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SITE-WORK DATE ID/SIG.COMMENTS OWNl,T DUII-DEI' DDT,CARATION
<br />t hcrcby afinn uid.i pndry ol lcrjrry rhar I in crcnrfl trrn thc ConrrNnn' l-iccd{ Llu r.r rhc ()lLsin8 rcui,' lscrir.rlt
<br />Sosircs{ xl Prolisi.n Code): Any Ciry .r Counry rhich rrqut \ r Fn i b c.tr{ruct. rlrcr. iNpnvc- dc' ,lnh r rcl\'n tr,y
<br />i crtrrc, lrtut) itr issurh.... rho rcqtrircs rhc.p!'li.atrr lor {Kh llnnir h lil.r \tndJ n,c Mr rhar )Eorshc is licc.scd nu ,:xnr
<br />t, rhc pmltnr\ of rh. Ci)nth.rofs Liccn{d ljw (Chrrtcr 9 CoDnneNin8 wirh Sc.rk,n TIXX) of Divtrion :1 .l rh. Busi'rcs xod
<br />Ilolc$iotr\Codc) or rhlrhcor\hc tcr.mpt rhcrcfro rndrhdb i\ turrlr rllc8cd cxcnudr AoylioLltrofsLtridrT0:ll5byrny
<br />rpplicrnr fn a pcrmir srbjc.B rh. r!!li.itrr tu r.ivil!ctrrlryolDornDr.than llvc huf,drrJ dolhd (55(X))
<br />l. rs owkr.l lhc]trotcny. ornrycrrn,lNs w hqrrc\!\ rhcr {,lc roN|[Nrri(in. willd.ltE$or(aftlrlt i .nrcn tur
<br />inrcRlcJ .r oii.rcl &r L r l sn.. 70.1.1. Bu\nr\r dtrd Pdc\$n\ (rodc Thc G)nrracrois Liccn!. l:* dm\ nor 4/y ti atr w,rcr oi
<br />rh.F)lrny $l$ lrilds or impro\c\ rhcNn. r wMdcs$rhu.'khi'n\.li.rhe(clforrhmulhhi1.rh.rostrcnrt'|.y..\,
<br />proliJcd rhar such i'npnn cnrnrs e nor iircnd.{ or olTcd f(tr \rk Il. ho! ctrr. rh^ hu rktiry or imlnN.nrtrr i\ s,l] sirhi'r o t rMr
<br />ol conDldior. rhc Owncr lluildcr Nill hr!. rk hurd.hofpn)vi'r! rh{ lror nt did mr huikl or inwot thc propcd, f{n rl{ Dtrry\c of
<br />l.r\o*ncrolrh.nn)|xdt,amcrrluriucly.ont.ri'Urirhli.ctr{rl..rtr.rort,..n(dcrrl[nmic.r(Sc.7(}ll.au\irt$
<br />aDdItlisartrCodc:1hcConlracrorrl,iccn\.1nwd{F\mrrt,llykranoacrotln,lxny}hobuilds rlrymlr\rh.....
<br />rnd *ho cotrrrcrsror ru.h Fic.rs snh r Cd n.t (s) licctr*d Iur\url h lhc Conrrctr'\ l-i..i* t]s)
<br />ln,rxc, untl.rSc.rn .B &l'a lttrr[srcxstr,
<br />Drle ornerl
<br />rvr)Rl(r|L$ coNtPFNaATION
<br />I)I IANAIIQN
<br />I h.nbyrltu uidc' FDrkyortcauryomol rhc hll.sir8dc.UrurnnN
<br />Ihrvcdlsillnuinrai'1,(tnifEnrcofCr.tr{nr!)S.llltr{trcf(tr*o'kcs conlllc sItrn.r( P'.vtrlcdf(trhySccri{,n.r?U)olihc
<br />Irtxtr G)dr. nn rhc pcrfonrun.c nl ihc work irwhirh rhc |Ennir is i\n,.n
<br />I hn\c nn(l sill trhirinir \orlcr\'$nI.D\xri,tr, i'r\u'rn... rir,tui'cd h) S..r ,rr 17(xr olrhc LtrhorCodc. lnr rlr r.fo,mrcc.i
<br />?/t /ttwi
<br />_l ccnilyrhrr i', rhcl).rlorr rRcolrhc s.rl lnr *hi.h rhi\ Nnni h t$cl.l shall nor cnTloyrnyl.rur irr rtrynrnncr
<br />\o trs b t ..nr suht .l !J rhc workcr compenr n,n hw\ofcrlifomia. ffdaprcc rhd rrl sh.uld hcc rE{$jcdhrhc
<br />wo*os .omrcnsrli( lmrhions of Sccr ioo ]7m ofuh. I nhtr C.xtr. I shrll tun hwilh conlly sith rhos Pmi\n N
<br />WARNINGT lirilurc ro scure workc^ .o'nFnixriinr corung. i\ utrhwlnl. trnd dnrll {'bJccr m cnPkritr ro. DinallENlics iRl
<br />.i\il lin.\ ut lo on. hutrtl'.d rho!\r dolh^ lSl(x).(XX)). u n r() rh. colr oi conDcn\arnnr, di'mecs .s prolidcd lor rhc
<br />,r,r",..%,rr/ry
<br />idc.cnr rrlrtr.t s la.\ryL
<br />t)l( t_,\R,\lt()N
<br />I hcrcby rm(nu.d$ pcnnlryolpcrjuy lhrl lxn lienwl nndcr pDvi\n ofchrfrd9lc.mnEncinaNirh sccrid 7o(t) ol Diririo.l
<br />ol rh. Busirr$n PnncssiuNColc. nrr liccnsc n io lnllfor.r] cflr.r
<br />1q't ceqfu_IJ,LTO
<br />^,. - /u/t(
<br />I hc'chy rlltrrndcr |-. lr, ort)crjury lh0t lhcrc k 0 con{rucrion lcndina dlctrcy tu rhd pdronndc ulrhc snlt r',,r which rhis Nnnir i\
<br />i\sucd (S$ l(D?. Civ C )
<br />AIILICANLDECI.A&UIa!
<br />llid,yafimrtrndcr pcfulry orFrjury onc ol tu hln,wirr dc.lrrari,nx:
<br />Dcnmhion fcnnirs A\hc\lo\ Noiifi.nri, F.doril RcCuhmf\ ( lirlc.l0. Prn6)
<br />-Rcquircd
<br />l.rrcr of Norill.rriin
<br />.l..rrt'1,,'rh('c,ld.'rcguJrntr.mlrrtr'gJ.h\Ln'cn,.,\itr.tr.,':.l1.'l'.,'h'.r.rl.|I,'rc,r
<br />y'.-''r,"',t'.^,u,,',{rnfl'lJr.trrndn cthJrrhcit(trr lntumnri(D i\cotu{r lr81elo..trDly w hrll(,ryrndc.n rr
<br />o'di',amc\ r dSrnr! l-rssrcl[irt lLr boi ir!rucrion. md lMch, rulhtri2c '.t,csctrldircs
<br />or rhn Cilya
<br />rtn,v. Drtrrioncd p.orcny lar i' tx{ri{n'
<br />^|'plicrnl
<br />rAEMlSi*nnNR
<br />i)I,rmrilft ntrnft lprinl)r s.
<br />-%;1)"
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Ceftif
<br />FINAL I ,lltollY lb>/
<br />Certiticate of Occupancy
<br />Notes, Remarks, Etc.
<br />--'
<br />BUILDING. INSPECTOR RECORD
<br />Subf loor/VenVl nsulation
<br />Ext-/lnt. Lath
<br />L.n,lcr. AJdrc.'
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