|
SITE.WORK tD/stG.COMMENTS OWNER BUII,T'ER DF:LCARATION
<br />I hcrcby rtlrm undcr p.nalty ol rcrjury lh.l I m.xcmfl rtun rhc annrrd,trr l-k.nsc bw lor lh. lollowmS rc,son (scc.?ojl i
<br />Businc$ i Pdt$ion Codc): Any Ciry or County whi.h rcquircs . FrDir t,, .otr(n,cl. lller. iq'!olc. dcmolish or rnair any
<br />dn'cttrE. prin r{ ils nsumcc. lho rcquircs rhc.! i.nr hrsu.h lEnnir ro filc! sienql srarcmnr rhar hcor sh. n [c.n{d pursudr
<br />lo rhc pn,vi(rns of rlf, Cdnta(!tr's Li.c.ed llw (Chnfl.r 9. Conmtuiie w h Scct,on '70tU ol Divnion I ot lltr Busincss arii
<br />Pn)lcsbns Cqlc) or rh lE or shc r crcmd thcrcrmm md rhc brnr rr, rhc rllegcd crcmpti r. Any viohtn'n or Selhn 103 L5 by y
<br />apfhcanr Lr r Frhir srhr.cB rh. rorlidd n, acivrlpcnllryoinolnrcrhrn rivc htrnJreJ dollais($500)
<br />-I,
<br />,s owner or rh. polcny. rtr hy cn{'[,rccs wirh *!ecs rs rhct $k .ompcnslri,'n. will Jo rhe work !n1 rh. (nde s n.r
<br />Ercfll.d or ott.rJ lrtr {L (Sr 7l}1]l, aurn $ dnd Prcf.*n,ns Culc: -thc Contrrln-! Li.cnsc Laq doc! nDr ,flrly kJ er .wn( ol
<br />rlf, p^)p.dy who ln'ilds u imprrrs rhcB'r,,uni wlh d{\ nrh kr* hiD(clt fi hcn.lfo, thoulh his or hcr owrcmnloyccs.
<br />on,vkl.rl rh.r nEI ihpn,vcftnrs d ior inrc LJ or o,tircJ ii'r \rlc ll tx,wc\cr. rhc 6ui[nng or impn]vcr ir v'U wiihin nc r.tr
<br />.l rcmtldion. rhc Owncr BuiUcr willhrvc rl[ hunb.olF'vir! rh.rh.or dr drl nolhul or impmvc rhc l'fi'oq1y lnr rhc Nqi,c ol
<br />L isdwncr Irhcpr)p.rly an cxclNivcly contdog snh h.n\cd c.tri nd$ n, .! nN(ruLr rhc ltr.ic.r(Sc. 1H.1. BNm$
<br />unllhlr$inCod.:lhc(i,rr.ttr\l-iccnscl-x*ilocsnoii|]!lyr)rtrown.rolpnncdyq[ohu'lJsorrnnn,v.srh.r.on.
<br />!n'l who .oDrm.rrlnr{'.hontccrsw hrCdnr&htr(r)lrcn\cJ Nusorh.(nn(i.r,trsl-cnn lrs)
<br />I mc(cmnr un,lcr SLU
<br />lraatrESs:colt8[xrallaN
<br />DECLARATTON
<br />I ncrcby alrnmunder I'cmlty ot pcrjury onc ol thc ltLbwinS dR..ldarionil
<br />I hrvc ! lwrll mrinl. aCcniicrlcofConscnr to Sclf-!.rurc n)r worko a .\nnFtrq..n. ds Frvid.d litr6ySeli.tr l?t{,oilhc
<br />ljl!)r C*lc. ld llrc p.rrormanc. of rhc work inr Rhich rh. I)fr n nru.d
<br />-l
<br />h!rc rnJ will m.inlain worteG' comp.nsil i,u inqmn.c. !\ rcqurel hy Sc.l Dn .l?00 oi rhc lnhor Oxlc, ti,r rhc l}crri'm rcol
<br />rhc *or[ lnr whah lhirlrcmil is issu.'l My wolkcr' (o,l1lEtrsrtotr nsunnec.irEr ann Oni.ynumbcruc:lQn V\/Vth.l
<br />I..nrlirh r rnrhcFrfo ndn..ofrhc work lar wh(h rh,t pL'nr i\,.\ucJ.I sh l nor .mtloy ..y tcr\on in lny nrmnc,
<br />\i ns b h.co tc ruhjcct t, rlt kxkcr .{mpcn!rri,'n hws ol Calitnm'r. aft]a!rcc (hrr il I nx,uu h..om $htrr brh.
<br />wrkcn.on{.nsari r}hv^ons .f Sccnon :l7U) ol rltr t-.hr clrlc, l \hrll n'nhwlh .on[ly q irh rh)r tx,vrons
<br />NARNINI]: Failurc l{, cutrrc Rlrkcr'conpcnslliu covc.isc i( nnla*h'1. u(l shlll sulrJcut !n cmpl,,ycr lo .nmhrl Fulrieund
<br />0v'l lines up !) one hu rcLl rhotrsinJ dollrr (Sl0(,.tuo). rn ail frln n, rhc .o( ol .ompcnsrri,,n. drmascs as pn,vidcd lnr ihc
<br />,aI tA lb'/v\
<br />I hcrcby afinmunJ$ fcmly l Frjurylhar I dm )i.u*d undo fovFn)n df Chrrrd 9(conm.ncnrS qirhS.ction ?0m)ofDivNoi I
<br />ot rhc Bu{tr.sr /trJ Pnncsri(ffCodr, rhd nry lie.n{ i\ in lnll tu(r r*l cilccr
<br />oto n...(Ntrn., . 4arv4?
<br />..*.".*( v tvlNtt 9014P-
<br />CONSTRUCTION LENDIN(; AGENCI
<br />I hctohyallir trtuld ltialry dl prJtry rh.r rlff i\ a con{trrion hnJing a!.ncy tr rh. l.rlirne c. ofrh. qork n{ phieh rhrs l.rmnr ii
<br />rnr.J (S(. 1097, C,r C )
<br />knd.r'i A,liE( _
<br /> IlLIt NlDEsttBltrllr!
<br />I lNt$y dl'rn un'lcr I).nilry oI0crjtrry on. ol rhc t,'lk'w'n! J..lrrr(u,s:
<br />l)cm)liri(r Pcrmirs rh.sr.s Noliri.rrion l:cJcml Rc-euhriorr rl ilc r0. P{r6)
<br />_R.q0md Ix(d ol Norilidton
<br />l.cnilyrh rnc rcJcr.l r.euhrins rgddins nsbcror rcn$vxlnrc.or rrtlkihk r) th,s |,n,irt.
<br />$F..r, 't, , t*.-,, ,n^ annl'rarion aBl n,rc r6ar rhc fi,K 'lrqnEilnr i,.oB1. r rsrm k,.ompry w h arr c y sBr (butrr!
<br />o,dn,x (.\ rnJ srrr( 1_rw\ r.Lrr g r) hu,u,ns r.r.\crdnr\ ol rhis C'ryrDd CounrJ r) cnrcr ut,n rlr
<br />ilxr. nrfl k,rll p'.p.ny Irn'nsp..rk'! p
<br />,\ppln.nr or A,l.nr siEnrrr
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u lation/ En erg y
<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 rlNlzl Dffnt]d .# y7
<br />Certilicate ol Occupancy fr
<br />Notes, Remarks, Etc.
<br />-+
<br />BUILDING- INSPECTOR RECORD
<br />DATE
<br />lhlc
<br />{tltl-a
<br />,,"," r.tltr/Zo
|