|
SITE-WORK DATE ID/SIG.EoMMENTS O\INER AUILDER DELCARATTON
<br />I hd.by ltlm undF poahy of pnjury rhar I m G\mpl fiom rh. Conrdor' L,'.cna hw for rh. followins ranin (s* 70.r I 5
<br />BNinN 6rn Profaion Cod.): Any Cn, o. Coud, wh(h r.quir6 r p.rnir ro Ndtud, .ho, imlrolq darclilh or lF.n &y
<br />!1tu!1ue prbr ro irs GslBtr.. also Equi6 rhc Aplicd for su.h Fmii to 61. . siBn.d 3tddmi rtu! tE or $c n [cd.d ,uMd
<br />kr rh. pmvisioB oallE Conlricrq! Lic.ns.d b* (chaBd 9, Cotr.n.in8 $nh sftiion 7m0 of Dilirion I ofth. ltulind Dd
<br />ProaBiod Co<!.) o, rhal h. or rtc it .xmpr rtacnon ord th. b.!G for th.6ll.sd noFion Any rioldioo ofs.dnn 7011 5 by ey
<br />rtpliqd fo. a poan subj6l3 rlr. rpplicdr to . civ il p.ehy of nor mor. ll& lir. huftlr.d dolle! { 1500).
<br />& s owna orrt propary, or hy 6nplor6 snh w+6 s rhcn $h.omFMion, $ill d. rh. $nt nd rlE JMw ! mr
<br />id.rLd orolf6.d tor elc (Sc 7O1.{. BBiB Md ProldsioN Cod. 11. coirrucr.r'r Licw Llw do6 nor eply ro d own6 nt
<br />'hl FoFty wrr bil& o. r!p'06llEEtr ad * h. d6 sh ${l( him.ll or h.slf or llmuh hir or hs own ophy6.
<br />Fovid.d thd sEh imF!\qEn E mt i drd.d orolf@d f., sL l( rssns. rh. hilrird.r lrp.rxffi i! $B snhh.( ra
<br />ot corpkb.. tlE O{@ Bulldd sil h.\. tlE hnda ofFovilB rhi lr or dr dil ml hrild or nqb! $. FnFy br tlE F,FE .f
<br />-1.
<br />6 o$G oarlE FDFry, o a.luiv.ly coddi.s wnh licdB.{t odrdoE io .odM rlE Fnj6r tsd 704,1, ElG
<br />r,!d hblsih Codc Th.c6ntrdd'r Lic@ Llv do6 mr !p?ly ro s ouns of[ropcny *ho h{ild! or iip@y6 rhoF..
<br />ud *lF coddr fm 3u.n Flins wnh g Coddo(r lk.ed pxRd ro
<br />'h.
<br />( o r.cld!Lk.Bt q)
<br />,,,,',."" )[ -' Y)' i 74;' j-H*
<br />!48[E8S:(AU[E$AUS!lflua6rla
<br />I h6o:\ ttfim undcr FEhy orFjury om ot th. lollos ill3 d.(l{dio6r
<br />_l hr\..n *'ill Minl.in. Ccrifta. of CoEl ro S.lf-lB4 lor Pwl6r omp.ndio., 6 Eovij.d fot b, Scrion 1700 orfi.
<br />L.td C.da for rlE Fftrlrft. of tt w t f.tr $ttb lh. rmn a i!.u.d
<br />_l ha\..d *ill mi lin *orld co,pdr.lrbn UerMa a rcqur.n h! sdion 1rm of rh.I.tr.r CoJ.. fd E Fl(n]lld. of
<br />6c mrt td u'hich lhis Fmn it is,cd. My *qr6i orqcdhtr irur.R ffi, rn FIG) nurbd n:
<br />Pol(y NUDIF:-E rpi6
<br />11i.-iry rr'" i.,* p*r.* orrlE $ ort 6r $hth rhir Fnn i e.d., ddlmr dnphr- o) rE$n r Dy M
<br />$ ato h<oE $titl ro rh. *qtd'@rpcBtrio. hs of C.lifoBd ad {e Or irubuld broft stlF ro t,E
<br />sorl6 omFsrbnFo\iri'Bof Sdhtr l7moarh. t bor C.di I lrdl fdlhe.nh @nrdt *nh rlE FUBhB$AR]IINC: F il@ ro sc srtd otrpGiiof, ordr3. 6 unhtrtul. lxl irll ebrar & alploF ro orn rl Fd6 od
<br />.ni f@ up ro oE huld,td rho66d & la. {t100.000), in .ddnbr h rlE cod or corp.rE rion. d&rus6 a Foldcd foi rL
<br />sftrion 1076 oflh. ljhor Codo itrrqd a.d rtdrl.! fG €2,/z-ze - /P
<br />utr}rIll(a}t&t!t4.8,
<br />Dt( I \ltrrn)\
<br />I hdrb, rl'm ud6 Fdy ol Fjury dln I o l,<qa.d un<16 Fornion orcl!,is I {onnffirrs *nt S6rbn 7000) ol DililDn l
<br />ol rh. B6in6 dd PmfsbE Cod., s'd Dy Lkde L i. tull lore id clTcr.
<br />codllaltrolJillaclc[lcl
<br />I halby allm urd6 FEly oa pqjury lhd llEr t r codd.lb. ldding .gdy tor llE FfolrMc. of lh. q ml tu $trh ltn Fmil .
<br />i$u.d (sd 1097. cir c)
<br />attu(alr.ll:claaarlJlt
<br />I hattr allm uid6 Fnalr, of pdjury o.. of rh. aollor ins dabr.r ioh3
<br />D.molitio. P6hiG-A3b6lG Norifi.d io. F.dd.l Rqrubrion\(T Ic40. P6n6)
<br />-R.qun.d
<br />tl{ld of Nolifi oiion
<br />I .alif, lhar thc Lrldat Erulaliotu r.sddins 6b.sros Eno\ al e. nor applicabk ro this prejd
<br />14cdif,rh l hrv. Gd rh! rpdi.alion &d rar. rhd lhc ah\r inlomatrcn is cotrd Iarr6romlnplrwirhlllCnyaml(ounry
<br />ordi@nc6 &d Sr6rc lrws Elarins ro building connruclion, ad hd.by dulhoriz. rcF6.r a1n6 olrnis ( irydnd (ounrylo 6rd urnn rh.
<br />""" /?- ,/o- /P
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy )lo 14 t-M er/-
<br />Drywall I t))-i},.,Y4)
<br />Ext./lnt. Lath 0t
<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 -t*t q
<br />Certificate of Occu (Jpancy
<br />Noles, Remarks, Etc
<br />BUILDING- INSPECTOR RECORD
|