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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE IDiSIG.COMMENTS OWNER BUILDER DET-CARAToN
<br />I hcdhy ,riirn undcr o.Mlly of pc,jury rhor I !m cicmrl iod iht G,nlh.rom' Liccns L.! for rhc nrhwing rcarn (S.c 70.11 5
<br />Itusincss oDd P,ofcsion Codc): Any ciry or c.udy whi.h rcquircs 6 Frni' b d,n{flcr, thcr, i,n[orc. demlth or qrn rny
<br />dddm. priub ih i\suancc. als lcauircs lie aptliclnr ar $chptrf,ir ro fil.a iiSmd sl cnEnl lharhcor\h.isliencd ru uMr
<br />ro lhc Dmri\iotrs olrh. Cookrcttr\ Lic.n\cd h* (Choflcr 9. Comftncins wirh s.crion 7000 of Divirion :l ofrh. Businr$ .trd
<br />Pofd\\n,nr Codc) oi rh0r lr or slE h crcmpr lhcrcfr.mMd lnc blsh r{r rh. dlde.d crcnl'lrion Any ri,hrion of S(rio! 70ll 5 hrnny
<br />qrpli.0nt Lrapcnnit suhj(ls rhe applicrnrr,a.ivilpcnrlry.rnornbrcthanfivchlndrcddollars($sfi)
<br />l. osnu orrk ni{,p.nt. or mycmthyccs wirh wasc\ tr\ rncn s.lc .onFn\arion. willdo lhc sork a.d rrr {du. itr tror
<br />imud.dor.llcrcdfor$lc(Sa7044-Businc\\rndPn)f.\sn,nsCGlclhcConrtrcloisl.itctrscl-wdo.\i.lalPlytornowmrot
<br />rhclx)t*-ny whobuildsori'\vov6rhcrN..ond{hod{rssuch$or[hnnscllorhcrellorrhn{,8hhisorhcrowi. doyccs.
<br />pr('vidcd r htrr \uch ialPnrcnrnts m mr i[dk]L{ or oflcrctl {(t sllc lt howos. rhe huildirg or iNlrrovcmnr is {nd wirhh .nc y*t
<br />olconrlcli n. rh: Osncr Brild.r sillhaR thc hurlci of thvinS rhd h.orlhc dkl nor hu Ll or nvn)rt rtE PmlLny lbr rhc PUrIx,*of
<br />-1.a!owmrofrhdpr.tny.,n.xclusivcly.onr0crinsuilhliccnsedconrncb^t,.o.{rucrrhc,,ni(r(SN70.Busin$rnd Pn,fcs\bn Codc:]'hc Conki.lols Liccn\c l-!* dtrs nor,pply b rn.wrur ofpn,pcrly *h(' toilds.r inrflovcs thcrcon-
<br />ond lho (nncl\ ior skh l,sjc.r\ eirh r Conrn.r.n s) li..nrd puruanr ro rhc Conkrttr\ Lrcnsc ljn1.
<br />-l
<br />!n cxcnrpr trndcrS(ridn I & PC li'rrhi\ ruYni
<br />UAAKBII:AUEENIAI]()N
<br />I!&CIAIIU()N
<br />I hrrchyrift rundcrNnxkyoft rjuryoncollhctulbwiDsJe.hrr(nnis
<br />lhvcmdwlll uir.inrCcnillclrcoiCon€ b sclllnsurc f(tr $orkcs corrFflsdion. r\ provnbdforblScction]ToOolrhc
<br />Itrfi, Gatc.l.r rh. pcd.rmarEc oithc aork r'orwhich rhc pcrnrir i\ i\\!.d
<br />Ihrmri(i{rllnri rnr workcri compcnurion in\unn.c.,\ rcqrncd btSc.ri( 17(x) ollhc l:,hor(lnlc. forrhc Pcrlormncc ol
<br />rh. sork r(rwhi.hrhs Nnnit is nsEd I'ly$orkc6 co tp.nsrrion n*urrnccc.riicr md Poli.y trun$.r rc:
<br />PS
<br />-l
<br />ccnittrhar in rhc FrrortuRcof rhc lorl for uhich rhi\ pcnrir i\ k\ucd,I shrlltror cmploynny Pr^.n ioa.t
<br />'nMncr$ 8 t, lrolm suhr.d to thc q'orke6 comEns t,n hs\ of Crlif i.. trnd lEN thir ii I shoukl tr.d sxbF_r to lhc
<br />workcrj co lrnsrrion nmvhion\ oi Sccr i('n -17{n of rhc lrhr ('.)dc. I $rll. fonhwirh c.nrdy w ir h rh.s lmvhi.ns
<br />\ryARNlN(; Fxilurc tu scurc sorkcr conrpcns{riotr .ovcrlgc is tnhsful, nd rhdll sutjccl in cnrPlor.r ro rnniMl lEnrhics r.d
<br />.nil lnr\ uf k, o c hutrdrcd rh.n\{ dolIr\($ll{}.lxX
<br />c. irlcrc{ rtrd nnN)_ s 1i.\
<br />i,r,. lhn'x!r! r\ J,r.\ ,l.Ll 1,tr rl'.
<br />",,., .) /-311 Appliotrl:><
<br />I hdby fitD utrds $frlryoiperjury rhrr I n undcr ntuvtbn of Chlplcr q (com'Emih! wiih SLtrio. ?(x)0) of Diltio. .l
<br />or thc Busntr\smd Pn,fclnorsCodc. rftl,ny li.cns. i\ i',ltl!nm. rfrlcfta.r
<br />B
<br />,.,",.qJi /16
<br />I hcrcby trflknunddr pcmlryofpcrjurr lhot lhcrc is r onrrrucri{,n lcndi.s agcn.y ror rhc nctlonun( orrhc work lor Bhich rhis lrcrn r is
<br />nsucd (Scc..l09?. Civ C )
<br />tffi;;rhc fcdcn I rcsu lal ions rcsordins dshc{o. rcn!,vil,n nor applicablc lo lhh proFl
<br />rc reld rhis,pplicarhn md siulc lhll rhc trh,rc inforharion n cotrc.r.I u8M lo.omfly{ith tllCiryand Counry
<br />l.r*s rchrin! n) huiUi'rg.otr{ru.1 r k$yitrrM tcr.pn\. rrrnr\i,frh!(-iry)nd(iiLnrrrotnrcruI[ rlt
<br />lhorc nrc tioncd Im|faylbr inspcclionpurr)
<br />,\t,t,lirxnr or.\Bu l Sitnrluro
<br />r'**ir"" --*,p;rr, f a uu:fk W ^u.4zlZ(/44P-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing ?ta-79.f/.<>1,(vD
<br />lnsulation/Energy
<br />Drywall 1
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar t-rs-/€ .)J/"* (/9
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL /,.' "/' /A J)zJa >@)
<br />Certif icate ol Occupancy
<br />Notes, Remarks, Etc
<br />UFER Ground
<br />Sublloor/Venl/l nsulation
<br />Ext./lnt. Lath
<br />Lc dcfr Ni r
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<br />ATIUCAII.DA:LAAAIIQN
<br />I hs.$, amm u nd.r Fnalty olpcrjury om ofrhc fdlosins dc.)lBtions:
<br />Dc'frniion Pennih A\rx{or Noliri..lion Fcdcml ReBulolions ('rnb40, Pd6)
<br />-Rcquircd
<br />l.ircr .r Ndificdion
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