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SITE.WORK DATE IDiSIG.COMMENTS (,WNER Et'II,DER DEI,CARATIoN
<br />I lrrrtr_ rmr r u Lr FM,ry ol FrJlry rh.r I !n .rcn{i ffl,m thc O'.rr!.b^ l-t.nt Ij* lDr rh. tulh,wir8 rco$tr (S.c 70.11 5
<br />Busintrs mi Pmlishn C(xl.r Any Cily or (i'unry rhich .cquirc\ 0 rEmrir (' cnn{d.r, .lr.r. inpn,vc. d.m'ltrt or rcI[n {ny
<br />nd.tuc. r.trnr h nt ii\u.R.. lko rr|Incr rhc lmlinnl itr16h F m! ro lik ! (ieftd i{clmr lhrr tEor s,E is licn<n Nrsrd
<br />n, rh. Frnn'o\ o, rtr Conr*riri l-f,.nad l:E lchdfln 9. c{nmEinS snh Sc(li,n TIXI) uf l)ivi\n)n I ol lh. ltu\inrs (nd
<br />PtuL*i(nrs C,xl. ) or rhar rEor stE s crcmnr tlkr.tinm utol rhcbasil l lh.alhrqlcr.tprn,n AnyloLrk,nolS.cri,n70.115 hyiny
<br />lnpliclnrt,tr!p..mir.ul'r.{hrh( |I)pl(snr h n.iriln hyoln, mn. rh:n li\. huklrcJ dolh^ (15(x)r
<br />l. trs ow.q olrhc rror.rry- or rry.,.nlotNs wirh u.x.\ u\ rh(n rh comnrn$rtr'n. *,ll'lu rlr qdk rnl th. {urE i N
<br />'arcddl {, oficrcJ l{' $k rS( 7{)''. Busfti! !.d [tof.\rx,nr Crk Tk Odrrl,r.\ l-i(anc I* &x\ nardyLJMo$mro!
<br />rlEpnrFn, whr hlildr or intmv( llEKn. rn wrn ,rE\ rKh *ort hin\clf or hekl f or rhiUu8h hii or hcr wtr.ry'|,,y..{.
<br />p(*kl.d rhsr rNh mtfl^rnrd.mdn hi.n&rl orollfrl tur qt lf.lr*LrE rh.t 'U'.8,r rlm$r irsLllrlhDnE)w
<br />ardrt'hi,n rh. Ormr Buil,lr sillll,l! rlt tuLn of F,yi.3 rhar lL or \rx Jid r, lnillDr inln*T rh. l,n,Fiy rr rh. nuqlrr of
<br />l. r\.*k, orth.,ft)Fny. !n.$hsn!lyc.nrrdios wirh li.cn\ c.nti.kx kr .on{tud rlrl)n,)d rscc 7i)4r. BunNs
<br />urxi lht\!r,nCaL-lh.cl'nt*ktr'\l-i.cn*l-.*(l,r\ft lpply ri, $ or n.. ol n.olEdy lh, iuilJ\ or mpi,^.s rhchn.
<br />ind *h) i{rdrf({u.hpn,Fktrith!(o Mronr)li..nedpurudt,rh.(1 r*rol r l-tctr{ lr* )
<br />Drl.la&.Lljl
<br />I hcrcby rlltmund{r F.alr) oaFrur}.E.,rh folb$h8 rl$hnrbns
<br />-l
<br />hatr urn sill Ei.tlin r CcnifEa'c ol Conenr t, s.li l.rnE r $0116. d'n{f,ndh.. I Forid,el itr b s a.]7morrtt
<br />l,lx, C{rt. ntr rh. Frtu.mrc ofrlE wort fttr *ith rlE rsrnir i\ nsurl
<br />._lhtr\.rkl*'lln*inrlnsorkc^.rn{inrrrx,htrtrorrftc r\ r.quir.d ht Sdri,tr:17(x)ol lhc ljhtr('({lc. i(r rh. llrlMNrK. ol
<br />rlf, $orl Iff tr hi.[ rhn Frn,ir i\ '\\url Mywodd\ r. $n\!rtr!n Nurrtrc..irr(urlFilcynumtxr r
<br />_lccnrfyrhar 'nrh( Frfortuhc nl rtr so* tu *hEhrhn F(n{ n Ns{.{.1\h.ll mr cn{lhrlnIFrwrn rn rnttBnmr
<br /><, 15 ro hRlrm {hFr ro ,lE r,)rtsi coqEnqlion b*r nf ( alifornii. and urrc. rh{ ir I \h,uld tE{.nr \uhi\r t' rlE
<br />s.rlr\ (-nrpcnlnron po{rio.s ofS(r{,n l'l(n ol rhc lrhr C,r]t.l \tEll. ft)dhtrnh (onlnly urrh rnN Pm!\hh
<br />1 il fi'.\ ut, ti ,trf, lrtrn(lr(d th'{\r nl J!llrr\ rSl(r).1rxr
<br />I h.rby .mrn uBhr IE ahy ., ncrJrr, th,r I 'm li(n*d r lcr F)thi,n oa (lErid 9 ramrE-'in3 r irh S<trn 7llU) ol D.rrirn l
<br />.r lh BusiE$ r,n Plofc(hnr Cod.. dn m! lrcnc n in flll litr r qi efid
<br />ra!$f,lqll0Ntlilulrilc[llx
<br />I h.rchy lttrnn undcr FMlry of rErjury till rhca n r onntulnn lrnd'nr .8d, fttr rlt F.fo.mrc. oa rhc ktrl fitr shah rh( Fnrl i5
<br />i\\u.dlsd 10)7,civ c )
<br />AITLICATiTI'ISJBA.II!]B
<br />lM)t rilam ofrl$ trtrrlry of trrjury oB ol lhc Inlhwrn8 nNlurlion\
<br />D!trx,lin,n t'cmir\ Art{{o\ Norifi.rr$i rcrk..l RcBulnrtr,nl ( l(lc.lo. Pan6,
<br />-Rcquncd
<br />krrcr ol Norifkrri,n'
<br />Icdilyrharrhcr.aki.lrctubri'nsrEUdinEr\ti{nrrrtrFulm,otrlf,lbkk,thiipn'Flr
<br />l..r r) rhrr I h d r.!lrh^ rmlkrrh r,(o,nplr{ hlll(-rrJ ikl (-'
<br />n rhACirvrnd C(n y n) rntJonl'tuff.\ rtr(lSL c las\ tulLri'l|r h hui
<br />rhrr N rir)nd |n'ltnyii'r NN
<br />orJ ts / - ro-,o
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation 1 )
<br />Roof Sheathing i/ // li 'ad-Vz ,/
<br />Shear Wall
<br />Framing
<br />ln su lation/E ne rq y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Il4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />FINAL 5/r,4/t8z-t ,xl 21;'a1aGX
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR BECORD
<br />Forms/Steel/Holdowns
<br />Flood Zone Certif .
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