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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNl]R AUII,DER DI),CARATION
<br />I trrcb, linm utus pcnalty oI Erjury lhal I m cxcnu rron rhc cDnt..br' Li.cn{ bw tur rh. Inlheire rcisnr (SN.7oll.s
<br />Burnrs nrn Prolc$n n CoJc): Any Cir, or Counly Nhi.h rcquncs 0 Frnril to c.nslru.i. ollr. improrc. dcmnsh or rcn r ?nv
<br />stucrur.. td,k, irs h\!mcc. !l$ rcqoncs rhc applicair inr suchFnnir k' nbu sisncd sralcm rhlr hror shc G li&n\cd Nr\ua('
<br />x, rhc ptriviions ol lhc Conlrccrois Liccnscd Lrw (Chil,cr 9. co nn.RinS *irh Scclion ?ux) ol Divtion -1 ol'lhc Businc$ otrd
<br />Pmrc\to.s Ctd.) .r rhar tEor\hc G crcn9r rhcrcfromond rhc hisis l'or lhc lllcgcd .rcmllion AnyrioloriotrotSccri,nT0:ll5 hy !n)
<br />raplica hrnFnnir suhjc-.ls lhc rpplicanl to r.ivilpcMlry.rnor nb6 rhnn fivc hundrcd dolldsl$50o).
<br />l. r\ owkr or rlt pmp.n y. 6r
<br />'ny
<br />cn,doyes *ilh wlrcs rs lhcn {nc .onrocn\al ion. will d. lhc sork ad rhc dBrh it ror
<br />inrcnd.rl or .,icrcd for $lc ( Se 7t}44. Busincs ind Pofc$ion\ Cod. Thr conracktr\ Liccn\c tiw d.c\ nor lptly ro 0n owncr ol
<br />rhc pnllrrly who boildsor nnr()h! rrrE)( xl slr dms {ch w'rt himsc lf or hcr*lf or rhroush hn or her .*n cnrployccs.
<br />povtlcd rhxt \u.h ir|n vcnrnrs ar { idcndrl or otr.nd f{, $L lf. h.)ktr. tlr bxildina .r inprovcftnr h sld wirhin onc }rr
<br />ofcon{lcrion- rhe(rncr BuiHs siu harc rhc huiddr.l proliiB rh,r hc or shc dil tror hikl or i'nprorc ltc lmFiy l'or rhc Iurrrsc ol
<br />l. rs owncr ofrh. l]tr,pcny. rmcrclusivcly conrrdins with li.cnscd conrrucrosro otrslruct rhc DmJsr (Src. ?OrJ. Buws
<br />.nd lhnasbn C.dc Ihc Ci'nt{kr's Li.rn\. Law doc\ nor alpit 10 m owncr or pnllcny *ho hrilds or imprtxr! rhcrcon,
<br />a J who conrrich fff suchnrojcchsirhao)nrmcro(o lrcn*d pu^u.nl lorhc(i, mcM sLic..e b$)
<br />I rn,crrD,t, utr,l.r SNri,,
<br />5/aa/eott**,
<br />I hfchy lf,irm urdrr t.n.llyoltcrjuryone olrhc lollo*in8 del.mrions
<br />-lhlvc
<br />nd sill nrirrain a Ccn irtorc oi Consnr n, scll lnsurc lo qorkcrs- comr.ns!ri(,n, $ |)rclidcd for byScclionl?(x)oirhc
<br />LIDr Codc. lu rhc i,.lf.numc ol lhc w.rk lbr slrich $. I).nrii i. n\ucd
<br />-l
<br />hrlc rnd $illnluinlair *orkcrs con,rc.salbn inuancc- rr rcqurcd hyS€rn,tr 3700olrhc Lnb.rG)dc.lbrlhl pcrro"Mncc ol
<br />rh. {u[ lor which rhtpcr.ril i! hstd Mt*orkcr'cnmprns0lion in\ur!.cc ciricr od Flicy nu mhcr sc:
<br />-l.cniiy
<br />rhil ir rhc pcrrbrmmc olrhc work ror which rln\ |trnrir R tsucd. I shrll troi ctrlPloy iny pcron in,n] mrnrcr
<br />s' rslo hc!,m $hjLrr tolhc workcn omFtr\arnrn hqs.lC,lihrnia. rtrd rgNlh itl\hould hc(nE nrhid rolhc
<br />{orkc^ conrpcn\ ionpmvhion\oiScclb.l70ool'rMtjtxrC'.nlc.Islhlr.fonhwilhconrtlylithrhoslrovisions
<br />WARNIN(;: t:rilum r' \ccurc s.rkcr\ co'npcn\!n'n.oEflgc i\ urhtrlt r nrLl uhi..r rn ctrlPl,i].r !' ui'n t'l |xulric\ xn(l
<br />cnil ftr\ up b onc hundrcd rhou{dd dollrn (Sllx). xJ). ifrndir rhc n,n of 6h.Ndi{m. drtuscs r\ prcvidcd ror rhc
<br />Sccrion 1076 orrhc lrfitr(i'd.. crc{ JtrJ rnorncy s Ticl
<br />5/,u-l-a:o!K 1
<br />I hcrchy nrltmundcr ncnalryofF,jury thrl I an liccned utrdcr tmrni.&.1 9lcomnEncnrs wnh Scclion 7()(D) oll)ivnion 3
<br />oi rhc B \i'i.s riJ llroli$i{rN (odc. d t licdn\c n i'r ln llnrccrtrd.llcrr
<br />CANIiIBIJqIPNIENDING.AGINII
<br />I hcreh, nlfird undcr Ilcnllrrofp.rjtryrhd ltq€ is r con(ruclion lcndins alc!try lar rhc pcrrornBncc ofrhc uork r(tr whhh rhi\ Fnnir i\
<br />nsucd (Sec.1097.Civ C ).
<br />AIIUTAN]-IIEII,JAAIION
<br />Ilrn$yrltlnru d ltrrlry.l rcrrrr otrc ol rhc li,lk*rnrr dr.h'nrtr0r
<br />Dc tul(i(ri Pcrr irs slrno\No!fi.rrru lildcrrl Rr!ulni{nnIIirlcar). I)rd6)
<br />Rrq0rrd trrt.r of Norili(ri(,n
<br />-l
<br />.dily rh ihc fcJcrll rc8ul.riotrr rcAalir8 rsbc(os r.n!)v m nor .tDli.rhlc lo this pmjNl
<br />I .c'rrr- rlrr I htr\c rc rlrn rfl)l'cn o turrr,n ^(,r( lxs'r.1o.,rulr- (nh ill( iryrfd (irtr y
<br />odimnccr rtrd Slrrc l-rvs rcliting ro htrildiDg .urh.rizc rcrcrcnr.rivcs ofthn Cnylnd Counry ro cnrcr uFn rhc
<br />rlxrr ntr ri,nrd |m)r. ! ntr i'\rccr(,,r)
<br />^pprirnnroraa.nrsisnsru* (
<br />0
<br />".." f/xs/t{
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lns u lat ion/E n erg y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />De puty Final Report
<br />Engineer Final Report
<br />FINAL tHYlt(l ,l,av@+,ry
<br />Certilicate of Occupancy I UI
<br />Notes, Bemarks, Etc.
<br />UFER Ground
<br />Flood Zone Certif .
<br />4?/'
<br />I-iccnrc Cldsr: l-icenscNlmttr:
<br />Dd. Conlr&lor
<br />I
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