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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNERAUM
<br />I hcrchy rfllnn undcr pcMny ol Frjury thdt I dn cxc'npr lI,nr lhc ConlEcror' Liccns tiv tbr rhc iollowitrg rclsl (Sc( 7o:11.s
<br />Blsincxs and Prori$ion Codc): Atry Cny or Connty $hicn requir.s a lEnnit to oniru.r. ulrcr iryrovc- .kmlhh' il]on lny
<br />nddm. pri(n ro ils issurnce. :ko rcquncs rh. anll{anr a{tr \!ch Fmir ro ,ilc a risned sllrcm.t that hc or she t licenscd puNrnl
<br />ro Ihc provni.ns or rhc Conrn.ror\ l-ilrnscd ljw (Chrprcr 9. Comrrcncnrs wrh Sc.rtu. 7000 ol Djvisnrn I or rhc Bxsinc*ind
<br />ProfcsionsGtc) orrtrt tEorshc is.r.nu thcrcfr.nrnd rh. htrsis lbrrhcsllc8cdcrcmprior AnyvidslionoiSccrionT0ll5hyany
<br />rmli..d (tr r r.rdir \!hjc.rl rhe amlicnnl ro rcivilFmlly.l tror.mrcrhln llvc hundr.d dolldi! ($5(rJ)
<br />!t. * "* *, nt,t
<br />"
<br />p*p"ny. or my cmplortcs wirh wnscs as rhcr slc $mpcnsanon. wrU do th. *ork ur, thc nmrm is mt
<br />irrcndcd or offcr.d lor slle (SN.?044,llusincs lnd Prorcsions C]odc Thc Contu rofs Licens. Llw docs.or lpply t, !n owernf
<br />rhcpmlEny who hoilds or nIomvN rh.a)n. n l wlr, dms {ci +r,* ninFcll or hcr scll or lhrcuSh hh or hcr ow. cnrplorcus.
<br />poviden rhnt such imaturmnb m tur inrendcd or onarct for sh ll howcvrr. thc hoildir8 or h{mvc'hnr is $kl *irhin o'r t*
<br />ol .onplcrkr. rhc Owtur Buiucr *ill har rh. bunin of tmvir8 rh,r tr or sh. dil dn ttuirl or itr{ltuh lnc pmFny aor rlt p!,Ins ol
<br />-{t. * n*n", nr,rr" p-p"ny, ,'n cr.lurircly conkacii'B wirh liccn{d conrncbN b coosrru.r rhc l,mtcr (se 704,r, Bu{in ss
<br />md h)r.\sio Codc: Thc Conllicrols Liccnsc Ltrw dMr no' aprly kr anowicr olp,npcn, who builds or improvc\ tnercon.r.d Nho conLa.rs itr ruch pnjc.t wirh I Co nrllct on 9 I iccnscd l)utrumt lo rhc Conlractors Licctr* tr*)
<br />I nm.rc'npi u.dcrSsrion_. B &PC forihicmsn
<br />Drt., Om*:
<br />ryoEKE&tttlMtENtfMN
<br />DLCLAIAIION
<br />Ih.rcby rltnDx lcr pcMlryofpcrjurronc ofrhc rnlh*iof dcclar.rn{r:
<br />*l hnrc {xlwillnuinrrin rCcnili.nr.olConscnr rr Sclt lnsurc lnr wnrkcG conpcnsarion. os fovidcd lor hyScclionlTmofrhc
<br />I ibor codc. ld rhc pcrfordarcc of rh. work tu wh ich rh. Dcirnir h issucd
<br />rh. sork r,tr*hichrhis ntnnit is h{k{. Myworkcr{i(n in\!fu .c .nricr rid I,lic) ntrmhrr rrc:
<br />_l.clifrrhdnrrhcltrturtu.cofrhcs.rkf{r*hichrhi\acnnir I Fsucd. I \hrtt nol cnr r)y itry pcr\otr o afly ninrcr
<br />v, ^n,tf,(nE {,bJ.cr l,' llN sorkcrs.onDctrsrhu hssorcrlifonrir. ! a8tocrh irl \hould hcco ,. s'hrccrt,rhc
<br />r.rkcr\ coiDctr\rrionptr,vi\ions.iSccltD-170Oolrh.titsrCodc.lshrll.la(hwirhr. rtry $irh rho* pn,yhi.is.
<br />WARNIN(;: I'i'lut t' {rurc workcr'.rnrpcnr{i{nr .o\is xtrlawlnl, .nd shdl suhicl an cnrdoy$ k)
<br />.ivil fitr.\ trp b onc ho(llcd thouqnd dolhB if n dirtrtrr r! rh. lon ofconrtcr\rrnnr. dr rgr
<br />Srcri({ ll)76olrh.lxhn (ixlL. intry.{ xn(lir
<br />"",". - 6/5/t y
<br />I hcrchr rrinmuMcr pcrrlly.fpcrtury rlrd I mr ll.cr i.(itrntlorIn,ivsi,mo,(hrt)U,,)(connn.n.i',8sirhScdion7l11r))oll)ivlsi,.l
<br />/:k4R
<br />I hcmby drrmnnder pcMlryofri.rjlry that rherc is o onnruciiotr Lndir8 i8.m, ror $c pcrfo.mN. ofrhc wu ror whichrhi\permir i\
<br />ksu.d(sm 1097. Civ C.)
<br />trndei\ Nanr
<br />Irtuld ( A,lJ'c{ _
<br />a-Pfrttalfl)[tl.A3arl()ti
<br />limbyrliimondcr pctrllry ol'pcriury om ofrh. n)ur$Ln[ dc.rirdrn rs
<br />l\moliinnr l'cnniIs.Asht\los Noli,icrliotr lrcdcml Rcgullrn,ns (1ii1r.10. Pnn6)
<br />-RquncJ
<br />Lcrrcr.f N.lifi di0.
<br />l.cniaylhrl I h.vc r.rd lhis ap,il i.nJ,xjldcrhnrihcrhrr lnlnrndor notrr.i l rsrlt L c.n,!lv snh all C randt.(rnrv
<br />odinanc.\ rnn Srxrc l:'ss rcldins huilding construcrion. nn hcr.byaurkrnc rcprccnhrivcs sfrlir Cnyand Coonry k,.nrcr u[x,n rhc
<br />!h'v. nrcnrnnrcd I'ropcny tur 6n'(
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathinq
<br />Shear Wall 7-rc..$ Jt ,{ffi)
<br />/4o tK,-t,tdh*4;7/.,,-
<br />Drywall 73tj,rc.Atq
<br />,6xt^ltnt. Latfr t pll t/b--t w
<br />a
<br />It4ason ry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cenif .
<br />FINAL //-t-ta J/a{o*G'(Q
<br />Certificate of Occu pancy
<br />ID/SIG.
<br />Forms/Steel/Holdowns
<br />Framinq
<br />lnsulation/Enerqy
<br />i.,442
<br />)zldW
<br />Pool Fence
<br />Notes, Remarks, Etc.ol thc aurinc\\rnd Pn,lision\ Codc. rnd my li.cn\c h in lnllhrccandeilccl.
<br />lccnrliihnr rlr lcdfrl rcguldnrn\ ogffi]nr8 r({no\ rcmrvrlnrc nor 0nt,ll.rhlc lo rhis Dfl!$r.
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