|
SITE.WORK DATE ID/SIG.COMMENTS OWNOI' BOI I,DI]R DET-CA I'A'TION
<br />I hcrby !fli.n' u ler p.iilry of D.DUr_v (hnr I dr.r.dpr f'oni ih. Conh.ros'Uc.osr llw fo. rh. tollo*ing aaen (5<.7011.5
<br />Aurincsi rnd P.oLslon Codc): Any Ciry o. Counry which rcrtutcs a l.mll in c.n(tocr, alrf, i'nprovc, dd'mlish or qun rnY
<br />shrnr.. prior h irs issu0ro.. aho Equi6 rh. eplicrnt hr {.h Fm b 6l a rigEd nskm rhn l. or $. i\ lic.nsd prtrsrnr
<br />h rh. pmvi(ions.rrhc Contacroir l-ic.nscd lrw (Chrpr.r {r. Comftncine *irh Sccrion 7flD ofl)ivhior I ollhc Eusincs a.d
<br />Pdesin,ns Code) or rhnr hc or lhe ix ciehpr iher.lioh rnl rhe bnrir tur r,E rllc3ql eknDriqr. Any violarbn ofSecrion 7031.5 tyatry
<br />molicid ro. r rEnnt rubidBrhc 00Dlrcan[orcivnD.nrhyornorrmrc un fiv. hundEd dollrB (l5m).
<br />_1. a\ o*ncr ol rh. pron nr, or my cfrplrlrcs wnh ra8.s ,s rhcn $h orma.nsdion, qill do thc M.k &d rh. {eue i\ mr
<br />i'n.nlal or .lT.r.d I'tr sl. (Se.?(l1,1. Bu$in.r\ Md Pof.r{oN CoJ.: Thc Conhcrolr Lice$. tiw d@s nol lpply lo an owftr ot
<br />rhe rop.ny wll) tuild:.r inlnohs rhcdn. lnd who l(Es n'ch *olt hihi.l, .. lE6! ll or rhrDl8h hi. oi lar o* .nplordr.
<br />pr.vidcd rhar slch impmvcmnk e mr id.ndcd or.ffcrd tor st L. ho'cvcr rh. huilding or irydwftd ir eB wnhin onc r.r
<br />olcon$lcrbn, tt! o{nd Bui0.r wiil hsw rh. ttrrlen ofpmvirs rh! tE o. sh. diJ d buiu or itrpn,E € popay ftr ilE plFo*oi
<br />_1. ar o*n.roIrh. Pl.p.dy, sn.rdusi!.|y.{nhcrii8 wirh lic.r*l doir&ro66.!n{ru.r rlE pmj..r (S*. ro4l. Bu\ies
<br />rnd Pnfa.n. Code. Thc Cofidols License Lor d@s m! amly b rn.wner of proF.ny who builds or impolrs rhdran.
<br />Md who...rnd$larsuchl,FjlcljwrhaC.nr6ro(nlicctr{dpur\udrrorlrcodkrkr'sLken$Ijw).
<br />I m.kmfl unds S*rion-, B & PC lbrrhisr.ann,
<br />u!lB[r8!:tu!r&!$!]!t!
<br />rE!L^-8{ILQ!
<br />I h.r.by ifltrn uf,d$ po,riry,,lp.rjuryon. olrh. ln1l,)rif,s d.clrrartr,nr
<br />Ihrv.rndwrllneinlahaCtn,fildcofc.n$nrr.S.,tlNuEtb!*o.1.'cootNarion.asp.Tvid.dfor6rs..tionl70Ootrh.
<br />lrsr Cndc lo, r hc lvformrc of r hc wtrl fo, whk h rh. Ia
<br />ffi*. "* *r, -,^"- *.'k.d' .ump. rlons,!'rN..lr Equ'edhys.!,Fnl?ooo tEtjbnr
<br />Z'!Xqt ri, "tuch+ir r'mir h s\u Vvwflk.1- tumR.nwr
<br />'on 'Bu'
<br />Jn! c tr,c' olnolrynumh.r
<br />;,"". qrATt Atzg .rtr a4/,
<br />Cod., tor rh. pd fongtr. .f
<br />4/0 (3 6 ?0
<br />_l ccnily rlEi in rtu r. aitun.c of rlrc wo* f.r *hich rhis 06nrr is isruc.l, I shall mt ery)loy My pcGon in any m ncr
<br />s Nto besN subld o thc *o.tc6 comp.$.rio. hw!otcrl'romia. a rgecrhdiltstbtrldb.iotusubicctrorh.
<br />*odi.b conD.nsriotr pDriiioNofSeclon 3700oirh.ljborCo,.lc.I sull. fodh*th.omply wirhrhosprovib(
<br />WARNING F.ilor ro sEuc work 6 amplosari'n owrdgc Ls unla*6r1. md shall sublccr .hploy.r ro cimd Ilcdlti\ ud
<br />civil finesuf roorchu rcd rhouslnd doll s(!l{x).(xxr).ra'idiri,,]rorh.coi.lcohp.nsion,d.N8.s.sPr.vid.!forrh.
<br />inr.Es anJ a omoy s f&\
<br />rZ 7/)c///?t5)1o/.Afl1
<br />LIgEITE!_e0.U&!Lr.lB
<br />lrqLASdltg!
<br />I hcrby.fllinunder pcn.hy.l p.rjury $ar l.m licced u.dcr poviiio. ol Chnpb 9(smmn.in8 *nh Sccrhn 7{XD) ofDivisiotr l
<br />of rhc Blsmcs\ md Pof.$ions Cdlc. !tuj hy lic.nsc n in tull f,xe ifrl effcsr.
<br />4t)zl7
<br />t./tt/t OLo /:/ t llE
<br />',D/t",
<br />/7aa77
<br />cotsf,ItrlcrQNl,I![llclclilcr
<br />I hcEby alTrD under penoltyofp€rJUrynd ih@ is r.onrEctiotr l i4 a8.tuy for rh. p.rfomN. of (he m.k fot whth rhb p.mi! is
<br />is$cil (Sc l(197, Civ. C.).
<br />AIPUCIItr.DECLAIAITAN
<br />I hsdy lfm nnJn ,.D.hy ot p.rjury onr of thc foUJoi,B dabrar ions:
<br />D.mririotr P.rmils-A$.slos Norinddtion F.d.ml R.sularions (TirL.r0, Pan6)
<br />R.q!n.d Il .r ol Noufplion
<br />.al{n,'srN,v,'l . tur,t|)lri.rhL n,rIn ntui.
<br />i'rlomrion n ror.cr I rgrc ro romply wirhail Cnyand Counry
<br />h.e by ! trdDriz. ..f.. \. trr ive\.lrhis Ctrytrnd Coudyt'
<br />rhnc Ddnri')n.(r tr)It{ny r,tr in\!.cri)n
<br />,\pplicdnr or At.nt SEnitum tDlO
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathino
<br />Framino
<br />lnsulalion/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />rl
<br />FINAL 3/s/zn -z .-u'zo)
<br />Certilicate of Occupancy ' ( /
<br />Notes, Remarks, Etc.
<br />(u rL/
<br />BUILDING- INSPECTOB RECORD
<br />Rev.08-07'2015
<br />Shear Wall
<br />t nd.,'s N!ft'-
|