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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG"COMMENTS OWNF:R BUII,DIIR DIiLCARATION
<br />I h.rcby alllr rhdM Fnrlry of Nrlury fid L,n cxctrrpr lom rhc (trrdd,6 l-icctrsc l. s nn ihc f.lk'wi'rg rcrsotr (Scc.70:11.5
<br />Bu\incss and Prcl!$tu Codc), Any Ciry or OrDry *hich r.qrncs r pcnnir h .onstru.r, trkcr. im[ove. dc.mlhh or rcnrn trny
<br />dn,rru,., ,ritr k, ir( is\untr(. rko rcquircs rhc ,|l,li.nd hr nElr Frnir h tilc r ri!rcd iJcnEtrr rhd hc or \h. B li.cnscd NhxMr
<br />r. rhc pr.ltion\ of rl.. Conrrrcrois t-ic.n*d tiw (Cllaprdr 9, connrkinS wirh S.clion 70(x) ol Divist'n I ol rh. Bu\inc$ rnd
<br />Pn,losion\C.dcJorrhrr h.orrhc is cx.'np hcrfrofl and rhc l)!sir lor rhc illcscd cxcnrption AnyviohrnrnofSdrionT0:ll 5hy.n!
<br />dpfli.r r ror a pcnnit subjc.hrhc rtplicmt r. ncirilpcorltyoiNr nn crhr livc huidmdduLltus (Ii5lD)
<br />_!. !s o*rcr ol rhc pn,pcn !_. .r nry u rtlclccs wir h wa,!.r N rhct sh .onrpcnsrion. wiu do rhe wort and rtr {urm il k
<br />i' c Ld or orT.rd for slc (5(.70.14. Busincss otrd P.ofessi.ns Codc: l hc Contrctr r Li.cnr. h$ do.s .ot ,pnly b a. owncr o,
<br />rhe pnrlEny who hnilds or i.{r,,ks rhmn. a wlx,ddssu.hq.*hihsclforh.rselfo,thmughhtorhc'osi.'nPloyc.r.
<br />pnridc(l rni such inrrovc'ftfi rrc nor inrc lcd or ollctod ftr sdL ll how$u. rhc huildir3 or inDrovcrnl is \old wirhi. o.c ,*r
<br />otoniplcrion. rlrowncr auikcr wlllh,vc Ihc hudcn oftmvins lhll tE or she dit nn hniB or nnlrok rl* pmpdy tu rhc !u'F,E ol
<br />L isostrqol rhcl[)ltny. anrcxclusirely.orrrcliDe wirh li(tr\cd coftx.ttr\ t, $n('!dr rh. nn,i.cris.c 7l) . Bu.i"t\\
<br />$JfDlt\\bnCodc'l'hcc(,nkrktrrl-i.ctrscLn(d(r\trorrt!lylr)itrourcroin(,pcdy*hobuild\oritrtptu\csrhcrc.tr.
<br />rM qh. contds for suclr protccrs wirh a Coolrrkri, lic.r\cd N(!a n) ik (i'nkki(tr s Liccnsc lir I
<br />I iD.i.nrnr undc. S.dio
<br />M!tr!!!LI!)U[I,iNATIO!
<br />Draul B[M!!
