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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER AUILOER DT,T,CARATION
<br />I hcrchy alfuh und.r 0cmlry ol r.rjury rlEi I am c\cmlr ln'i rhc crnr on'L[cn\c tlw ntr lh.lollowins rcatun(Sc.7o]1.5'
<br />Brsinc\s aid Piinassion Co'lc): Any Cily o! Cdumy whi.h equncs ! rmn b cdn{ru.r. .lrct. imprrvc. &ml,sh or El'rtr uv .
<br />{flduq J,n)r b (s t a&.. lko rcqutcx Ihc apPlicMl lor su.h pcmr b filc r siSn d slolcmnr rhar L or sh. t liccns'-l lssuanr
<br />h rhc l)n)v6ons or lh. Contracttr s l-i..nsc'l tjw (Chfrcr 9, Commcncin3 w h serDn 7u)0 ol Divirirn I or lhc Busims anJ ''
<br />Pn)ic$ionsC&jc)orrharn orshcN.rcn r lhcrcliom .nd lhc bas,s ,i,r rh. rllcgcii crempri! A.yviokrnlnofsctri)nl{lll.5by,nv
<br />appli.a.r ,oM Fmir suhJccrslh. rnpli.ani h ac'vilpcnalryDln.t m,c rh,n fiv. hundrcd Jollm (5500)
<br />-1.
<br />as ownfor rh. pop(ny. (tr nrycmployecs snn wrg.s s rhcir elc..mpcnr n)n, wJl do llr wo all rhc d*rm i\ rtn
<br />inrcftlcd or ollcrcd ntr sole 1Sd,704.,1. Busmc* anJ Pnnt$i,ns CoJ.r Tn. ctn ra.nr's t-iccnk tlw &'cs .ol .pply tu ,n owkt of
<br />ih. pof.dy *lxr hu,lds or impnN.s rh.dh. r wln' d,rs sth R)& hm\cll or hc6c lf or r lmu3h hit or hcr own ehIlov..r.
<br />pruvidctl rhar such imlfl,rcmnts e lFl inrcBlcd q oNrEl fr ek.Il, hwcvc(llEh'l1]ing or inlDEmnr ls sU wirhmorc ]ta
<br />.i o'ruhl n. tlE own.r Buillcr will hlvc rh. bod.n oa pnvry lhal hc o, shc did fr huiLi or nlmw thc lrolEiy ror lh. pu.pos ot
<br />I. ,soqtuJofrlf, prul.ny. rmcrch'\ivcly cnm&ir8 w(h lrcnscJ conrrirrns ro c.n(d.r rh. ptujccr rscc. 7(*4, Bosr.*
<br />anl Pn,lt$hn C{ c:IhcCunrr.ehtrst,i.en\.lrwdmrnorrntlybinown.r.fF)pcnywlx)6urldsorin0ioltsrhcreon.
<br />rnd who.o rad s li)r s!.h pn,j.* wnh i Cdnth.t,)(n h.nscd lusurnr ro rlE al,nta.ttr s l-iccnrc Law)
<br />_l atu.r.nrpt trn'lcr Sc.r
<br />uoarc8$coulENs ngNuEcl4xarlg!
<br />I hcrchy alhrm undcr pcnalryoffrjury onc ol rh.Iollo*urr Jc.larurkn,ll
<br />I h{vc rrl will mriJ ri', , Ccn itilc .t Ons.nl 1,, Sclt,n\ur. tur krkcn- conDcnsar ion. as ,$vdL\l ltr bv S.dbn ll00 ofrhc
<br />tjlitr Cixlc, for rhc p.rli)mlncc ol rhc wo* lor whieh the Frmir i\ i\so.J
<br />,J hrv. atul willnrinrrin workcr' LonFnsrrion Nurnncc, al rclu cd hySc.rnn ]70{r ofrhc ljhorcodc. for rhc pciolmn col
<br />rhs p.m r I r \unl. My *,,k.r\:!,inrFr'qii{ rn\urrntc, n*' ni F'l(} numhcr s^.--t"1, Q^t"r\
<br />qyto(J(A"$q
<br />-l
<br />ccn,l-vrhr rrhc rrc.Inrnuncc olrhc workhr whi(h rhN lf,rmir ( i\\d,l ar! mt cq:loyanyPcron in.nvmanncr
<br />n) $ r. tc$m slbjcd ro rhc sr*ds .ampcns.li,n hws ol Crlildnna. md.eEc rhrr itl should h.(tm subr.r brh.
<br />B.rk.r' (nnF-nsrr(r I)lovtron! dl S..ltrr 17lx)ol rh. lr'lltr I {hall lnnhw(h.ofrply Birh(ln)r pr)vi\i,)ns
<br />tVARNINC lrilur. i{, wur. workcrs Lonrn ,r\irsr ..rctrgc li'|. J d \lrrll n,bFr( rn .n,doy.r ki cnnn l lt.tr ltr: rn,]
<br />n) otr. l,tr r.J rhotr\rtrd rl.lLr\ iSll()lxxr) tr,) tlf, uo( ol comt nsrrr)n. dmrfcs ar tn,vdcd nt rhc
<br />l.irCdc. nn.rc{ rtrd knmy \ licr
<br />h
<br />Ih. by rilnN trtrrl.r Irnaliyolp.rtur! rhxr Itrm I'ctr{(lun'l.r Pov'\n,ptcr I (d,mmnci',s w'th Sc.ton ?0(x1) olDirtion l
<br />ol rtu Bnnm\lnnd Pnnc$i,)ns Codc. arxt.,y I'ccn\. r tull l t ! cllicr.
<br />la\n1L?>
<br />I h.rcby .llim unncr i'cMlly ot p.rjury rhd ih.rc L a N.(d.rbn bDlins ,s.ncy for th. Frlbmanc. of rhc wrk for qhich rhn Fmir ii
<br />tsucd (se.1097. civ. c ).
<br />AI'FLICANI DECLARATION
<br />I tEctry alifr utulcr ncndhy oi p.rjury ore olrhc .olbwhg d.clulions:
<br />Dcfrn i(,n Pemirs Artf,sos Nor itr. n,n kdcral R.sular $n! (Td lc 40. PM6)
<br />_R.quird L.rrcr ol N,rili.ari,r
<br />I.cn yrhrrrhc ltlcrrlrcBulihonsesrdin8 rshcs(o c'novrl m nol UPll.!6lc b rh^ p(,jL{r
<br />l.cn'l!rl lll,vrr thl\i rh, rh. alivc nrli)lmarNn t om.r. I rgrc t,r comdy wnh all Cnyan.l Counry
<br />onlu,mr.s rnd Srrrc l-rws rclllng t ofrirt Ciry mn Coutrryro enrcr urr rh.
<br />atxnc k-nrnn.'t pmp.n, kn
<br />ADpli.anr or Alcn( Sixnrlu
<br />dion., hcEby Nrk)rnc r.pr.*nrdivcs
<br />2-x
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Sheathing
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL r-26"t1 vwil
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />Shear Wall
<br />Pool Fence
<br />Flood Zone Certil.
<br />I
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