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BUILDING- INSPECTOR RECOHD
<br />SITE-WORK DATE ID/SIG.COMMENTS O1INER BUII-Df, N DELCARATION
<br />I hcrchy uinn under o.nllry,)l pcrjury rhlr I am cxcnrr from rh. Co.rr!.t,r' l-i:cn\c liw ntr r[c rallownE rcrsn (Sa.7l)]1.5
<br />Ausinrss nnd Pofcsion Cnlc): A.t Cily or Counr, shi.h lnncs r t irnir k, cotr(rud. 5lrer. imprxs, dcnnnish or rcp uy
<br />stru.luc. fior l. ns issuancc, lko rcluncs rhc aidicMl lbr such Frnrii r. lile r \isn.n dakmnr rhd lt or stu h liccns.l Pusu.nt
<br />tu rhc !tuvisions of th. C. ractor's Liccnscd trw (Chnptr 9. Comnrc!trin8 uirh Scclion ?([X) ot Diliin,i ] ofrh. Busin.ss trnd
<br />Prorc$iotrsCodc)orrhat hcor \hc nexcnDl lhcrcfroman lhcl,u{hturrhcrll.gcdcx.'nnrion.Anyviohrnrnofsarhnl0llSby!n}
<br />trprlicanr li,r , pcrnrir subJ..k rh. lrtli.,nri{'aci!ilpc.dLr}ol .r rErcthM fivc lru Mrcd dollatr l$5(rO)
<br />-1.rsowrcrolrhc!rcleny.ormycnDn,rtc\wirhwlgcsisrhcir$lcco'npcnsdion,willdorhcsorkdnlt
<br />nrBNi\tr.r
<br />inr.nd.i or otltred for qh (SN.7IX.I. Burituss rnd I\ fcs\ion\ C.dc: Thc Ci.t{hni Licctrsc Law docs nol :'rpl, h M owncr ol
<br />rhc pDrr,ly wl$ build( or irqrmEs thcNtr. !trd $ho doc( \u.h wo him\.llorh.r\c1forrhn)ughhisorh.r.wrcmPloyecs.
<br />f(,vnbd rhar nrch imFn*rmna rtu ton inbndli d ollLtod lff $L. ll. hoBercr. rlf hoiklirg or nnpr*enrnt is w,t] wirhin "m Jrr
<br />oiconDbri{,n. rhc O*ncr Buildcr *illhnlc rhc hurdcn ol!ruving rhd hc o' \lr did ior buikl or nn[ovc rhc l,mpcny l',)r rhc pu!$c ol
<br />Lr\owncrofrhepmpedy.mr.r.lu\i!clyconka.riigwirhliccn*tconr!.torrocon{rucllhtnmjcd(S(7(}t4.Bu\incs
<br />otrd Pslcshn Codc: Thc Conlr..ln s Liccnsc kw docs nol $rly to !n o*trcr oipop.ny who builds oi improvcs lhcrcon.
<br />lnd who ..nracrsru\u.hp$J.{rsuilhrConr..ior(tlic..!cd pusurnt rorhcC.ffacrols l-iccnsc Lls)
<br />I d .rcnr|n undcr SNr
<br />D8t.' ownei
<br />w(|RKERs' c()nifl iNs^iro,,a
<br />DECIAAAIIO!
<br />I h.rcby nltnn undci ptn.hyofpcrluryonc olrhc tnlbwirS dcclnrlionsl
<br />-l
<br />haveondwill moinrain rCenificarcofConscnr h Scla lnsurc r(n sorkdi L{nprnsdion..s providcd rbr t y Sdion lTlD or rhc
<br />rbrrhcpcdornurccoflhcsolknn whichrhcJrcnnir ni\\ucd
<br />s ilL rs r.quircdh,Sdio.:1700oflhcljlirCr e. tu Ihc Pcrfoniu{c of
<br />sdn insuBncc cricr ffil policy numbcr u.:Jtirn N NUcd Nlt \o*crs
<br />l.cnifyrhnt in rhc l.rfonmrcc ol r hc work lor which rhn pcnni, i\ nsucd.l \h8llnor c'Vk,yrnyFrs'n in rnynun.cr
<br />w mtu hcom suhict to rhc w.rkc6 co',pctr\,rion ln,s orClliromir. mJ,atc th irl should lBonrc subiccl lorhc
<br />vodcr'compcns.riotrrmvhionsoiSedtn:lTlr0ofrhcLrbradc.lshzll.lnnhsith.onlrlyrirnlhoEprovni,'nr
<br />WARNIN(:: Filur r. $.urr woikcr
<br />.ivil lin.s up u oN hutrdrcd rhousatrd
<br />s.crnD 1076ol rhc tihor Gxlc. irlcrc{
<br />,,,". ?-/g-lt
<br />.otrrtrtrldr{ .o!c8nc is nn loyf ro dnninal lcnrlrics and
<br />darEEc( os prori.lcd for thc
<br />I hcrhyalfirnrndcr Fnalry of Frlury rh la.r 9{co,mmins*irhS.ctinr70u))ofDivisiorl
<br />ol rhc llNlnc\\rtrrl t'roL\lon\ tinl.. Jxt n,y liccn{ i\ in fuLlktr( dcllc(r ,/,{lrrsCru
<br />I hcEhy ullinr under lttrrlryotpciuryrnd rh.re istrcon{tucrnn kndins ag.n.y lirr rhc |r on:urccoflhc $ort ix shich rhi! psmir i\
<br />issu.d (Scc.:1097. Civ. C )
<br />dIPIIIANLDECLAAAIION
<br />I lIrchy.lfinn und.r !.nalty ol !.rjury onc ollhc fol!,$i.E dlTl&iion\:
<br />Dcmrnion P.rnirs sbc os No'ifi.{io'r tudcrrl RcSul.rio.s (Tnh 40. Pan6r
<br />R.qxisd Lrncr ot M)lih.arirn
<br />-lrenilylh
<br />rhcfcdcldrcgthrion\rclrrdi',gaslf,nosrrnn,vrlrctrorrt tnhl.k,rhrftu].tr
<br />I rlar'.,,,,n'rly tr rh rll Cir).'rd a.nnr\
<br />yaurlnriTc rcprcscnrarivesolrhi\Ciry dcoutrrrrocnts u,xrthc
<br />,","3-/f -[
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation tl
<br />Rool Sheathinq I ktl.lr( 4 Wr{llt"-lb-
<br />Shear Wall
<br />Framinq
<br />lnsu latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Beport
<br />Flood Zone Certif
<br />FINAL tL/<tfij ,'fhut tr"
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />I rn,l., . ltJ,.\.
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