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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS OWNER BUILDER DET,CARAIION
<br />I hcrcby 0ntnr undcr ncnrlly ol pcriur] rhar I m cxcm,r tro'n lhc Grntd.n,s Li.cnsc Llw lor lhe rbllowins rcNni (5..?0.11.5
<br />llusinc$ snd Pr.rcsion Codc): Ant ciry or Counrt uhi'h r.qutcs a t'(n ro con{tud- slrs. imriovc. d.orolhh or rcpon any
<br />sru.tue. prbr ra its issulncc-ul$rcquirc!thcsrplkrnrf.tru.hpcflnirn)lllcasiBmds cmnr lhol hcor she is liccnsd Pu^oanr
<br />r. rhc tsvisiotu orrlt conlractols Liccnsd L.w (Chloq 9. Comnrcrci.E *ith sc.rir,6 7000 ol DivGion 3 of lhc Bosinc$ and
<br />Ptutu*nrnsCDdc)orrMthcorshetercmnlrh.relronmdrhci,a\isrorrh.ilk!.dcx.mption.AntviohlionofSccrirnT0.rl5byrny
<br />aprlicr tnr o pcirtril sul'jcch rhc aJ)plicanr k, acivilp.nahyolnor nrrc rhan nvc hudrcddollar (S500r
<br />L o{n.rotrh. roFdy. or myml,)loyes wirh $rses as thcn {,t compcisrn,n. willdo rrE*ort dd r,E slrudft n mr
<br />iNcrtcd or olIcrcd for slc (56 ?Ol-t. Brsi@ss rnd Pn,fcsions Cod.: rhc (intn rol s Liccnsc L.w d.es nor applt i(, !n o*ncr of
<br />rhclnlrny wla, huilds or nil,Fvcs rlrrcn. rd who dms su.n solt hinscllor hcrqlfor rhmugh his.r tur oun cnyt,yccs.
<br />pmlidcd rhar such impbEmnts e mr intcndcd orofNl fot$L ll k)*cwi rh. h{ikiinB or nrgmlcm h$0*irhinom Frr
<br />ofol{hr i,n. tlE Ow.cr Buitlcr *ill havu rlt bordm or noving rhn hc or shc dil nol ttrild or impmt dt poFiy fo. llt purlD* nf
<br />I.$owncrofrhcliropcny.rm.xchsivclyrotuadi',8wirhli.c\r otrttM\ h cotrnn.t rhc preict (Sec 7014. Suenc$
<br />tr t lhJfd\ir Codc Thc Contmctol s Liccnsc Laq docs nor opnly h m ow cr of pn,!.d y who builds or inPmv$ lhcrRnr,
<br />rtrd $ho contruchforsuch pr.j.rk *irh a Co .rcro(n licciscd rusumr lorhc(bnlmd.tr s Liccnsc ljw)
<br />Ilrvc.ndwillmoinloinaCcnificarcofC.oscmbsclllNrrororsorlLysconrEtrsation.!sptr,idcdLrbyssrionlTmolrhc
<br />l:'ixrCodc. r(trrhc p.'ronMnccof rhc"o,i tor whicnlhc I'trlnir n nsncd
<br />Il[v.rid*illnDflorworkcrrcon{'.nsarioninsurancc.rsrcqundhySc.ttun:l?U)olrhcLahorCodc.nnrhdpcrfonnrrc.i
<br />CU
<br />-l
<br />ccnity rhlr in rhe peraortuk. orrh. work ror whrh rhN Fnnir n nucd. I shall nor cmpk,y,ny p.non in rny
<br />w At,bc.onr sub(rt lo thc $orkes' .omrctr\al bn hw\oICxlii(mi
<br />worrcA onrpcnsrrion povnions olSarn,n :l?00nf rhc ltrhtr CoJ..
<br />wAnNlNc l.1rlurc r' q'u,c $,rh'.'.nnF'r\xrtr{ ! c'3r'. F u
<br />r, aid 4rcrh.r if I should hccom subjcd t, rhc
<br />I rhrll. f.nhBirhcomply silh rh.c ptuvision\.
<br />rhwtul. ud \hall snhj.cr M c'nplorr Io diminll F-trrlrics an'l
<br />ion nr rhc co{ of co'np.nrario.. drntrEcs as pnilidcd Lr rhcijm\ up l0 onc hundrcd rh.us.nd
<br />onddEm!'*r
<br />^pffi
<br />,l
<br />O I
<br />I furclJ! rnntriuidcr Ntrrlry.l pcrlrylhnr I rD llccr{d trtr{lcr tniinirn,o,(hxtrcr91.o .nncncirg Nilh S.crid 7000) ofDivisiotr 3
<br />01 rh.lni\i',c$ rnd Pdrs\n,ns Code. {nl fry liccnsc i\ if hrllftl\ !trd cilorr
<br />)-
<br />coNirf,ucurrxLDNlJlc-&Glll;r
<br />I h.obt amrn und.r Fn.lr, oi pcrjury rhlr rherc t a consrrcri,n L.dinB iScmy ior rh. PcriornErcc ofrhc *ork ror whi.h rhis rrmir t
<br />t\ucd {S.c 1097. Civ C.)
<br />l.c ilirhdrhclidcrrlrcSUhrnntrrclrdi',8r\h(no\.cnn,vdrrctroldt,fll.hl.r,rhisnn,l(r
<br />-t?ccnilyrhd I hrvc Bd rhh appli.ariofl ud nrlc thrr lhc rtrvc innrnr!ri,)n i tu.o.Dly qnh illCiltr d C,,uniy
<br />.r(l rn'..\ rDtlSrrrr I)s\ r.Lri,,g
<br />abnvc rtrrioDcd fruFnylnr l-
<br />;;lffi
<br />/&
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Boof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />./A
<br />FINAL t7--l't-u d"ptl')
<br />Certif icate ol Occupancv
<br />Notes, Remarks, Etc
<br />Set Backs
<br />Sublloor/Vent/l nsu lation
<br />I dnrcxcnrDr utrdcr Sc.uotr .B &PC f,{ 'hi. rr"on
<br />Dite: Okner:
<br />ua8$;al:g.DltDNll-u()!
<br />DECI.A&TII9tr
<br />I hcr.byillirBundcrpcnullyof p.rjrryu..f rh.tullosi'rtdcclaturnff
<br />dnrllrn\ri,,r i'truBftc.lnrcr ad lolicy numhcr m:
<br />l 6l+t
<br />AIIU9INLDICIABAIIAN
<br />I hcd'y -m!ndcr pen!lry orl,crjuryotrc o,lhc tollowinE dcc[ruln'ns:
<br />txmlirb. Pcrmih-Ash.sros Norin arion Fcd$alR.gulnrions (Tirlc 40. P0n6)
<br />-Rcquncd
<br />Lcrrc! olNorir{dion
<br />\or V[ 4->
<br />tt
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