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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BI]ILDER DI'LCARA'I]ON <br />I hcrchy afirfl uMcr D.nalry 01ncliury rhar t onr cxcnDr lmnr rhc Conrdct,h t-i.en\c ur r.r rhc rt lowira rcnnnr (Scc 70:ll5 <br />Bu\incs\ a.d Pofcsion Codc): Any Ciry or Couory stih rdqun \ d ncnn( k' o.irucr. ,lrq. nnpolc, dc'Rni\h or rotnt rny <br />rdcrurc- rrin r0 ils irrnnftc. rho r.quircs rhc +Ili.Mr lor strch Fnnit to filc r stncd (o'cNnt lfialhcorrhc i\ li..nscd t'ur\xxnr <br />k, thc Brvhions ol'rhc Conlraclo s Liccnscd li* (Chaprcr 9- CoD,ticin8 wirh sc.rn TuI) of Divnion I ot rhc Busi'rc$ rnd <br />Pdar\i,nrCod.) orrhar lrdrshc iscxcnr thcrcfr.r d rhcb$is ntrihc lllc-qcn crcnrrio! Anrviohrb..fs.crionr0ll.5by0 y <br />aptlica tu aFnni subjccrsrhc q'llicanr lo acivillcnnlryofnol nore rhu ilvc hundrcd dolh^ ($5LU) <br />_l-osownerotrhcpopsny.(trmrempk,r..swirherscsasrhct\n.onrpcnsdion.willdolhewo md thc nmrm k mr <br />imcnddd oroflcrcd for qle (Sr 704{. Ausir.s\ rnd Prof.ssiurs Colc Thc Conr!&lois Liccnr La* d@\ ior rprly ro 0n ow.cr oi <br />rhc Impcdy *r$ t'uild! or iqrors rhcEm Ml who d{B smh $o hnns.llorhcr*lforrhmuShhhorhqo*ncmpbycc\- <br />prnvdcd rhar su.h iinnmEnEnc oc nor inrcd.rl or olI.rd rnr slc lt hosrkr. rh. hrilti4 or inrrlftftnr h $ld Brh m )rr <br />ofcomphrion.ltr Owncr Buikh. wilt hlK thc hurdcn of[ovnE fiar hc or shc dit nol build or imnmvc th. rmtdy for rhc luqnc oi <br />L a3 owncr of Ihc pmpcny. m cr.lusivcly cotrh.n.g wirh l,.c.scd N r..xns lo connrud rhc rojc.i lsc. 7O!1. Busms <br />ond h)rssion Codc: l-hc Conrrlcloas Li.cnsc Law do.s nor apply lo m o*nd or roFny sho huilds ot imptotts rhcrcoi, <br />nd who .onrro.rs fu sn.h !r,jc.( wilh r codn.ro(o li.c.scd pusu,nr rorhccontrlcrofr Licen* Lrw) <br />I oncxc'npr undcr S(lion <br />o".,?-- / 7' t <br />DICLAIAIION <br />I hcrcby offi.n undcr pcnrltyolpc,juryooc ol lhc tollosnr8 dcclArlrtnN: <br />Ihrvcd)dwill uinrain. Ccni6corcoiconscnr lo Sclf.lnsurc lor $ork6 compensdnnr is Fovidcd fo. bySeliotr 3T00 olrhr <br />trhJr C{nc- for rhc pcrlo,.Enft of rhc wort for which rhc trmi h isu.d. <br />I hrvcnnd will nri din w.rkcrl comtcns.lion itrnmrce. as rcquncdnySdt'o:l7IX)ofrh.lrborCodc.lorrhct't.lorronccol <br />rhc wor* fd whiclr rhislcnnir is issu.n Myaorkcs Lnnrpctrsation insutunccdrirr Md E)li.yiun6.rdc: <br />Cmi.r:- <br />-l.cnlryrhnrinrhcpcrfoflEnccofrh.worklnrwhirhrhi:pcnnir <br />n is\ucd.l (hrll nor .nPloy !n] Pc.$n inrnv r ncr <br />$ as b bc.on subjc.r to rh. workcn conlrtr$rion liws ol caliiotrin, {nd l]grcc rhai irl shouklbc.o rc srhjcd ro rhc <br />sorkc .omFn\.rn l)n,visbN of Scd i0 :l7u) of rhc Lrhor ()dc. l \h{ll. tu rhsirh c. li)ly q irh rho$ |r)visions <br />WARNIN(; Iirilurd x) \ccurr $orlo'\ co rtci\dnnr rrd[c i\ tr lnwlul. rtrd (hr]l uhr..r aD cnfl,))a, t, cnnii"nl Fmht\ tri <br />.ivil ftr\ up (, otrc hrDdr.d rhou$id dollnr( 1Sl D), in addiiion ro rhc cosl olcomli.nerbn, dimgcs * lrovdcn lot lhc <br />S..r(n loT6ofrliL lrlxtr (-rxir. i'[.'cr ]d <br />?:11:! <d <br />^ <br />DECLA.E{IION <br />I hcrchy olitrm undc. lcnahyolrcrjuryrhlr I "n lien\dd Lnde. tmvi\i.n otChrpt.r I (onnErcin-q *ilh Scdion 7m0) .l oivision :l <br />ol rhc aurincss and Pof.ssionsCodc, od nrylicensc t in tullforcc anl e[ec' <br />AIII.ICANLIECIASAIIO! <br />IhcEbydlmuDdcrpcnalryof p(rruryomorrh.lollowingducl rrn,ns: <br />Dcmlirion Pcmrih AstEnos NorilE,ri.n F.dd,lRcgxhrbns (TirL l0. Pd6J <br />-Rcqutcd <br />Ltttcr of NolifEdthn <br />I clnilyrhr rh.lddcrrlrt!0lx.oi\ rgrd trr ad o\turno\rl c tr.r,nfli.il,lc b rin |[t.r <br />odinrnccs nnd Sl0rc Li{s rch(inglo i'rgcotrnru.ri{n,.rntlhcrrhyrurlxtrirr.tr$.rturn.\ollhisCir)_x Co!nrt k, circr utirt rlf, <br />nlxrr dri(nul t,n)td!yfr, <br />Appliont or l*tnl SiAn (urc --( '''?''7-tz-tY <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/Vent/l nsulation <br />Roof Sheathinq a .-/-L-/3.?r-r' <br />Framino <br />lnsulation/Energy <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 />Enoineer Final Report <br />Flood Zone Certif . <br />FINAL t0 -3- l{h-WL <br />Certif icate of Occupancy <br />Notes, Remarks, Etc. <br />D-5a11 <br />Shear Wall <br />/r\ <br />I-i.ctr\. ([s\: I-,ccn\c Nunntr <br />Dnrn (-unlrtu litr <br />tlrNErxucuoNrDltltNclclucr <br />I hcrchy alltm !ndc, rEnall, ot Frjnry rhd rh&. h a co.srrucri,n LndinB .B.n.y lor Ihc pcrl'omnce ot rh. trk ror which thn FnDil h <br />Gsucd 1S...l(r?, Civ. C.). <br />tf,ndn'( NJ . _ <br />L.ndcis Addrcss: <br />- <br />I