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SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVlnsulation
<br />Roof Sheathinq l\\r\r4 a,(44i)\Shear Wall
<br />Framinq
<br />lnsulalion/Energy
<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 />I
<br />Certificate of Occu anc
<br />Notes Remarks Etc.
<br />FINAL
<br />OWNER BUII,DER DEL('ARATION
<br />I h.r.b, rmrn und6 noahy ol pc'jury lh.r I @ .r.mpr from rh. Conrtacka L'..ns. Li* for th. tollowins l.Mn {sd 701 I t
<br />tluinBr !d Por6rn n ( od.) An, cny or Coonty *nich rcqlnB a pqn ro cDBrrud. dlts, inpror., daio&h ot Epair uv
<br />3rtu.r@, rdro ir. isuoc..tro r.qutr6lh. lpplic t lorruchpd r tu.. si8f,cd slarodl lhli h.ot d'.i5licdEd plmul
<br />x' rnc lrDvisioN ol rtE Coora.tor s Lic.nrd lrw lchrrr6 9, Comncncins wirh Sction 7Cx)0 of Divtion ] oflh. aain.s sd
<br />Iro l*nrn! (i'd.) or rhlr h. or !h. n qdnrn ltE fiom md lh. b6ir tu lh. alLs.d .rcnplion. Any vioblion oas.dion 701 L5 bv anv
<br />.mli.nnr lor a Fmh subl(k !h. arplicel to t civil pc.ally of.or nor. $m liv. hur&cd doUE (1500)
<br />l. s oms ollh. proFry. or ny.mplot6 wnn w.gd s rh.n 5b omFEtliorl * dodElstsdlh.nnrr@id
<br />(ldn d or ofr6.d for ..1. (Se 704.1, Buind 6d Piofsiod Co<lc Thc ( onindm t l-i.@ Llw rb6 rcl @ply b 6 o"G ol
<br />rlE pr.Fty str hrildr or mFs6 thasn, &n wh. d.6 3u.n wd himclaor hs*lr or ihrouBh hn o. ha om mploy6,
<br />pm,rl.n $!r ruch imFlvsElr E @l iiad.doroEE.d 6rsL.l( rbwe- tlE hi&rE r irqnvdrd is sld whnnon ra
<br />ofcorplchtr l,E ()*ra tt)ild will h.r ltE hdar otFo{is dd lE or nE did ml hil] q iil.o6 |h. FlFry 6r llE Frpc or
<br />-r, _
<br />/ /5s ""* .t rt'. r-pary. d qclu'Ely codd,4 *th I'ccns.d conErros ro NMtud rtl FDj.d (s6. ?oa'{. &snB
<br />.rn PiDtsir co&: r n. (ontdcror r Lic6k lrw do6 Nr .pply 6 e om6 olplp€ly sho build! or iDpm6 th6@rr
<br />.flj sh! colIltri t6 !u.h Fbid! vnn . Codko(r) ltdE d pu6rat h rl'. Conln.ls r Licde L.v)
<br />_l M.rmo mdrr S(rio
<br />z.* t4>4V \r,*-
<br />-a--
<br />/t
<br />/ $ oRlitiRszdfllFis,(FroN/ llf,(l.6aarlo!
<br />I hscb .mrn unds p.ony of Fju.y oE ofrh. follotrinB d.(ldllnrB
<br />-l
<br />h.v. !n *iU dor.in. Cqtifr& of Con$t lo S.l,-lM for wtdt ompolrioq e Fovij.d tor by kio.l7m of dr
<br />trbor Code lG rlE Ff(ffi. of tb. s t 6. sikh th. FEjt i i$.d
<br />-l
<br />hrv..d *rll Mimin *!ri., corFdrion ilMeq s rqur.d q( S..iion l?OO otth. bbot cod., for rlE Ffo|l:r&E ol
<br />rlE *!rl for *-hi.h rhi! Fnh i is.d M, wdtdt oipalrb. il!ffi. cait td poliy t@bd &
<br />u rlE Ffn,rrl'e of rh. sort for rhth rhir Fnh it isu.d. I rhll mr aPhy ut FeE in ey .mE
<br />sbjd b rlE sorr6' otrrposdion lr* 3 olc.lifomi{ di r8R rhd it I rtrould b..oG *tifl b tlE
<br />srld omFdbn Fotir.E of S.dit. l70o of rlE ti.. code I rldl fonh*nt o,ql' wili tho- FotiioB
<br />*AlNlNC FahG ro GG *nta' omFlrion o\slsc ir uhwtul. Dd !t!.I $bin r @ploF io sibi..l pdlli! dd
<br />cill li.6 up ro oE hutiEd rltrts'd &,ltsr (lll)0.000). B tddnD. ro rh. .d of .omFtE lr( d,r+6 a ForiLd for lh.
<br />/ tt/t o&. hrq.! ud.trdtr'r lG
<br />X,."'277
<br />I h6.ty rltm u,!dd Frty olFjury thi I e tcd u!& poviriotr oacluFs 9lonrllEine $ith sdb. r00o) of Dnaio.l
<br />of ihc tl6n6 ai Itofdii6 Co&, .!d my lt6e a n! tuU lor -d cfid
<br />Lic@Nunbq:
<br />-
<br />COIIIAJJCIIA!.IEdDIIG.ACEIC(
<br />I hc.ty rlTm uida FutyolFrury thd tlE i. odrulbn bnins tscy fo. E Ff.ffi of llt*qt 6r $hih fii9 psia E
<br />ia!.d {Sd. 1097, Cir C ).
<br />alrulAdlDeo.aSano!
<br />I h.6y .trm uds F.!y ot Fjot, oE of fi. lolrrsitrS &len io6:
<br />Ddnohbn PaTiFA3bdd I'J<,rifr.rb. F.d..l R.3uhi.m (Tnk,O, Prn6)
<br />-R.quftd
<br />l.rlq ol|lod6.iir
<br />-
<br />I cor,f) rh, rh. fqlad EtulnbB EsrdlB 6!do. @rtl R mr +plrlbk ro lhB FoF
<br />fi!,-r,, ,* , ^, *,nE rrplrdDn rt nd. rht rlE.bo!. inrordio! B or<1 I .sE ro @lP|y wnh tu ( nr.d counrv
<br />,ndmE6 .,rd std. I .q Eb q ro hrJdrs coMiotr ,rd hq.t'y tuhoi@ ftt ddnit6 of thii Cny ltd Courty lo dd
<br />'4on
<br />th.
<br />f,.or,n-, -//zv//,
<br />lfl,l4il/Fxfl
<br />II
<br />BUILDING. INSPECTOR RECORD
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