' dks su.h *\)* hnnscl, or hcscllor lhrcugh his or hcr o*nc'nnk,rccs.
<br />lovidcdihorsuch impmvcnEnls m frn inrcndol orollercd ir sE Il hrwchr, rh. hiklinSo! i.rpr.lcm h sok eirhin onc )cu
<br />orconpkru rh. O*ftr Buiklcr will haK thc t rdcnofpmvir8 rh,r tr or sic dd ml l{ir.l or improrc lhc poFn, ror rhc rurrFs or
<br />L $ owncr of rhc pmncny. !fl .rclusivcly conrod ir8 *ilh liccnEd conrrucroF to con(dd rhe pmFcr (Sft 7lx4, Brshcss
<br />and PnrissiDCodc:TtcConrlrtr\Li.cnscLawdffsnor,ptlykJr.!sn.rorpii,pc ywho build!or impmves rh.rcon.
<br />rnd who .ommrs for such lsrccls qilh . Contlcro(s) lnrnscd pusua lo thc Conlrack" \ licn$ hw).
<br />>""F,er
<br />lrrLtaat!(D
<br />I ho'.hl xlltrm unn.r |[trrLry olp.rru'j_ oDc of rl[ ln IN tr,! (lrrlnrrrii, I
<br />I hrvc r willnuinrai'rrC.n'li.rrcorCon\.nrk)Sclilhurcr(nworlds.ompcnsnrion.B\ ptr)vnhdartrbySc.r'or:l70Oorr1r
<br />l.ohorOnlc.lnrlhcncri.rmanccofrhc"brtforwhirhrhcp.nnir i\i$u.d
<br />_l hrvc rnJ sill trri' ni'r *orkcr' conprnsrri(n, i'rurancc. r\ rcquncd hySccriotr:lT0Oollhc hi.r Ordc. forrhc n rr.rnwr'. r
<br />rhc *ork l,n Nhich rhis pcrmir i\ nlrLrl My *ork.^ .o'q{tr$tun nr'uran.c .rrid $ trnicy nunrhcr m:
<br />l-J%inny thn n t6. t1!turtuRc.l rhc u'orl nr *h,ch rhi\ p.rn n isu.d. I shall nol cnpioy any pt(o. in any nrnncr
<br />$ as to 6com suhjecr lo rhc Boikcn compcnssrion la's ol Culili,rii,. 6d rg@ ihr irl shuld tEconE subrc.r lolhc
<br />uolkcn' cotnp.nstiotr pmvisions oa Secrion :17u) of lllc Lah, Codc. I shall. fonhwfh LsnDly *ith lhn* !n!isn,n\
<br />WARNING: Failxrc k, ecurc workc( ompcnssrion covcmSc rs unhsiul. ond shlll suhi*r a. cnpbrtr to riflIinll lEmhics d
<br />! 'l finr\ ut h .nc hun4rcd r
<br />sc.trotr 1,76 oL,lfrc tibolcodc.
<br />x"",..424r
<br />housrtrd dollars (Sl()o.m0). i. Mdirioo ro :ffin,r drnD8cs is provided i({ rlE
<br />iricrcsl !nddrorncy s lccs
<br />DECI,ANAIIa!
<br />I herchy aalth udcr p.ndlry of pcijurr rhar I lien{d und.r povkhn ol Chrptcr 9 (commmin8 sith Sdcri.n 7{xx)) .r Division 3
<br />of thc Busimss and Pmfcssions Code. arn m, lt.nr t in flll tue lrl cflatr.
<br />C()NSTRUC'I'!oN I FNOIN(; ACENCY
<br />I h.mby rfiirnund.r Fnihyofpcuuryrhar thcrc h a con(ruction lcnding lscnct f.r rhc p.rloi,nmcc ofrh. work li,r $hi.h rhis lf,nnn t
<br />i\\!cd isrc .]m7,Civ C )
<br />APIIICAIIDIiCLAEAII!}N
<br />I heby drtrm u.dcr lEnnll y or pcrjury onc olthc rollnsin8 dcclarari,ns
<br />Dcfrnirnr P.nnirs A*hc(oc Noliil.0riotr Fcdcr!l Rcsulorions ('lirlc4l). Pln6)
<br />Rcquircd hrlc. uf Norifi carhn
<br />ilyrhi rhc ltJcrJlruguhri(nN r.Eirding r\h.rrsto tr,vrlarcfornl]pi.{hlct,rIi\pxijo.r'#*:y rh,r I hiv. rcld rhn amhalion ud (drc rh|( lhc ahorc irfonurion n corc.r Lere ro..mPlt wirh all Cil y r Counry
<br />dd Srrrc ljas rcldiD! k)bui consrru.lion. drl hcrcbyaulhoriT. rc!rc\cnrrriv.s.rrhn ciy.nd Counr
<br />rh.rc trEtrri{) r,l nr)n.'ry l(tr i,,\|r..ri,tr/
<br />\ppliunr or As.nt slsmluF c7 //4*
<br />4184zzz
<br />x
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground )
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framrng
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lVasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />FINAL PlalR n '-?s)
<br />Certilicate ol Occupancy IIUV (_-,,'
<br />Notes, Remarks, Etc
<br />\
<br />I
|