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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorivent/l nsulation
<br />Rool Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulationi Ene rgy
<br />Drywall
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handic Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />/L
<br />FINAL (-//41t1/',
<br />Certiticate 6f Occupa ncy
<br />Notes, Remafis, Etc
<br />7
<br />OWNI.]I' BUIt,DUR DELCARATION
<br />I h.rchy rfiinn under Fnalry of p.riury 6ar Lm.r.mfl lom rh. G)nrid.n' Liccns. I-.s f(tr rhe nrtbrim r..$i (S(7rl-rl5
<br />Bu\in.sr .nd Pn,f.sn'n Cod.) Any(n/ or Colnry ehich r.qut.s a nennt h connrud..h.., imDtuve, d.mlhh or rclrnr.n,
<br />{rcrur., prir !' irs nsu.B.. nh r.qui.s rh. applicanr tu su.h Fmi b lil. a sigEd d.mnr rhd h. .r \h. n lic.trrd l)ursnnr
<br />o rh. pnrvniois of rh. Contacror'\ l-ic.nsal l,aw {Clnprd 9, C.mm.ncjnt eirh S.crion 7([l(| of Divisi',n :l ofrh. ausin.ss rnd
<br />Pnrt $ions Cod.) or rh,r h or \rE ir.i.mfl $.rcft)m nd rh.lish fr ih. L-s.{.r.nf,ion Anyvi,I{ionofs.d$n 70:ll 5hydny
<br />rmlicrnifqaFnnirruhj.c(rh..mltinrbacivilncnnxyoln.r,nftrhufivehundr.ddntkn($5U))
<br />l. rs owFrofrh. pnp.dr. o, my.ntloy..s sirh wa8.r m rh.tr c,k .\,nD.nerion. *illdo (h. so* ind rlt {um i\ ior
<br />' .nld .r dff.i.d f(n s.lc (S.c 7ll1]l. Bu\ir.s 3.d ftoLsr)r( C l.: Th. o) m(tr\ Lic.i€ L{e dors nor inpl, r. nn o}n.r df
<br />rlE n()Fny vh) tuiJdsor imFmv.s rh.Fr. ml uh, d,Bq'.h tr!* himi.lfor hrn.lfor rhnushhn (tr h.r ovn.mrk,F.s.
<br />,'tuvided rhd such imltr{,v.ftnk r. nn inkid.J or {'fi.Gr arn ql.. Il lBw.E . rhe tarldin3 d n{'nremd k $ld wlhin on. r.tr
<br />oI compltbn. *E Ownd Burus vill h.v. rL l rd.n .f F,viry lnd lt or sh€ dil nor hill or irpmv. fi. pn'I.ny fo, rh. IDqns. of
<br />_1. iloen.rofrh.prorny. im.klusiv.ly.ommdin8 $nh t..n$J.onrr.!rr).oo{Dd rrE fml.d (S.c 7(}r,r, Bu\ies
<br />r l,r tB\irnC'!1.: Th. C.nti.!r's l-ic.i\e l-r* docs nd xttly b rn o{n.r oflnip.ay sh. huilir.r imln,v.s rh.re.n.
<br />and wh..,nrtrsl'rq.hnn)j.dswnhnCo hcnlntlic.nkdpu^ux rr rh€ Contrrdois Lt.n€ l-rw)
<br />lrmerenrtir trnder Sc.rion .8 &l!('nyrhtrci$n
<br />D.l.: ()*n..
<br />wonxuli. rrrm t'r, m,rrrrn
<br />lrlict axAllo!
<br />I h.rchy ifllrm uidcr ncn lry olpnjtry on of rh. f(n,,,win-q il.clrtrdi.n\:
<br />-l
<br />hak rlwillnEinr.inrC.niaEar.otC.ns.nr!.S.lf-li$rcf(nsork.6 c\rmpcn{rii,fi pnrid.d linbrS.cri()nl70Oofih.
<br />l-ahtr C,xl.. fitr rh( |ttrtorroic. rif rh. wDA for shi.h rh. p.mn i issu.d
<br />-)/lhnr. rn,l $'ll nrnrarirorlehrinFnqr[n'n\urinc..trsci]!tJhyS.ctn)n:l7ol)ofrheLahorCode.forrhrp.rfomanc.of
<br />rh. work fin which rht p..nir N irsJ My work.r' .omr.nsrion inrul:x. .ri.r ard poltl .u mh.. rrc
<br />\n
<br />x*"r,-,Q215417 ,,,10'15-202c-t
<br />I c.nifyrhd in rh. I'.rf.rome .ft h. qork fin which thi\ p.rmn is nsu.d,lshrllnor.mnk,y any p.rvr in rny mrnn
<br />qJ i\n) h...m uhject h rhc v.ll(er'c.mp.nvr ion bws of()hturnia, rnd a8rcc rim ifl shuld h.c.N \uhjd !J rlE
<br />sd*.r'$nrn.nsarionrn,vnionsofS.crion:17(x).frlElrhrCtil.,l\hill,n)dh*irhcomnlyliihrhJ*pn,viri,rnr
<br />WARNTN(;: Folur. n, *.u.. wtrk(l lndp.n$ion covcn[. is ,'nhwful, trnd \hall \uht cr m cnrpt,Fr b dminal Fn ir md
<br />civil fin.\ up ro one hundr.d rlhusmd d.ll.^ (lltn,o0o), in dirion kr ih. coq.fcomt ns.rnrn. dafrq.s r\ pnrvid.d frrh.
<br />S..rioi:ll)76.frh. L.htr Gld..lm.r.r and. .rey i f..s qhH6
<br />I Xr.NSl r) C()N r RACIr)R
<br />pr_('r {R,trloN
<br />I h.fthy ilfirnxnd.r Fnalryofp.rEry rhar I am lenq! ud.r fnvki!. ofChrfls 9 (comtrncin3 *irh S.di.n7(XX) ofDivishn l
<br />oI rhe Bu\in.$ rnd Pn)Lsions Cod.. and my lic.n* i{ intullIr.. sJxl.ff{r
<br />(-3)."-**,-*,, )d54J&18
<br />\ /zt /2o?a "..,*",.. ft}ql9 PmArg inc
<br />q)AIIAUCIIONITNDINGIC!!.CI
<br />Ih.Ebyilfirmond.rFn ryoap.rjurythd6.r.hrc.nrrudirnh in8 ag.n.y for rh. p..fomrB. .a !h. wmk fM phich rhis Fmr h
<br />is\u.dlse l(r97. Civ C,.
<br />AIII.ICANLDICIAAAIIo!
<br />I h.,*, aftmund.r lltnalry o{Frjury om of$. foln,witrgd..lr.ri.ns
<br />Dennition l,ermirs Ast'.{ \ i\.rilic!(i.n F.d.rrl Rc3ulsonr(Tirle 40, Pd6)
<br />-Reqtrift
<br />d kr.r of Norifrari{,i
<br />onflrri.c\ o(lSrir.liw\ Nhrin8 n, huiklln!.onnrucrion, rnd h.rehl a [nn.r.p'.\.nr]riv.\ofrhi\(iryrnd(irnryh.nr.ruErnrh€
<br />nri,,ne'lrn'n.ny r' in\n di nulrr,ql
<br />,*n*.u"rr*-* /11
<br />*^" r,,.,r, <lrfeYFrl S1lffta ,,,,rlztlW
<br />tlev 0B'07-2.115
<br />BUILDING. INSPECTOR RECORD
<br />Ext./lnt. Lath
<br />lrndd s 4,ft.s
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