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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNi]R A!ILDER DELCARATION
<br />I h.rchy rmnn utrdcr p.nnlry of pcrjury lhal I 0n qenrpl ln,n lhc Contac($- Li.cn* Law lbr lhc lolloeins r.r\.tr (Sc..70.11.5
<br />lru\incx rnd P,ofc$ion Co<lc) An, Cir, or Coonr, ahirh rcqxn.t n trnnir to con(ruc|. alrcr. inftuv.. ilcnmli\h.r rcntrn ony
<br />(flciurc. pi{ni. ir\ n:u,n.c.,ho rcauics thc,plrnnr for \u.h F.nir lo Ilc a si!ftd ,rd f,nr rh.t hco, shc h liccns.n Nrsusnr
<br />ro rhc lolnions of thc Cotrrrucroi\ Ll..nsd Lrw lchapr.r 9, Connnc.cinS sith Sccrion ?000 ol Divnion .l oflhc BusnEs 0nd
<br />Pmlc$ions CRlc) or lh hcor sh. i\ crcmpr rh.r.rro dndrhclMsisforrhc0llcscdcic'nPrn,n Anyvn,hoonofsc.lion?0:ll5hyuiy
<br />lnllicunrttr tr pcmrir ru$Jc.h rhc ,l)plicad ro acivilpcnallyolnor nnrcrirn llle huidEddollars (s5tx)).
<br />-1.
<br />as owNr of rh. l]ri,Fnr, or ny cntldlei wnh *agcs a3 rh.n irc .ortpctrsri.n. will do rhc wrk drd rhc (n,cluE is mr
<br />ifl.tu]cd.roltar.drors{h(Se.?044.Busim$undltoit$ionsCodc:ThcC.nt.dolsLiccnscL0*docsnoraPplyt,anown.rof
<br />rhc nmrcny sho brink or i'npmvcs rh.6tr. Ml wk, dds such sork hinNclf or hcrcll or rhrcrgh his .r hcr oan cmploycc\.
<br />provAcdlholsuch iormrcnrnrs rr n i.rcndcd oroflctd tur\alc.ll h.$cr.r. rhc itriklinA or itr{'dcmnr h$ld*irhinon. }t
<br />ofonr,lction. Ih. owncr Builcr *illhrvc rhc hurdcn ofrtr,vins rrli h. oi sh. did.ol huild or im0trte lnc pR,tdy lor rlE nury)$ol
<br />E-14. d nuir.rrhc lmp.iy. Mr crclu\ncl) .nnrnrns wirh liccnscd ronlm.rosro con(rucr ihc puFd (scc.7041. Busincss
<br />rdl hrs\k,n Codc ThcCon[acr.is Lrcn.c Los docs nnr rmlyb,nosncrofProt.dywho buildcor in,Prov.. rhcrcon.
<br />trnd $ho conrBcr\ ttr srch phfrN wirh a C.[tu.k,(s) lrctrscd pusuanr r,) rhc (i, ra.roi1 Li.cnsc hw)
<br />-l
<br />rncxcrrrl ttrd.r Sccr V-rr*.n-4rr1*,l)l!( 1,,\I \ ltr)N
<br />I hcrchyiiltnutrd.r prtrllryol p.rju'y on ol rh. hl[,wirt d$lrnrnD\
<br />I hrvc M'l will nmn ain!CcnificorcolConscnrri,ScltlNtrrcr(rworkcrJ..nDcnsdion,!s Ptr,Udcd ftr hySccri.n l7(x)otrhc
<br />tirtr Cod.. ru rh. F.iroituRc of rhc $ork rd *hich I hc Fn.ir h islued
<br />-l hrvc and $illnli'rhin workdn $'npctrsrrk, iNurrftc, Dr rcquircd hySccrnnr.17(X)ol rhc LrlnrCodc.ltrlhc pcrlonnriccof
<br />rhc scrk lor whkh rhn p.iinir is irskrl. My wolkcn snll)cnsoti.n iNu,rn.. cmio i,il l,licy nu'nhcr uc:
<br />E#:;:difyrhrr hrhc Nrlormrnccol rht wo ftr whirhrhn p('nir is ksucd.l $all0or emnloy anypcr$n in rtry nDnrcr
<br />'
<br />tic.unc suh]ecr r. rh. wo*cif .onr|fnrarion lnvsofClrifori!. ond r8rcc rhrr il I stn)uld hcconE subjcd lo rht
<br />rrtrlc^.onDri\ari,rnolnn)trrolSrclion]7(nolrhcLrhtrCdc.t\hill.ndhtrirh(nnflyLvirhrhxcPmvi"i(r$
<br />IVARNING I'rilurc h $urc s$k..'' .. D. sdri(lr .ovcrrtc is utrhslu. and shrll \rbj.d m c Dloycr r,, .nninrl Pcnrlrics rnd
<br />.ivil ftrcs up lo orc htrnd'crl rhou\d d dollm ($l(x).UX)). ir iddil]on ro
<br />s(rtrrr.10?a.r rh. I rNtr(r
<br />$ -
<br />^rru-r, )(
<br />I)t.t( I lR,\Il()N
<br />I h.rhy,r6rfr undfi l.MI(yofp.rjury rnal I !m lien{d uDdcr 0oltiotr orchrfla 9lconnEncins sirh Sc.rhtr 7fio) olOivi\ion:l
<br />ot rhc Businc\s and Pmr.s\ions Cod.. n my lkensc is in rul 6.e Id .fl..r
<br />i\\kd (Sc. 1097. Civ C.)
<br />A.8TUIANLIII.LAXAITAN
<br />I lrnby rmnn utrdcr lcnrlr, ol pcrju., orc ol rhc fink,trnrg d(hniions
<br />Dctrxrliri{ Pcrilirs A\bc(os Noliiicrlion r'cdcril Rcsulart,ns lTirfu.{), Pin6)
<br />Itclut (l l,.rrrr ol Norifiurio
<br />Set Backs
<br />UFER Ground
<br />Subf looriVenVlnsUlAtioO
<br />Rool Sheathi 7-2-/k -1T14t,, t ,_,2-1)
<br />Shear Wall I 0\
<br />Framino
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 7-so -tr KJL{IL)
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc. .-)"t'\-,n
<br />t- lJ
<br />_,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />C(rNS'l Rflcl lON I r.NI)INC;\(;ENCY
<br />I hcr cby rflirm trndcr lf,nalry oi lcrjnrr rhd rh&c i{ r .one rucin)n hndir8 alcmy iff rh Fr,nn arcc ot rhc {ork for *hrh rhN Jtm t
<br />I.cniiyrhdrh.fcdcElrcgul,rion\rtlrdin8*h(nosrcnr,ulff.norsIPli.lhlet,rhi{rDj.cr
<br />EJUnn,ry,nn t a. n.t tnA rnNk'arintr anr irc rhsr rhcahtrc inlorn n ir.odc.r Iasrelo<nnplrwirhrllCirvrndCounrv
<br />;-dndr.^ Jn,l \rd. r Ju'rLr'tr^ iohu'ld'ns coNrru.h"r. an,j h.r.t, sdrh."/. r.fryrnrJrtrc.,'l'r,^t,r -l r n,n'.'ru.,'"',r'l" ri
<br />,hovc trf,.'.ad I' F-r) r,r in.r,rn nurF.c\ , - 7./
<br />^;;..;""_^,;,.-;,,-"*' ?/'"q & A-".-* *," . y'u/a tp
<br />""*n**-",,n,* X-,? ;;24;+iLR EE;e*/ 1
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