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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS O'IVNER AUILDER DELCARA'TION
<br />I h.rchy rffirn undcr pcnrlryofFrjtrry rhrr I u cr.nrpi lnr. rhc ConrrtN Lic.i* L s ror rr folk,snr8 rcason rSN703l.5
<br />Burr.\s ,nd Pdcs\ion Cdl.): Any Ciry or (i,unry shich rcqrnc\ r lf,nnir t, .otr{rucr. ilrcr. improvc. ncndi\h t{ rcnln ony
<br />srru.rurc. lriorro irs hsumcc. rlso rcquncs rhc {'Ili.nnt f.r \u.h lEnnn b fiha sisncd sdcmnr rhar hcor fic is liccn\cJ pururnr
<br />ro rhc pn'vi\n,n\ of rh. G,ntr.kn \ l-i..n{d l-ss (Chrprcr 9. Con,nrn in! wirh S..ri.n 7(XX) ol Divisiotr :l ofrhc llu\inc$ atrd
<br />Pmltsr.s (-odc) or thal h.oishc iscxcmpr rhcrcftumdM rhc hnlis hrrhcnllcpcd crcnrlrion Anyrirnllionol'S(_rion70ll5byrtry
<br />arpliclnr lor!permir suhj(h rlE upplicrnlk'3civilpcnalryofnolnrorcrhrniivchundrcJdollrsl3500)
<br />-1.
<br />is owmr of lhc pmpcny. or my cmployccs with wrAcs as rhct $lc onl.nsal ion- will do rl'd work arxl rh. snr@ ir nor
<br />inrc lc{l oro0crcd for slc (SE 7044. Busin.s and kolcssi.ns Cdlc: 'I'h. Contr$rois l-iccn* lrs'der nor {0!yk,ano*ncrof
<br />thc lmlEny who hoilds o. irl]i)eEs rlErc.. &d who dm\ \Kh *,i hnnsclloi hfislfor rhtuugh his or hcr own cmPhyecs.
<br />pRrvid.il rhtrr so.h inPIo{mnrs m nor inrcndcJ o, ull.ftrl f(n elc li h,wvd, rtr huikling ur ir{trorrmnt ii sU wirhin om )rf
<br />olcoflrlcrion. $r Owncr Buinr vill h!rc lh. hxlcn ol pruv,.g rlu hc .r shc did nol build or impro\r thc lopsly tor lhc puqr$ ol
<br />_1. r\ owncr o, rhe lmpcnr, arcrclrlie.lyconrracring wirh li.cnscd contr.nrsro con{flcr rtr,mrc.! (Scc.7(}1,l. ltun.cs
<br />aftl Plofssir Cddcr'lhc Cotrtrador's Liccns. L.w docs mr.tply i. anowncr of pnlcny who l,uilfi o. improvs ihtrcon.
<br />lnd *ho conlncls lhr such pmjcts wirh a Conlmcro(s) liccnscd ounua"t ro rhe Conrracroii l,i..nse bw).
<br />-l
<br />m d€qr unil( Sc.rioi .B.&PC forrhis E4on
<br />D.1., O*r..
<br />}T!}AtrE&S:!!JMENIAIION
<br />DICIdN{II.N
<br />I hc6by rmfln undcr Fnrky of r,.rjury onc ofrhc following dcclrroriotrs
<br />Ih.vconl*illmra.CcniaEarcofcon*nrtosclfltrrurctbrworkcGcomlcnsalion,aspmlidcdrorbyS€crionl?00ofrh.
<br />hh)r C.d.. for rh. pdf.nMrc .l rh. Nork for whth rhc pcrfrn i\ i\su.d
<br />-l
<br />hare and will minhin {orkc( con\xnsorion insu6mc, os rcquircd by Selion lT00 of rhc ktxn Codc, ror rhc lsfoflmne oi
<br />l\c qql lor whKh rhF r{rmil i\ nnEn. iy'J ] rkch a mncnsornn rtrsuBtrc..{i( arltini) numh' tr.
<br />,*^, Er-Lnarz l(
<br />o
<br />Iccnifyrhr i'r ih. pcrr{rrunce ofrhc work f{n whichrfii\ p.ihir i\ i\\udd. I shdll tror .mtlo, a y p.r$n in uy nnnucr
<br />*,Nt,bc.om{ubjc.rrorhc*orkc6.onl.trs0lionhssolc,liroflrir.MdusNrhlritl$o!ldif,cont\uhr..rrorhc
<br />Rr'*cr' conr.nsdiotr lrovisions ol Scclbn :l7Lro ol ihc Lthn Codc. I \hall. tbnhwith onrply wir h itus !rcvisionr
<br />WARNINC lrlilurc ki scu. workc^ .o'h|xn\dnnr.ovcag. is unhwful. aM \hntl sub],cr rn cnrdoycr ro rinrinll pc'rhic\ md
<br />.ivil find\ u! t,.,r hundrcJ rhonsrnd dolld (trlrlo.UD)- in uddirhd n) rhc.os of.onrrEnsrlion. drmagc\ !s pmvidcd fu rhc
<br />Sr.rtrn.1076,'frhr lrhtrCoJc, tr crc{ rM anonf,y (
<br />z/zlt r
<br />I hcmhy rfim undcr pcnllryofpcrjrryrhr I ar licc0ql undcr pnlnion ol Chaprd 9 (conmn.i'rg wirh Scdion 7Lr(x))oaDirnion l
<br />ol rhc ansi.csand PRntssionr Codc. unn nry liccnsc is in lull lore md cllccr
<br />gqztzq
<br />tlz/ r c 5'f Srf-< S-rlv,<.J
<br />rQlstBiJcraNrllDlNcic[Acr
<br />I h.'rhy rlfirn utrdcr ncn,lry o t pcrjuly thrr rhcr i\ r.onsrtucrtun kndnrg rsri.y rar rhc Nnohnan.c ofrhc $ork n, which rhi\ rrn,ir is
<br />ir{'.d rSc. llnr ('iv a i
<br />AITUCANLDEITAAAUON
<br />I hnhy dlmr undcr pcnrhy of trrjury orc ol rhc tuln,qir8 d..larations:
<br />DcnDlirbi P.nnns Ash.ros Norifi.drion ftdcrrl RcguhrnnN (Tillc,l0. Pdn6)
<br />Rcqntcd L.rrcrtrl Nor ill.oiion
<br />l.cnit rhrrrhc ltdrrrl rcEUhri(nr r.lrftli',9 J\h.{o\rcntrtrrlJr tror xfplrrhlc !i dn\ In,i(r
<br />l.cdify rhd I hrvc rcid rhh afpli.irim Md {ntc rh{r rhc ah)!c inLnnrl()n is.orcd. I ll8re r. mnrply wirh rll a'nrrnd counry
<br />odimn.cs d Srdro trw\ rl,ring b buiklinS.oniru.rion. ud rrrcby dudrnrzc rct,rcscrrdnrs oirhis Ciry and Cottrry i, drcr ul.i rlt; -':,.: ;;,.:"'q"-*.) -)-
<br />,.,mtrircn,nr,nrin,): fl 5o,rt TP".
<br />*",212//r
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVl nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coal
<br />l\4aso n ry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL g-t7-19 V"WIL)"
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Erection Pads
<br />Ext./lnt. Lath
<br />T-Bar
<br />4/.4,,/r r
<br />a
<br />I{'.1 ". A.l,l',..
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