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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS oWNI]R BUII,DER DELCATIATION
<br />I hcrchy llfirn udcr pcMlry {rr t^--rJury rhar I am crcnrpr linnr rlE Conltrror' Lidnsc Ltrw tur rhc fi)l|,,*ing rcn\otr (sN ?0lll5
<br />Arsirc\\ drl Pi(ncs\io C.dc)r Any Cily o! Counry Nhic[ rcqrnc\ r Pcnnir io otrsrucr- rhcr- nnPtuvc. dcnmlish ot rpair oy
<br />slfldrtrc. prio, ro irs t\uucc- ako rcqut!\ rh. Lprhrm rd nkh lt ni( ro Iilc r sisncd {rrctunr rhir h. ot shc is licci{d Nrurnr
<br />io rhc pmritnnr\ or rlt cont!.ktr.s Licen*d L,e (Chiplc! 0. Conurn.nrg with Scction7d)O ol Di!(n,n :r olrhc Businesl and '
<br />Pn)fc*ion\ct)dc) ur rhnt lEor shc iscrcmpt rhcrcfron d rhch'\i\ f(tr rhcilLlcdcxcnrPrion Any\i,,lln,nofsalhnT0ll5hydny
<br />afflicrnr ior r pcflnil $l,l.cls rhe rpnlicrnrr.a.ivilNnrlryor oitrk clhatri\chu rcddolln^(l5m)
<br />l,xs owncr trhc|x)txny.nrnrycnrplo)rcswirhwascs^rhcirvncco lpcnsnriotr. will do lhc *ork dd rh. selurc is ror
<br />inlcrdcd orofitrcd lor {lc ISN 7(N4. Busnris nM Pdcrsions Codcr'Ihc Conrructr'\ l-itcnsc li* d.cl nor oPply t' an own rol
<br />rhcpruI)Lny who buildl or n\,rcvcs rhcrcn. a'xl rk) docs such *{'lt hnns.lfor hcr*lf.rrhmughhh orhcros cmrloy.cs.
<br />providcJ rhrrsurh irrovc'tunh in i.r inrcMcrln.iarcd ntr\rlt ll h.*cv.r Ihe brildi't! or nnilftntnr ,s qikl wirhin(,'f, !t
<br />olconrrhrtn. dc Owncr lluitls willhn[ rhe bdrdcn ofp.(,vn'! rld h. or shc did tror h,iil or i'nProrc rtur lm)ltny tdr ltE puqxM of
<br />-1.
<br />$owncroirhctnlcny, nm.r.lusivclycotrtr.rir8 wirh li(nscd.onrractns ro.1nNrfl.r rh. lroiccr (Scc 7()r,1. Bu\inus
<br />dd Plltssb Codc Thc Conrnctor's Liccn{ tis doc\ nor rpply ti o*n.roiProli.ny$ho huildso' imln)vcs rhercon.
<br />rtrd who conrrarrs rar su.h fuc.r wirh a (b mcro(9li.crscd !u6u rrorheCo ttkr'! Li.ctrsc tiw )
<br />-l
<br />rDcxcnrpr unJcr Sdrtn B. & t'C li,rrhi\ rcrvn,
<br />UABtrIIN:g}ruNSAII!]N
<br />DICI,ISAIION
<br />I hdrdhy rfisnontlcr Fndhyol Frjury onc ofrhc follo$n,S,lcchrariont:
<br />Ihrvcandwillmrinrainrc-cdillcatcofConscnrbSclfln\urulinsor*c6.onIrcnsolion.as providcd fd bysR..rim 3?uJ ofrhc
<br />Liho. Cod€. nr rhc pcraorrotrcc or rh. Bork for qhich (hc rEntrit is i\sucd
<br />I ha!. rnd sill nrinuin workcri conwensalion in\urancc. a\ ruquncdhyS..riotrlT(Dorrh.LlhorCud.,fordcFcnntmnccoa
<br />rhc sork t.r whi.h rhis pcrnrir is isscd. My worker' conrFn$rn,n in\ur .c .rrid and policy numtEr dd:
<br />-lccniiyrhrri'rrh.Itrronnrrcorlhc$olknxwhlchrhi\t--rnil
<br />is Asrcd,I srtdll trorcnDby iny Pcr!r rtrynr ncr
<br />so r\ ro h..o E suhlc.r r' rhc *orkcr con,p.nsarion hes.fcrlilnnar, and r8rcc rhulil l \ln)ukltf,conic ruhl.d rorhc
<br />i( r t"ovi\ions olSc.ri{nr.l7fil olrhc Lhtr C,xlc.l \hll.lonhrilh cornly \iih rho{ ln,vi\iLrr\
<br />WARNINC: alilu.e b KUrc *orkcis .o urns idr covcri8c i\ utrh*tl
<br />.ivil lincs up t, on hundrcd rhousNtrd dollrs (Slm.Ux). ir ullirtr h I n orcompcDsarion. drroscs a\ Providcd for lhc
<br />S(xon 1076 orrh. bh, Cudc. inrcrcn lnd auormt \ ltcs
<br />,^,". o'/2tr n*,,*,,, A
<br />I h.nbyrfiin uNl$ pcMlty o l P.rjury lhar I an lirn{tloiJcr Pn)risn olChtlrcr9lconrnEncin! sirh Sccrir 7000) "irriltir 1
<br />ol rhc Busirrs rtul Ptulcs\iorNCodc. md my liccnsc is in iull Irtr( sd cffccr.
<br />q
<br />I hcrc$v rnnmundcr pcnalry otn rjnry tld th&c n. co.qrucriotr lcndina alcmy r.r ih. P.rtinruncc olrh. work r(, uhich rhn tEnni n
<br />AIELIqANLDEII.ABAIIqN
<br />I ls$y allhn undq ncnulry of rcrjury otrc ofrhc followiDr dNlamtions:
<br />Dcrholition PcrnrirgAsbcsros Norificarion Fcd.r.l RcluldbnslTitlc 10, P!n6)
<br />Rcquned brlcr of NolincliioD
<br />l.cnilylhd lhelcdcrrlrrguIri(, \ r.8ddin8!st{sro\ r.mnrlirc troli0t]Licllblc roihi l]fl)jccr
<br />iriorun,i iscorcci.l aE ccro.omplrwirh.llC ytrnd Counly
<br />ortlinrnccs rnJ Srrrc l-rs\toLritr8 k) builiinE .o0{n'.rion hcrcby$rhorizcr{rcsc ativcsolrhi\CiryMdC.uDryrocnlsuIx)nrh.
<br />rh!!. trtrnr L trLl D!-'f,d! l;r i,a'i it,r
<br />^,,,,..,',",,,:,',
<br />-,,,',,,,* K ,rrr"e/Z/
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/ aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL ql%ltq'1.l,t {lr'Drt t ?'1)
<br />uuCertiticate of Occupancy
<br />Notes, Remarks, Etc
<br />suhjer nn cnulorcr ro ohinrlp.mxics mn
<br />irsx.d (S.c.1097, Civ. C.)
<br />LinJa'r Nrmr
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<br />l.ctr.lcr. AJdrc..
<br />_l.cn'l) rh IhrvlrJil rln. r!f''c0r nnMd.rr'c'\J rhc
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