<br />I hcr.by dfiinnundcr lEnrh, ofrqjury om of rh. followin8 dshrurioil
<br />I hrvc md qill ui'ndr r Ccnili.[c of Cotrscnr lr Sclll trrrc li)r \q[cr\. co ,rcn\ 1i(trr. t{ F,vdcd lor hy S$r i{n] :1700 ol rhc
<br />l-atxn Cftle. r(n rhc pcrtummc ufrhc$oik Lr shi.hrlrc Fnnir i\ i\{,cd
<br />lhavcnndlillmrnrinsnrkcrr.onrpctr\rri,nin\uft.c..r\rrqrtcdbys..rtr:lr00oflhcl-ab.rC(){Ic.fttrhcpdnnnr!rr
<br />rhc s rt lorwhichlhn pcrmir is M,*orkc^ comf.n\rri(n in\utur.c.rnicr []l Fri.y trtrnrhrr lrr
<br />5 ,!c
<br />q I l-15?at tt ll 3l'?ott
<br />,le ilylhar ir lhc rcrformn.c olrrt woik t{tr whi.h rhis n nnir h ssucd.I shrllnolemploy trny peson in rny nEnncr
<br />s.trst)h..on1cruhl..rrothc"(trlnccomFnsnlion,ovsofCllil'ornio.andagrccrhliflsh,uldhc.orftsuhjcdlolhc
<br />wolkm.on!.nsariotrprovnionsofSccrion3?drolrhclihorGxlc.l{hdl.r,fhwirhcomPlyqilhthoePmvtior
<br />WARNTNC: Foilurc lo wrE Mrkc^ .onrcosarnnr.rlcriat ir unLwful. lrkl shrll suhj(l u! empl,,rdr t, aimirar lEtuhts itrd
<br />.nil lnEr up lo .N hu rcJ lhou\rd d.llrr\ iSl(n ro rhc cosr of comrcnsdion. dsnkps ds proridcd lor rh.
<br />s(rkr Lro76.rrlr lr|rtr crlr. irrr.! rntl xl
<br />illz"tt
<br />DECI.AAAION
<br />I hcnh, artrmxndcr p.ndlty ol !.rjury th.t I am liensd undcr provi\io. orchtrlrcr 9(comnf,Rirr8 *irh S€rion TlnO) of Dilkion:l
<br />of rh. Busi'E\r ,M Pmre$io.s Codc. ud my licensc h in lull lhrcc od catc.r
<br />1'1kls*
<br />l2u+
<br />CANSIAJJEtrANIINDITGAGENCI
<br />I h.rhy .f6.rn utrd.r JEmlry of p.rjuly lhal rhcrc is a .onsrtocrn,n bndnrg agcn.y lor th. ,Erformncc of lhe worl for whi.h dis t)€mn ir
<br />i\ru.d{S.c 1097. Civ. C.)
<br />arlucalr.![ll &&uoN
<br />I tsrhy.lfi m undcr lEnilry otpcrjury ooc ol rlt ft nlowins dft hrrri{,.s
<br />L:}.N,lirion Pdrni's Asb.sos Norific,riotr Fcdcnr RcSul ions (Tillc40. P!n6)
<br />-Rcquirdd
<br />lrrr.r of Norifi cdtnr
<br />-l
<br />onilyrhnlrh.ltdcralrcgul0lion\ rca ni'13 \hc{osd r,rrl
<br />'c
<br />ior rJtfli.ihlc rorhn pn)cci
<br />I ccdiryrld I hrvc rdid rhis rtpli.dnrn od (rlcrhd lhcnH)vc inl(nruri{r i\.om.r LerL{ h'conflywilhrllCiry]nd A,unr)
<br />ordi'r.ctrndsr,rcLswsrcldinBrobni6nrBconnrudion.annhcrcbyaurlnrizcr.rrscnhnvcsorrhhCityondCounrylocnrcrrlx)nrh.
<br />rho!d ff,trrnnkl 0'on.'1y ktr l, *'JL 1z4Apoliernl or Agcnr SiEtr{tu
<br />Ztb'Z
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />S u blloor/Ve nt/l nsulatioq I
<br />Roof Sheathinq I.#t )fr/t /r{.1/A c n4^</\-,/Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil
<br />FINAL vh/,11 . )tW;^
<br />Certiticate of Occu anc
<br />tes Remarks Etc.
<br />3 rB d 31 Qvt o
<br />t )r
<br />/\c - r90t
<br />kndc"\ Nam'
<br />t-ndcr\ Adtl..r _
<br />tt
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