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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER EIJII-DER DELCARATION
<br />I hcrcby lffi,rn undcr p$rlry or p.rjxry rhrr I a'n.rcnrpr lonr rhc C.rkdo6 Liccn* L.w fitr thc folloeiD8 rcisotr (scc.70ltl.5
<br />Burn'c$ !'rl Prolcsion Corle) Any Cily or Counly whih rcquiEs a rf,rnir ro onnrucl. alr€r. nnpr.ve. dcnrli{h or rcprn !ny,
<br />slructu . rrioir, irs i\\umc.3ko rcquircs rhcnnpli.! ror su.h r.mil ro fil.a \i3ncd nat.ftnr rh,r hcorihc G lic.nsrd lur{mr
<br />kJ rh. pmvnions ofrh. Co.r&ctofs Liccnscd Lrw (Chtrtr.r 9, Cunncncins wirh Seclion Tuxr ol Divnion I oi rhc Eusincs trnd
<br />PnttsionsCod.)o'rharlEorshchcrcnurrhcrcflornotrdrhcbr\hf.rrhcalhBcd.rcnion Any vn,hrio. olSdlhi T(lll 5 hy xny
<br />q,rlicant li,ra Dcrnit subic.k rhc appli.rnr ro rcivil!.ntrlryofDor morclhotr livc hundrcd dollns ($soo).
<br />l. rs owtrn ofrh. tn)Fny- or dy enlPn,,lcs *ith Ba8cs $ rhtn stu.onrpri\dnnr. willdo rhc trork aJ rh€iturlR i\ to
<br />inrcrdcn orofltEd r.r slc (sN.704-4, ausindsuid Prolc\sios Crrrc: Thc Co ra.lols Liccnsc tl* docs not .mry to atr owDcr or
<br />rhc pmrcdy wh, hills or imphvcs rhtmn. and $ho dms ru.h ro* hinN.lfor hcrellor rhDugh ht nr hcr o!,n cnrloyc.s.
<br />ln)!id.d ihri ruch inDorcmnh oe mr inrentiel n o,fcrd for \aL ll hoqckr. rh. huildin! or idrbktunr is $ld shhi'r on. trr
<br />ofcomplctior rhc owncr Build.r willhr!. rh. bunlcnolrrovin8 tird heornrc did noitl Iin ()vc lhc ImFny nn thc luqnr.r
<br />_l- a\ osncr ol rh. pmr.ny. on .r.luriv.ly conkrr in8 *irh liccnscd c.nraflr lo cotr\rrud rnc prcicr (S( 7(}l-{, Bu\inc$
<br />(rxl h.fcssi,n Codc: Thc Conrrcrois l-iccnlc l-aq dNs nor attlyro M o*ncr ofnol*n, sh() build\ or i'nptu!.s rhcrc.n.
<br />rnd whn conlncrsior such nmicls wirh a c.nkacrtrG) liccnscd pu^rnnr rorhccontucrois Li.cn\c l-ow)
<br />I amcrrmpr undcr SNtio
<br />tloali[astg.)MfENsatlaN
<br />lrD.cta.8arll)N
<br />I hrch! rflnm uidcr lcMkyotrrrjurvonc olrh( lnll.\eirs dc.lirdlotr(
<br />lharLndwillnmnririGniltarcolConrcnri'Sclllnrurcn)rsorlcrscoml.nsri.n.,\[ovidcdiorhySccrior.]TmoIrhc
<br />litxtr (.(1., lor rhc p.rrorfrm.. of rhc r.rk rr shich r hc pcrmi! is isnEi
<br />rhr wort 1,tr trhich rhi\ pcrmir i\ i$u.d Mysorkc^ conl{trvrnr (urd.c.rr'rr rlpli.y nunih.r:m:
<br />P.liry NuDhcr: Expnr\
<br />_lccnifythar rh.pflorman..ofrtuworklo$hi.hrhisp.nnn is i\\rcd.I rhrtl orcnDbyriyp.rsotrir{nynrmnr
<br />sr r k, S.!-m shJcn lo lhc sol(cr' conf.nqriotr l.w\ of Crliturnii, nn,l aercc rhm if I \h,rtd hc.onr su$jccr h rtf,
<br />qorkc*' compcnsar ion pDrisions ol Sarion 3rO0 oi rhc I -ft.r Cdlc. I \htrll. lon hsirh .. lnly wirh rho$ pmlhi, \.
<br />WARNINC: l.dilurc k, $cure aorkfa ofrpcn\di{,n covcri8c i\ urlaslirl. and rh{ll s,hjccr an cmploycr io diminrl pctrtrlti.s ind
<br />civil tncs np 10 onc hrndr.d rhousind dolhn (s100.(xx)). in indiion ro lhc.osl .lcompctrs.rio.. danmEcs 0s lrovidcd ftr rhc
<br />S..ri, 11176.l rhc Lfi* (-r)d(. ir mn dd xronry \ fi.s
<br />ZZ.l( .rrr,,**,
<br />I hcrchy{fllrnrnd.rpcnllryolp.rj1tr}rhrrI an licmql u.d$th,ri\n olChi.rI(.omrnci'rgwirhSccrion7ffn)ofDivi\nrn.l
<br />.l lhc Dusinc$ rtrd PFfcsiors Codc. m hylicc sci\n'tulllbre! clltct.
<br />D"t", 3 -2-S
<br />I hcrcby rlrtm utrdcr pcnrlryolD.rj!ry lhd lh.r. h r.ondtucrion bndins DE.Ey for rhe pcdomoncc ollhc sork tr,hich rhh pcrmir n
<br />tsrcd (SG...1097. Civ. C.)
<br />drflltall.-0&;lrtBAltll!
<br />I h.nbyimn undc. I].n,lr, ollErjury om ol'rhc lollovine dc.lsarions
<br />I)cnnlirion PennirlAsbcnos N.ri11.$ion F.d$al RcEulari,,0r ('tirlc,10. Pln6)
<br />-Rcquncd
<br />tlxcr of Norifi cdiln
<br />l.cniryrhd lhr rcdcrul rc8uhri,nrs r.!fliir! rsbc(osrcnrrrirr. ror rf/trnhlc t, rhn pxrjrcr
<br />_lccnilyrhrt I hav. r.ad rhi\apllicaihnrBlstlrclhallicrh'rr inforn t r is cdiiNr. l ll3m ni .o rly wirh rll cly and couflt
<br />ordimNcs.nd Siarc Ijws rclring rr huikting connrudion. 0tulhcrchyaurktrizc rcflcrc.rarivcs ofrhh Ciry dnr] Coufly ro c cr ul!,n rhc
<br />,lbrc mnr ioncd tmp.nv itr inspcc
<br />,\l)Dlir nl or,\,r$l Sixn rtrrr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Shear Wall
<br />Framin s
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Pool Fence
<br />T-Bar
<br />De U Final Re ort
<br />En gineer Final Report
<br />Flood Zone Certif .
<br />FINAL *\r\r\Au.(\ilJ
<br />Certif icate ol Occupancy
<br />Roof Sheathinq
<br />It4asonry
<br />Handicap Req.
<br />Notes, Remarks, Etc.
<br />Cdricr:_
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