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BUILDING- INSPECTOR RECORD
<br />OWNI]R BT'ILDER DEI,CARATX)N
<br />I hcrcby rilnn unlo pcMlry of pc.jury rhar I tun crcnpr tom rhc Co.trdtu^ Lictrs. bw r'or ihc rollowinS rcas,n (SLr.?011.5
<br />Busitrc$ md Profissio. Codc): Any Cily o. County ehi.h NtutN a pcihir to cotrslrucr. atler. nnprove. &mli\h o. Enrn any
<br />srructurc. prhrro irs nsuance. lho rcquncs thc opdicmr lor su.h Frmi ro fika si8ned srdcmnt th(l hcor shc n li.cnd, tusuanr
<br />lo thc pnrvhio0s ol rhc Conlrr.tols Li.cnkd tiw lCh,prcr 9, C.nnnc.cint wirh Scction ?Lx)l) ol Divniotr ll ollhc BustE$ ond
<br />ftof.$ionr Codc) or rhar hcorrhc hcicryr rhcrcfrcn.nd ficbosis lb, iic 3llcgcd ercmnrion AnrviolarionofSftrio.T0ll5bynn,
<br />itpli.a lorrrr.nntsubjcrsrh. aplliclnrtorcivilr.nrhyornormrcrhmfiv.hu.drcddolltrs(3500)
<br />l. is owncr of r hc poltny, !. tu, .nDk,rccs wirh wascs !s rhcir s,lc d,nrpc srr i(,n. will do rtr wtrl( uxl rh. slndurc is ml
<br />inrcrrlcd oronarcd lnrelc(S(.7Or4, Busincssrnd Phf..shns Codc: Thc Contrd.r.is l-kctr* tjw des tr(,I aprrly ro an owrcr o,
<br />rhc proFny who hoilds or iq8,er lhc@n, ari Nho des sEh *o,t himscllor hcrrclror rhmqh hi\ or hcr own.mplort.s,
<br />pmviJcd lhrt such npnlrnEnh m nor irldxlL{ or ofliacd for sk.ll how.ru.rh.hurkltrE.r inprorc.Enr h hld wihinonc }rs
<br />ofcom iirr, rh. OwNr Buildcr sillh.rc thc bDrdctr olFnrving rhd lr or shc did tr.|huild o. nqmtr rlr pmpcny lbr ric l)trllosc oi
<br />I. N.wrcrorrh. ropdy,. rcxclnsivcly..tua.rnr! snh liccnsdd.otrri.r,sb.onir.t ihc tm]c.r (Scc. ?014. Businui\
<br />nnd h.aesion Codc lhc C.nrmcrof\ t,icclsc l,awdocs not rpplyx, m ounc! of pror.(, who build\or i.provcs rhcrc.tr.
<br />rnd who onrBds ror su.hpmj$h*irh. onrrbdI li..n{d,u6u.nr k'rlrConracktr s Licc.\c L!w).
<br />-l0mcrc'npr
<br />!trdcr Scctlnr-. B. & P.C. lor this rcN)n
<br />IraBrl:&Lrau[IiltarrQN
<br />IIEILA.BAI,IIIN
<br />I hc.ch,rlitntu cr Fnallyolp.rjuryoic olihc li)lk'*irs declff(rioN:
<br />+lhdc dtr,llnu hm d Ccn rficarc or Cun{nr t, s(lr.lNur. nr workgr conqEnsalbn. as p^*idcd f{rb,sc.rk'n r?00orrh.
<br />Lih.r ('"Jc. lor rhc rElnnmc oi r hr tr o* i.r wh ( h rh. n
<br />'
<br />m F FUcd
<br />I hrlc rin silln[i'nai'r so rri contp.trsnri,,n in\!rrn... ]s r.qotcJhySc.ri,nr:17(X)orr[clih.rGdc.lorrheI).nhnunccoi
<br />rh( \$rk ntr$hichrh,\ p.nnir i\Mr" *.rkc^' !on'Nn\rrit,, i'l rrmr.ntr:cr r.d tx,liry tru r' tr,.
<br />- 4z-4tt t-t-
<br />l.cnify rhrr nr d1. pcrfonnncc ofrh. work for whth rhi\ !.nnir h hsucd. I shnll nor ctrltllo, atry pcren ir any manner
<br />s!srobccomsu$lcclrolhcworkc6'con0cnsorionhwsofc.lilonrii-andlgrclndillsl'ouldrrconrsubj..rt,rh.'
<br />*orlers conrpcnslrion pnvhi,,ns olSeclion l7(x)ofrhc ljtnr Codc.lshrll. ronns,irh co,nply *irh rh,s pmvi\n,ns.
<br />WARNIN(;: F.ihrc !, \ccurc sorkcB ompcnsdnr .ovuhlc is unldsful. trtrd dull subjcct 0n cmploro ro crimirll Ftrrhics rnd
<br />civil &r! up to onc hundrcd rhousaDd dollnN linn!$ r\ l,'ovidr(l r,n rhc
<br />Scdnr 1076 or rhc trtr Codc. ir crcst nnd llkx
<br />Dlitt..\tr.\'ll{)N
<br />I hcrhy arlirmrndcr pculryofftrrory nu I d lic.sl uodcr pmrhi,n or Chanrfi 9 (d,frnrmin8 airh s.di.n 70u)) oi Divis ion 3
<br />ol lhc Uusincss ond Proltssions Co.lc. and my liccnsc is in full rbrcc nnd elitcL.
<br />/6o10 c' 2
<br />I,?lt"fir .-'^
<br />CaNfIB.U(IlQNLINDlNlrlliIIl:l
<br />n\ucd rscc 1097 cn c i
<br />AIIUIANfIIIiI;LA8AIIIJN
<br />I hcrby r,tinn rndcr ncnalry oitcrj(y oic orrhc Lllowin8 d(hriions:
<br />Dcnmlirn'n Pcrmirs Asbcsros Norilication fcdcalRcEulrrionsl'lirlc 10. Prn6r
<br />-Rcquncd
<br />Gtrcr ol Noliicdii,n
<br />I.cdiryrh.r rhc rcd.nlrcBul.riotrs rSdd,n8 isb.no\ ic'mv0l rc nor lPtli.rbl.lo rhis pm]ccr
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/Vent/l nsulalion
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<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 Beport
<br />Flood Zone Certif
<br />I
<br />FINAL ,Yh a/lrl -t 44;\
<br />Ce rtif icate of Occupancy / '/
<br />Notes Remarks, Etc
<br />r/z1r
<br />UFER Ground
<br />tf,odcr'' Addre$'
<br />-
<br />JIuc trr i,'trcd t l]lnylor in$9f i.ntrFPl\
<br />ttopticatr or r,'*tr siswrrrc/y'-/ 4/4
<br />ncm lF Mn.,Drinl':
<br />I
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