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BUILDING- INSPECTOR RECORD
<br />SITE-WOBK DATE IDiSIG.OWNER BU!LDER DELCARATION
<br />I hercby atrirn undcr pcnahy (,r p.rjlry rhar I an crc'nfl lmm rhc Conkrt,r' Li..nR bw ror rhc lolloqir8 rc,$n (Scc.7(llll.5
<br />Busin.\s n l Pmfcsbn CoJc): Atry Cil, or C.xnry vhicl rcqun Fnnir lo conslru.i. allcr. inrprovc. dcdoli\h .r rctx r rny
<br />srrlrcrrtrc. lrntrro irs issu.ncc..ko rcquncs rhc r|)l]lic.trr ior suchlcflnirr0 nh i sisncd srurcmnr rhxr hc.rdr h liccflscd punurnr
<br />to thc ptuvisiotrs ofrhc Co[rr.ktr\ Lic.ns.d liw (Chrrr.r 9. C.nrm.n.irg wirh Scdiotr 7Ux) of Divhion -] ol ll{ Btrsincs rnd
<br />ProfcssionsCodc)orthrltrorshc ncrenur lhcrctomand lhc bNi\ I'or rhc rllcscdcicmprion AnyliolarionofSc.rninTOll5bydtry
<br />rptli.antfornp.mirsnbjmr\rh.amlicnnrbrcivilpcmlryofnornbdrhnfivchrndrcddollrr(3500r.
<br />-1..s
<br />osNr oilhc pmpcdy. or nryenrDloF.r wilh w!8cs as lh.n vnc conrF:rsalion. $illdo rhc work and rhc {nrtur i\ tr.r
<br />inlcnd.d orollcrcd lor elc (Scc 7044, Busincrs r Ellcssions Crdc Thc C.Mtrclols Lknrc l-xw d..s ior rprly nr rnowncr ol
<br />rhc F,pcny wlh hoilds or i'ryn,Er !h.isn. rfrlqlx, rk{s such w)rk hi'nscll.r hcFclfor rhnnrgh his or hcrawn ca,phyccs.
<br />prcvidcd rhrr srch irymlcmn( m Rn inrcndcd or ollcftl f{n slc ll howc\ti rh. buildiig or iinpmrcnrnr i\ sld 'irhin o c )rrr
<br />olc.n!]hlio.. llE owncr guild.r *ill n vc rhc burdcn of p.oins thal hc or shc dil mr hniH or i'nnnrlc rhc ntuFny lltr rtE tu(nc or
<br />l. i\ o*n.r ol rh. F,n!ny, rn .rcll\ivc ly .onrrrrirA *irh licctrlcd conrrrnx h .1,n{nc(lf, troF{r ( Sc. r(ll!l. hNncs
<br />d lh,lir\in1(bdc: ThcO fucttr s Lrcis. trw d... nordppltrd rno*mr.ftniNdy Bh,) bulldsor iD0r.vcs rhcrcon-
<br />rnn sho connr* i,rsuch nr)lccl\*ilhi Gflmcro(r licctrri Nstrul lo rhc C.nlrrktr s l,lccnsc Lr*)
<br />-l
<br />rmcxc rpr undcrScclion-
<br />-.
<br />B & PC lbrrhi\ r{$tr
<br />]tl)n$i8s:r9}llriNl rloN
<br />DECL ITIIION
<br />I hcrchtnlln rutrdcrI)c rhtolNrltrryoNolrhc k,il('{nrBdL{ln'rri, !
<br />IhrrcmdwillnhnndiiaC.diu$rcofcon\c k,scllln\ur.,sork.6-.unpcn$rnr.n\pftrvicdli,rbySccrion.rTOoolrhc
<br />Iltxr C{ilc- tur rhc pcri,nxh-'r or rhc *ork ftn tr hich ilE rcnnit is i$ucd
<br />I hrlc rnd willrnxi' ri'r workcrr (o ,pcn!rrion naurrn.c- r\ rcqutcdl,ySNri,)n:l7lX) frh. tjlx, Codc.li,r rlrc p.rlinnJNcol
<br />rhc sork I{, shirh rhn pcrnrir i\ ir\ud.l Mysorkcrs r.nrnci\rrion i',\urrr... nicr rNl J!ili.y nuDrbcr dc:
<br />riV\ r,t wr-rr (l,tS7^
<br />"nod+-o l./.ln
<br />l.cnilirhar i'rrh.n rformn..ofrhc *dr* r.r which rhi\ p.rmi n i{\ucd.l shdllnot cmploy0ny lErson in!ny mitricr
<br />$ slo hctu'E subjcct tolhc workc^ o.Dctrsaliotr l0ws oi Caliinniu. nl(grccrhariil\houldh.co'csrhF.rr,rh.
<br />sorkcr'.oDDcns
<br />'otrflovisionsorScclion]700.rlhcLrtrC-odc.l$rll.n]nh*irhcondywirhrhospolisnrsIYARNIN(; Flilurd k, $curc sorkci('.o,nNnsari,nr $rtrnAc is lnhslul. rnd shrll {rhlc.r !. cnrlloycr lo crinrinxl pcBlti.s rnd
<br />.ivil find\ u') kJ.ft hundrd rhousand dollm (Sl(x),(XXr. i'r addirn,n b rh. cost ol cornpcnqt
<br />).,,'iidv"I"?-201$;:,,:,,
<br />*
<br />DECI.AAAIUN
<br />I hcrcbyninn undcr p.n.lty.l ncrjury thd I !m liccn*{ utrdcr pmvision.l Ctupler 9l.onrnEncirE wirh S.crion TlxD) ofDivision:l
<br />.f rhc Br\itus\ r d Profcs\i(rN Codc..nd nyli.cn\. N in rull nnd rl.ffc.l
<br />?rc4
<br />t'tAY 17 ?I10..,,."",..
<br />CQNSIAUCIION.LENIIIACTTQENI:I
<br />I hcrchy irtrm und$ p.n.hyofF iury rh0t rhc( h r.o.iru.tirn Lndir8.Acncy for lhc pcr{ormnc of thc Norl r(, whkh rht !.nnir is
<br />hsucd (Sc. .109?. Civ C.).
<br />ArtutaIillEcl, &rll9li
<br />llrnhyrmnu.dcr pcnally oilcrjury onc oirhc iolrowin8 dcchmli.n\,
<br />llcmolilnnr Pcnnirs Asbcsos Nolificalion ltdcril RcsulBlions l lirlclr). Prn6r
<br />Itr( tr nrl l..lr.r rl Nlr li(xli,ri
<br />/-ffiil:ffi;toE nnrglstf,{osrc nnrlxr. rri rml'.nhlc t) rhn frnrrr
<br />nand stilcrhd Ihcr&)vc irlartr$rirr i\ cotrccl lrBrccl,
<br />nhr!o ndrl on.d I'orn)_ ln, i',\)o(ri(u prrB^r\
<br />,\ll,li.xnt r i\!0rSixnittrre
<br />P.mrilft mnN lprint)l ar.t I 4ra
<br />, .omply wirh allCiryrnn County
<br />rhn Cn, and Counirt, cnrLr xtr rtE
<br />""iii:l!l lwa
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />F ramrng 5tu /ig >.Bl len+ x.t
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certil
<br />FINAL 6'-/?-/8,t*ltt-E ar/
<br />Certilicale of Occupancy
<br />Notes, Remarks , Etc.
<br />COMMENTS
<br />Sublloor/VenVl nsulation
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