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BUILDING- INSPECTOR BECORD
<br />SITE.WOHK DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
<br />I hcrchy aftm undcr pcnrlty of Frjury lh l om cxcnn lrcm rh. G'drr&l.s t-i.cnsc tiw Ior rhc r'olbwiry r. on (Sn.' 70.11 5
<br />Busincss aln Profcssiofl Cdc): Any Ciry or C,omy shich rcqxid a Frmn ro conslDd, ahn. imlmvc. &mlkh or Eran any
<br />situcrurc, priff b ik t\u|ncc. rho rcquircs Ihc,Itlic.m ro. suc[ pcrmi o,ilc ! sisncd narcmd th lror shc is liccn*d pursuutrr
<br />ro rhc rrovGions oltlE Conrrerois Liccnsd tlw (Chaprcr L Com.minS sith scdion roo0 of Divisi.n I orrhc susincss ond
<br />Porc*ionr culc) or lh.t h.orshc h crcnDr rheElmmand rhcn1(h lor lhc ollqcdcrcDprn,n Ant viol*'io ofScclion?Oll.5hyany
<br />aprrlicanraor!p..mils!biNrsrhc{'plicsnrtua.ivilpcalryoanol'norcrhrnfivchundrcddollas(55Cx))
<br />I. as owtrcr or ihc !m,rny. or nrt cnrdorcs I irh wigc{ is lhcir hlc .oryctruriotr. *ill do rir sork dd rhc \ttu1uc ir nol
<br />i cMLrd oroftrcd lor slc (Sa.r()4r. Busimsr llld lrrofcsiors Code'Ihc G,nracbr's Li..nsd kq does nor apply r. an o(ncror
<br />rhc FRr.d, wh) builds or inDm!.s rhcBu. lnd who docs $'ch xnk hi'nscll or hc^clfor rlh)reh hi\ or hcr own cn,ploy.cs.
<br />lmliJcd rhar {kh i'nprch,m s m mr inrcndcd ff ofcrcd ror eh ll. ho{tq. rhc hilding or irqrmvc'ftnr is eld wilhirr trc F rr
<br />oicomolcrion. rhc O*ncr BniHc, will ha* lhc burdcn ofrovins lh,r he or \hc did frr }iild or imtrcvc dr pm!rcny ,u ltE ptrrF'*or
<br />_1.!\o*,ncroirhcpmpcny-rncrclusilclronrrmriigwirhlicctr\cd$nti.ttrsbcorslruclrh.pftjcct(Sc.7Ul.1,Bd\i',c.s
<br />ntrd lh'rssir Codc: Thc Contrmr{ s Lic.trsc Lnw docs norlpply k, !tr owncr oltn)NnJ" who builds or imrrovcs rh.rcon-
<br />anJ sho.o a((ln\uclrtmj..hsnha(nnMcri(nlicctr\cdNNmnrrorhcConlncln\l-iccn\cL!*)
<br />I dtcx. rpr u.dd Scrn a & PC lbrr[i\ rcrson
<br />Dol.: O*ner
<br />wonxens crrilPEns,\itoN
<br />D}:CIAXAIII]N
<br />I hcrby dfilrm unddr prMlry of F,.lury om ofrh. followirB dL{larariotrs
<br />I hrvc .nd will nuinllin i Ccnitalc of Con*ol ro Seli I nsure rbr workers coq*n\dio.. rs ,n,vidcd lor by S.llior :l?(x) or rlt
<br />trh1r Codc, ror rhc p.rromDcc of lhc work for uhich rhc lcrmil t issucd
<br />-lhlrcandsillm.itrrrinNorkccconrcnsalioninsurarcc-asrcqutcdhysccrn,n.lTtrorrh.h$rC.dc.rbrlhcrerlonuneot,cnnir hissud. Myworkcri conrNrsrliur insu8tr.c c"trif ml r,li.y.utrtbcr tucl
<br />&:;
<br />q_,.or r(L l
<br />lc.nilr rhrr in (h. p.rrbnurrc ofrhc $ork lnr $hL(h rhn J{rnir A I shallDor cmploy rny p.r$n inany hn cr
<br />$ * ro b..otr subj.{r r. th. workcrs'.omFnsirnnr hws of C,lironi.. i aselhll ilI rhould hcom biccttorhc
<br />wulkcN.on{.ns.liotrpmvisionsofsNrion3T0oof$ctitbrCodc.lshlll.rbnhwilnconlPlywirhrhd$[.v(ions
<br />WARNING: Failurc to surc ,orlcF oopcns ioi covrrlc ir x.lrwtul, ntrd shall subicr on cn0loltt ro ciniml lf,mhi.s Md
<br />cilil fincs up to one hundrcd rhousrnd dollaa l$100.000). in rddirir ro lhc cosi ol co.rlcnelion. dntu3es r{ providol f(r rhc
<br />S.Lriun 1076 of rhc l-16, C dc inrcrc{ Jnn dtromt \ f.r\
<br />Y"",.. +/l-/tx aDD,ion,: * r'--/ r r +1 - ucENsErrcQNualroa
<br />DE!:I,AXAIAN
<br />I lEEby !firmu.dcr I'eMlty of pcrjury rial I an licc.sn uodq rm$ionofChsfl€r 9 (.ommkin8 *ilh scction T(IJo) ofl)ilhioo l
<br />ol lhc Busin ssa PrcrcssionsCode. Nl nry lhcnsc i i. tullforccn cf,cr.
<br />C-?7{rtgoS
<br />CT,INEI8]J!:IIT}I{IE!DII(iAGT!!I
<br />I h.rcby .rtrm undcr lEnrlty of pcrjury lhol rh.E is a con(ruction lcndinr lseq lor rh. Frroroc. ot rh. *ork lor whih rhis lErnil b
<br />issu.rl (S.c. -1097. Ci!. C.).
<br />drtu$ltD[clrltsauoN
<br />I h.R'byanlnnundcr Fnally olpcrjury om olrhc rbllo*ins dc.l !lio"s
<br />Dcmolirt'n Pcfinils-A\hcaros Nolificiiion Ftdcr0l RcBul0lbns (Tillc 40. P!n6)
<br />Rcquircd Lrlcr of Norifi carh.
<br />l..nilyihi rhc fcdcrrlrcgulrri.ns toEddi'rg ashtnr\ rc.,.! larc rripflr$lc hrhirU,)rc.t
<br />I ccniryrhd I h.vc rcodihn ifplicorionand sllrcrhar rhc lhovc inlons ioni\cotrccr Iacmt,
<br />ordin.kcs dtrd Srnl. LrwsrcbritrE h buildin8 consrruclion. nnd hcrciyaurhoriz!rcprcsc arilcsorr
<br />.oinly wirh allCiryand County
<br />rhnr nr nftd poFny for tNN.r
<br />At,plicrnl or Axrol Sisnnlum
<br />\-u**^",,n,,,
<br />":y__
<br />el-
<br />'"''V/ff
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulalion I
<br />Roof Sheathing 7/alf,-4&4
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL
<br />^Notes, Remarks, Etc.rn
<br />r--'
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<br />Erection Pads
<br />Shear Wall
<br />Certilicate of Occupancv
<br />M, AA/*t6,tutrla ku.,A
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<br />trnd.r'r Addr$
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