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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE tD/stG.COMMENTS OWNER AUII-DDR DELC RATION
<br />I hcrchy aififln utucr pcnllry {n p.rjury rhar I am crcnl rro rh. o)ntidoF Liccnsc ljs rrtr Ihc rolk,wtrr8 tcrhn (Scc TOl l 5
<br />Br\i'rcs 3nn Prolc$n'n C.dc) try Ciry or Coutriy whi.h rcqtrirc\ a F,nrir x, .oo{dcr. ,lid, infrovc. dcflnli\h or rPrn rnt
<br />lrru.rur. pri.rb irs is\u.tr.c. rls rcqlncslhc alplicinl lorsuch pc nir b lilc a ns.cd idcmnr rhd h.or shc i\ li.. s.d lnNrnr
<br />ro rhc Il'olisions of ihc Conrr.ttr ! Liotrsd trw (ChlPr$ 9. (-(mmcrcing *irt S.crion 71X)0 of Dilin.n .1 oa rhc Bu\incs\ nnd
<br />Prcrcssiotrs Codc) or rh lf,or shc iscrcmpr rhcrclromrtu lhctusil nn rh. olldgcd c{cmPti.n. Anyviollri{,nolSccri, T0ll5byrny
<br />, lnxtrr'. rr{' 1{hJir'!rnc.'nt,ltrJnir.a.r'lllcn.'lrv.lm,ni'rcrhlr,i..5rrd-'l'l.llri\'(<rr)i
<br />lA&". .*,*, ",,* r.,"ny. or n,r enrpl,)rs {,rlr q!gc\ !\ rhri, v,r... Irnsarion. qirrdo thcuorkun,riht {n.rur is n.r
<br />inrcnjL1 qorrcrc.t r,,i srtc ri.r zui,r. e,""*. ,.,1 P",r"*"i ,n, t\d. rhc c;N rodr'\ t.iccn\c I iw dnc\ ior rplly ro !n owncr or
<br />rhc totryry uho trilds d nnnn)vcs rher$n. lxl wk' &f,s su.h slft [nnsc ll o' h$*lf.r rhnu3h hG o! hcr owtr cnPhyc.s.
<br />povid.d rhar such i'npn n*irs.k norinrcnd.dorofidcd for srk llho$cvc'.rhchildiigorimpn,vcnEnr$srdwilhino'tt.-e
<br />oi con{,lclion.lhc owncr Buills willhrt rhe hurdcn ofpiovi',g rlun h. or \hc diil Dol huild or imprcvc rhc nmp.dy for rh. lur[ft oi
<br />-1.
<br />ffowncroirhcrmpcny. xncrcltrsivclyconra.ring sirh licrn\cd.otrtr.rors ro.otrnru.l rhc pnjcr (tu. ?014,ltx\inc$
<br />aft] Pn,fs\iDCodcThcclnrri.tnr'sLiccnrcLiwdocsnorapnlyhrno$mrofpi{)tdyRh.huildrotinrProlesrhcrcoi.
<br />rnd *ho coDroch lir \uch pn)j.c( sirh, c{n r,ck,(n lic.iscd !tr6u0trr r.lhcConrradoirl-ic.n\c lj*)
<br />DECLATAIION
<br />I hcrcby rlitn undcr pclrlry orFrjury onc otrhc rdbwins d..l*rri(rs:
<br />-lharcddwillmaintli,r!Cdnificrr.ofcon\cnrros.lfltr\unfoiw.*cr'compcnerion.asprovidcdf(trbys(liotr3?U)olrh.Labor aode. for rhc pcrfoirrEncc ofrhc tork for which rh. p.rni i\ ir\x.d.
<br />Ihrvcrnd*itl un rinwurkcrs.o.{'cnsrrioninsurincc.a\ rcqutcd by Sccrion lTllo.frh. trtrr (tic. irrhc porrnxnr..r
<br />ihd sorl for which rhi\ l.mii is iss(n. Mywo cis comPcnslrior iNnrrmc carifi aril F!i.ynumhcratc:
<br />q.l'.) Nutr.h.r:-
<br />fffi*"'', u", ,,* n,'",,tumc,i,rr wo r rq qlrh,r,i rc,n'i, i, \.u.r. r .hxll ior c rtnoy i ry tEr*r n rnr_ n inrr
<br />u !slo bcconr hjcd rorhc wo rkcli .. npc nsrt ion laqs df Crllturnin, rklalrcc rh)r iflrholl(ltrt. tsrhtdtorhc
<br />Norkcr cohpcn\arn,n Fovi\io.\ of S(tidr :l7LD of rhc bhtr C.dc.lsttrll. n'nh*irh con,ply wirh rho{ tnrvhiotrs
<br />WARNINC [ii]u. ni scurc workc^ (nnncnsdion cokragc i\ u lrwlul.
<br />civil nncs up ro onc hund!.d rh.u\rnd dollrr\ (Sl{n.fix)). nr rdd(i(itr ro I
<br />i::Iptv
<br />IIA;IdAAIION
<br />I hdrcby arfirnxnd.r pcn,lryolNrjury rh{t I am liccnEd u cr provhi{r of chrflo e
<br />of rhc Bu\ircs\dnd I'darsions Codc, ntrd nryliccnsc h in 6rlllhr.c 0dcfrccr.
<br />sih Sc.rin,7(XX, ofDivi\iotr l
<br />A.TTLICINI.DECI.AAAIION
<br />I tu!'ty 0fim undcr !.nrlry olpcrJury onc of rhc f(rlowine dcclrrrknrl
<br />Dcmolilioo PcrnilAsbcnor Norificali{,n Frcd.ral Rcgulii{ \ Iriih 40, Pnd6)
<br />Rcqutcd txtts of Norifi clri'n
<br />ffi*,;;ffi;;
<br />riotr\ rcBmding .{ic(os rcDmval arc nor,pnlic$lc t, rhis,)ioj(l.
<br />icrri,,nr' {arcrhrrrhcrhnc i'rlonMr r isc.rrc.r laarc.ro..mJ,ltsirhillCiryr Counry
<br />rurMrnc r.[c\.frarir.s.lrhn Cir, itrd Coutrry ro cnr.r uPn rhc
<br />rll)rc n,rnrnnrd tn,Ir ) lrr
<br />0
<br />5.,, zh"/ts
<br />Set Backs
<br />Erection Pads
<br />UFER Ground )
<br />SLAB Floor
<br />Sublloor/VenVl nsulatron
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL i l?-t 141;atwptl ,D)
<br />certificate of occupancyT ql
<br />Notes, Remarks, Etc
<br />Fo rm s/Stee l/ H o ldown s
<br />CANSIBUqIIONITIDIIGJCENCI
<br />IhcnDyrlEflnu.r,rtrnllyofpcrjuryrhstrlrrcha.a,ndrucrionhnrlinS+ctrcyl'orrhcpcrlornunccofrhcwor*(trNhichrhistcrmiris
<br />n\xcd (S... :1097, Civ C.).
<br />I .rJ.r',\ Nrm. _
<br />tindfl-. Add.R
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