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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER DUILDI]R DELCARATION
<br />I hcrcby ,rltm und.r Fnahy (,r r.rrury rh,r I an cxcm lron rhc (bnrllcur t,iccnsc Ljw n, lhc followi.r r$$n (S.c 7o.ll 5
<br />Busin.s lnd Prolt$ion Celc): Ant Cny or Counr, qhi.h rcquncs a p.mir ro .onnru.r. llrer. idirovc. crcBrGh 'tr mFtr,rny
<br />sdciurc- priorlo irs i$um.c. nko rcquircs lhc.prli.Mt f.r \u.h Fmnr ro lllc a siSmd srarcmtrr thrt heor shc is licctrscd nu$urtrr
<br />to rh. t'n)visions ol lh. Contrctr's Li.cnrd tis (Chnpicr 9, Co'nmcncing sirh Scdi.i 7(XX) of Divhbn I offic Busir.\s and
<br />Pdt$ion\Codc) orrhar hcorshe hcxcmpr rhcrcfronrlnd rhc hash lor rhc rllcgcd cx.mplion. Anyviol ionofSerionTO:11.5byrny
<br />rrpli.ani ror a Fcrdir subjm( rhc 4llicanr ro acivilpenlllyofnor anrcrhin fivc hnndrcd dol,am t$500)
<br />-l-
<br />ar osm, oi lhc Dmpcn y. or nry cmpbyccs qilh wrgcr N rhoir $lii .onlEnkrion- -ill do rhc *o* ud ltE snt1uE ir nur
<br />i c,xLd or otfc{d for srlc lS( 7044. Busincs snd Pnr{c\sn,ns Cixlc:'lh. Conrrnn\ l-icnr Lsw d(B noi rmly ro !..wtrd of
<br />rhcpmlEny Nho buildror inpovcs rhcrcn. arxl who d,rs such wrt himscli.r hcrsllor rhmuEh his or h.r osn.mpkJy&i,
<br />pmvidcl lhlr such inrfloEnEnts uc mr i cMLn .r olTmd f(n *lc. ll h)wcvui, ttr huiuing ur iry,tuRmnt is olil wirhn om )cr
<br />ofco,rpL'on. Ir. O*ncr Buil].r will hrw rhc blrdcn of pmqne lhnr h. or dr di{ nol huild o. in{mK nqmtdy lnr tlE Nr,$r ol
<br />_l. nsowncrol rhc,ml1.yrj", tmcx.lusiv.l).onrrcrin! wnh li..n\cd conra.trn\ h .otr{dcr rh pnrrL.i ls.. T(r4,{. Bu\ir,r\\
<br />rtul hnli\iD Codc:'lhc Conlraclars l-i.cnsc l,aq docs n.r itplt tu rD oFncr oftrorny wh. hnilds or nn[.vc\ ihcrcotr.
<br />rnd wh. conrE.rsror such F+crswirha A'n(racr{,nn liccnqd pusurrrrorhcConrracrois l-iccn\c La*).
<br />-l
<br />m cx.np! u.do s*rio._. B & P.C. for rhn rclson.
<br />Dols O*n..
<br />raBtrrlurau&NsallaN
<br />IIITIAIAIIOAIhcrchyrfllr trtrdcr ncialryot NrJUryu'E ol rhc ln]l,iwing dNlxrxii,n,\
<br />I h,!crdtill nrainrain aCcrlificalc ofConscnr toSclrlflsurc ror sor*cB' con[cn{rl mn. rs provx,cd r'or by S€rion 3?00 ollhc
<br />hbor Codc. for lhc pcriormnce oi rhc work rbr whi.h lhc r.nhir is hsu.d.
<br />I hrvc and will mainlnin workcla con{Ens.lion insur.ncc. .s r.quircdbys.\rionlTmolrhctiborCodc,lorrhci'c o.miN.oi
<br />rhc w.rk i,tr *fiich Inis pcnnil is issudl. My workcrl cotrlp.ns,riotr irlurm.ccMicmnd Nli.ynunrb.ruc:
<br />I c.niaylhrr inrhc tcrfo rmr nL{ of thc work for *hich rhi\ pcrnil n hsuc,l.l \hallnor cnuloylny pcr$n in rny
<br />'naancr\. as to $ccom subrd b llt. wor*.^ comp.Ndrion lrw\ ofcrlifomid. and +rc. rhd if I nruu h.$nE subict b thc
<br />workcrr'coq).nsrridrpovkionsofs(tionl?fiJ.frh.tiborc.rlc.tlhrll.fodhwirhconrplywirhrh.*pdvisnN
<br />WARNINC Frilurc ro surc NorkcG' com,Ensllion o!cn8. is utrhwirl. rrd shnll \uhFrr no cnl,lloFr ro ai nrl pcntrllics 0M
<br />.ivil fitrcs rp h orc hundrcd lhousand dolhs ($l00.uD). ir sddiriotr Io th. con of compensarhn. danE3cs a\ providcd l'or lh.
<br />s..ri,,n:l{)76ofrhc LItry A'dc. intcrcsr lnd arrolEy\ tccs
<br />IICTN$LIaNIIICJIqA
<br />DECI.AA{IION
<br />I hcEby 0lfinn uMcr pcDrkyofNqury rh.r I rtrr li..nyd un{lcr ro\hi{,n olChrprDr 9 (co'nftncin8 wirh S(ri,n 7(XX)) ofDrvision l
<br />of rhc Btrsincssind Ptut \snrnsCodc, nnd nry liccnsc h in iulli.r.c dcfic.r
<br />CANEIBJ]CI]I}NIBIIIiGIIiENqI
<br />I hcftby rmrrlndcr lcnllryotptrjtrtlhal lhcrc h a cotrstruction bndin8 lsency ior th. Erformancc olthc aork lor shich rhn pcnnir is
<br />isucd (Scc.3097. Civ C.).
<br />I..niryrhrr rhc fcdcnrl rc8!lnrion\ EsrdinE 0shc\ros rcnFvll arc mt np0li.rhlc ro rhis projccr
<br />I.cdilyrhr l hlrc read lhnlPplicllion un sloldh fic ntrvc ininnfl ion is cotrsr l.s.eloc.mplysnhlllCnylndCounly
<br />.nhrnccs ond Sr.tc L.ws rclirin8 tn huildin8 con(ru.tion. d hcrcbyjurhortcrcprcrnrorircsofr[isCn,lndCounrrrocnrcrut'otrrhc
<br />ahov. mnrioned p.otcnyior inspcclion N{'oscs
<br />l\DDlicrnl or ,\lcnl Si,r.rltrrc
<br />Set Backs
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing l;2o-t8 z '{:/ruc,to:9e /A-ta// tL[/,/:<-
<br />Shear Wall
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />[/asonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL 1/,2-4/ tb Joe
<br />Certificate of Occu /pancy
<br />Framinq
<br />lnsulation/Enerqy
<br />T-Bar
<br />lo I
<br />Notes, Remarks, Etc.
<br />I l..n{ ( r\{ I .(n\t Nun {'
<br />l)rik Co r.!ct,.
<br />AIEI,ICANLIIECITAIAITI}!
<br />lholbyimrmu cr pctrrlry oitcryury orc ot rhc l'otlowing d..larnriois.
<br />Dcrmlirion P.rm l^sh. os Noti6. tun r{d.kl Rqrlarion\ ( tirlc rg). Pan6)
<br />-R!.quircd
<br />Lrlcr ol N.rifaltiotr
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