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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNNR BI JII,DI:R DllI,CARATION
<br />I h.rhy alltm unlcr Fnrky or pcrjury th.r I im c\cm ri rh. O,nlratloG Ltcn:. kw ror rhc rokwin3 rea$n (Scc 70.11 5
<br />Bun.css a Por.ssNn Grjc): Any Cily or Cohry,hiuh ,equirs i lxmir ro onnru.r. alra. im!ro!c, J.nnsh or rPatr My
<br />(rudurc. rwh irs 6ru,nc. also r.q ifts rh.aptlicdr for suchlxm l. lilc a srsncd sl.rcBd rnd rtor shc $ li.!n$al pumor
<br />to thc ptuv(ions of rlE O'nlrrcktr s LEcns.J Lrw (Chaflc. 0, Cb6mn ine wdh Sc.non 7(rO oI Divnnu .l or'h. ausm$ ed
<br />Pnra$i,'ns CGlc) oriharh.orrlr. tr cx.frpr rhmrtum ed rh. h.ss ri,rlhc illqc! excn rion. Ary r'ol,rion ot Sctio.?01L5 hy any
<br />l,)plidnr ,r s lcrhn .uhj*h thc appnclnt to.crvrlpcnallyol trol Btrc rhan lilc hrodtdJoll,r (!50o).
<br />l, rs .wrcr ol I lrc pnrpcrry. or m, cmployc.\ w h wa8.s rs rlttr !n $mPcns.ron, *ill do rtf, wotk arrl rhL nnttuF $ Rn
<br />inrcnd..l or olltrcd lnr sJ. (Scc 7014, Bus es rfll ftrlis(nr! Cdtc: I hc O'at&kr's Li..n* tf,w J.c\ nor lplly b an owncr ol
<br />rhcp(,|rny wh) hu'lJ\ or inrp(*rs rlrd,r.nd wls n,rr nr'h woL hrnr$ll dr hcrrlf or rhn,ugh ht.r h( own cmpl'yccs.
<br />povrdc(l lhrr n'ch mlmvc'r.ts m nd dc ctl or olltRl lnr {lt ll, howcvcr. rhc htr,thg or in\Tovcmnr N *,}J w{hm onc }cd
<br />ofo'n Lii,n. rlr Own$ BniU.r will h.ve rhc brrdcn ol |n oin! rhll lu or \1r ']ii Rn hu J .r nDbvc rhc Im)no1y li)r rhc lt{b\c of
<br />I..(own(ofrhcpn)a.ny.amcr.lusivclyconkr.ri,,gw[hlic..sclconkdcronroconsrntc(rlEPmr.cr(Sc.7t}l4,Busoc$
<br />rnd Pn,li$im ct'd.: l h. O)nra.(x\ Liccnsc Law d.cs n r lpply b o own.r df propeny who hu,lds or inpnrvcs rh.rcon.
<br />lnd who uonlr$k n)r su.h lroFcr\ wirh d G)ntado(s) h..i.d pursudr k, thc Ctnirr.roi\ I-ic.nic trw)
<br />I inr.rcnr onncr Sccr B & PC lffrln(nasnr
<br />WORI(ERS' CON!PENSATION
<br />DECIABAIIO!
<br />I hcrcby allt'nunJcr ncnahyor pcrjury oft o, ih. nnkr*tr,s Jthrarklns
<br />Ihrvcitrdwrllnrn rn ! Ccn ii.lrc oi Con{d n}Sclr:nrurc lor workcn'co rttns ion.$ nfuv e(llnrhyscdnn1700ofrlrc
<br />l-rlxtr(i c. ntrrl( B rlonrtuc ot thc work li)r whi.hlhc t'crrir r i$ucJ.
<br />I hrvcind trnlnrflir w.rkcra oomp..\irii). 'n\u!rn...3\ 'cqun'lhySccrDnl70Oolth.tihorCo,tc,lffrhcltcrLnMN.oin rucr| Mtworkc'r.onrpctr\ir(r huBncc crmcr nt F)lrcy numhtr r.:
<br />(U (--t
<br />54afi151 1 cl ZL\t q
<br />-l
<br />un,fy rhar
<br />'n
<br />rh. FrrfornBtu! oI lhc *ork tar wiK[ rhrs llcrm is ksocJ,I sh.ll nor cmtlo]lnyPcr$n in rny franncr
<br />$ as!)hculm{tjcd n,rhc workds umr.ns.rd, hws orciLtumi{.nd a8rc haliII stutl(l hc(m {brcct ltrl,.
<br />woi(en $m!.ns!rionpolt n\ of Scdion .lT00 of tlr ttrhx C,ilc. l shrll. Iotrhwirh .-nPly wirh (h)e Pnrvsion\.
<br />IVARNIN(;: F.rlurc b sceurc w(trkcr .omp.nsarion .olor8c i\ trnlrwrul, ind shrll suhi$r rn cnPbycr n)
<br />(1vil iircs trt l,' otrc htrndr.J ilnL\an'l 'ioLlrr\ l{10O.(X)0) JtlJ !
<br />(ii.. nn.r!( rnd rrnfl.y \
<br />3 G I 1,t
<br />I tFrhy rllrm und.r Fmliy.i!.rjury dd I rm lientd undct nn'vr ot Ch{r.r 9 (cdmmnc$8 w h S..ti,n ?O&)) ofDiv6ion l
<br />.f rhc Au!n.$ dl Prnc!\i,,n\ Co'lc. ,nl mylic.nt r r tu|1,,trcc vxl cllcet.
<br />D ,\L d44'
<br />OG Lbtl ra DU I
<br />CA.NSIBIJCIIOIILENDIXEIGENCI
<br />I hcftby alurnondcr fEtr.lry ol p.ljuryrhat rnere t a d,ndrurrion hnJhr 4ctr.y lor tlr lcnolmNc o! rhc k 6r whi.hlhnFmir t
<br />isskd (Scr .1097, Civ. C ).
<br />AIILTCANI.I]EIIAIIIIO!
<br />I h.re6y onim unJcr !.nrlry ol n rjory oft ot rh. fdlowin* 'lcclda( trN
<br />Dcmloon Pcrmts^shc(os Norilicirin Fcdcral Rceulariinr (Tnl. 40, PN6)
<br />ashc(o\r.nxn3latun.r rntlicrhlclorhirpn,J..(
<br />. rl rh..Lrin. tr,r,rDr.{rtr"\ 10nc.
<br />C y dnl Countyn) cnrcr uto (h(
<br />rbovc nrnrinNl PrrNny tar a Db 2lt1
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coal
<br />lVasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL 4lNtq',4rur6.,&b)trrCertiticate ol Occupancy
<br />Notes, Remarks, Etc
<br />Lcnici\ Nim:
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