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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNDR AUII,TJER DI]LCARATION
<br />I hcrcl'y rl6rs uidd p.n.lry of n rJury lnd I u cxcdpr rn,n rh. Co.trocntri l-icci$ ljw for lhc lollowin,s drsoi (s(.70:11.5
<br />au\incs\ rlld P.oli$ion Codc): An, Ciry or Counry whi.h rcautcs r Fnnir ro .otr(rucr. alrcr. imlt.k. d.'nolish or rcpat uv
<br />srtuclurc. prhrro irs issuancc. dl$ nqun sth! i0Dlicunl r'or $ch pcrnrir ro iilc I sisncd sllremnr thd h.or shc is licctr{d put\urlJ
<br />ro rhc Prcri\bns of lht Cotrlmckr s t,iccn*d Liw {Ch.ttrd 9. Commcncing *irh Sc.rio. ?000 ol Dilkion :l ofrhc tlusiners and
<br />P6r.*ionscrodc)orrhit hcorsh. h.r.nu rhcrclionrond rhc hash nn rh.nlkrgL{cxcmption Any!i.t ionoiSccrionT0ll5hydny
<br />aprliconr lor ! pcnnir rubJrch rlt rmlic.nl ro!.ivilPcmlryolnor nbrc rhN nvc hutulr.dd.ll-s (3500).
<br />l. N .wrcr of rh. pmpeny- or my enploltt! wirh wu8.s as lhcir v,le co rNns,tion. uilldo the ,ort iixl th. slMr@ i\ n
<br />inr.i.d or oflcrcd lor slc ( sF.7o4,l. Busincs Md Pllft\snn$ Cod. Thc Conl!!.roi s t-ic.ns hu docs not lplly ro an owmi ol
<br />rhc pollny who hoildr or in ms rh.d4 {rd wh diB uh solk him.lf ur hcr*lf or rhmtrgh hii or hd o$n erylorc.s
<br />p..vidcd rhar such inrtDr.rnrs m mr i .Eldl nr ofictn nn c c ll lx,kw. ttE ttriuinA or il{,Dkmnr is $ld 'nhin om txd
<br />ofcntrFl:li,n. rtE O{n* Buitlcr will h!rc rhc h .n o( EovinS rhd lE or shc dil mr buikl o. inpmw U. Iopdry fot lhc lrqr{ ot
<br />L as ounci.rlhc pmpcny. smcxclu\ivclyconrdins *irh lienscd conkr.ro6 ro con(rucr rhc nojcd (S(. 7(84. Bustrcs(
<br />arn PmGsbn Gdc: Thc contlcrols Liccnsc l-r* do.\ not +lly ro.tr o*ncr orltup.rlv who builds or nhlrovcs rhctcon.
<br />and who .ont ctshr $chlmFcrswirhi L:onrB.r(tr( 9 liccnEd ptr\nMr r. lhc Conrtaclni\ Lic.nsc trw).
<br />-l
<br />a .xc'nB ufldcrSelion-. A. & P.C. n,rhn ttrs.n
<br />l,.le O*n..
<br />woRKFR.Y C(rNtpF]\SATI(rN
<br />UICLAMIION
<br />I he,eby aflirnund.r pcntrhy of pcrjlr, one.lrhc rolrr,winS d(ltrlolions:
<br />-liaveddwill
<br />ai6l,in!CenificoleofConscnrbsclf.lNrru|orwortctronp.ns.tiotr.aslrcvidedforbvSslnrn:1700.rlhc
<br />lor lhc pcnni,n i.c or Ihc toI lor w|ich drc,rnnn is is\u.d.
<br />xnd$ill r n rrrvorkcn con,Fn\rri(rt irr\un .c, i\ r.qtrii.dbySdidrJTlrOolrhclrhntrCodc.lirrlhcpcrfon r c'ol
<br />compensarioi ii\urM.c c.ricr und policy nunrhcr oc:
<br />ctx)
<br />-l.ertify
<br />rhar i. thd p.rfoirnrNc olrhc work ir shi.h this Fnnir h isslcd. I \hru nor cmplov any p.r$n r inv manncr
<br />n,L\robromsubrdlolhcwi.r{.omPcn{rionlnwsofcllifffnir,.ndasNlhlrirI\h,xldh...msuhjccrbrh.
<br />wrk&J .omp.trslrion provhiois of SNr io. l?m ot rhc ljlx, Gxlc. I shrll. lonhwirh dJfrply eirh lhoe Dovi\n,ns
<br />WARNINC: F"iluR ro *.u,c sork conp.n\nrk,n covcdSc ir lnhwfll !tu1 sh,ll subJccl an cmplortr b cnninallLNlri\ 3id
<br />civil fincs up lo ot hundrcd rhoD\lnd dolls\ ($lo0om). in ddiln'n l{, rh. (){ ol conlpensation. dnmgrs N pravidcd rn rh'
<br />::XiHii[" :;t{k*u++r@
<br />I h.rby rntrm und.r rnolly of pcrjury rh.r l,m licn$n u.dcr Pnrirhn ofChlllcr 9 (odtukin8 with SNlbn 7Lrx)) 'rl)ivision l
<br />of rhe Busin$r 3nd Polcsions Codc, el ny liccne is in tull aorcc 4.d .ff..r
<br />,b
<br />(:oNSTRUCI-lON I LNDIN(i A(iENCY
<br />I hcrbr alfrr utdcr |Efalryofrrcloiy rll.l rhdt t !.ot{n'cri'd hndir8 tgcNy lot Ihc Frfonun.c ollhc *ork tr qhich dris P'nnir is
<br />i\slcd (S.c :1097, Civ. C.)
<br />I.cnilyrhrrlrcltdcralr.golari(rNn8rdirrsn\ticsro\rcn)!rlrr.nurrPPliclhl.rorhnpn,jNr.
<br />ffi$i;:r,lhard rid rhi(rpnliclrion md \inrc rhrrrhcnh)vc irrli'IrrBrn,n h.oncLr laarero.o'npl!sirhrllCilvaiJCou ry
<br />dc Law\ EldinS to buildin,c rotr\rtuct.n. iRl 0urh.ri2c rcprcscnhliEs oflhi\ Ciry und Couniylo enrcr tF,.rhc
<br />t Sq F0X
<br />,","!1reI(
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulalion/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 />Enqineer Final Report
<br />Flood Zone Certif.
<br />FINAL u/ 70/tv .<tA1 ,0
<br />Certificate of Occupancv
<br />Notes, Remarks, Etc
<br />ATEUIANLDEIIAEAIION
<br />I hcr.ty ollm uddcr p.n,lly ol r^-rjury one orrh. r.lbwnr8 d(lurationi:
<br />DcnBlilion Pcrn c AstEdos Noriiicrlion lcdc,ul Rcsulnri{,ns (Tnt 40- Pa 6)
<br />-Rcquircd
<br />ldrcr ol N.rifi c.rhn
<br />I
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