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SITE-WORK DATE ID/SIG.COMMENTS OWNER AI]ILDER DELCARATION
<br />I lrr.by xtltm rtulcr !.n ry,'r pcrjury lh{ I dn cxcmDl ln)nr rhc Conkic(n\- Licne Llw fd thc li,ll,,wins tar,n (Scc.70rl s
<br />Btrsin.$ a,J Pn,lcssion C,i.lc): Any Ciry or Counry wh(h rcquucs . lrnn nr .ondrucr. dlrcr, in0i.vc, dcnn Nh or rPlir :r'
<br />(num, ptrtrb ik iisuanc..,l$ rcqun s thc.ttncMl lorsu.h Irrmir (' l,lc r s+n.J natmnl rhat lEor shc n lic.h*d puN,nr
<br />b rh. pNvnons of lhc C.nrracro.r Lic.n{J rlw (ch,t'r.r 9, Conrmcr.ins *rrh Sccrn,n 7flI) or Division .l oflhc Burn.sr 4d
<br />Pnrissnrns O)dc) or rhar lE o, \hc h ercnfl lhcrctrom ud th. hdsis tnr lltr allcsed .rchNon. r1ny !$Lt$n of Ssri,n 70.r L5 hy any
<br />lpplicldn)rapernnrubjcckrhc.ppli.antlor.ivilpc.lllyotfrnmorcrhrnlivchundrclnollts($500)
<br />tN.r\ u*rcr l rhc ptuI.n,.,trhl cnfhrc\ wih tr.cc(.r rh.t v,lc.ompcn\ dn, wdl do rlE *o* lrj lhc (ndN t nor
<br />inrc,xLd or o,lcrcJ nr sdc (Se 7044. Blshes a.'l Pruf.stuni Cdi.r Thc G)nra.rois l-rcnsc lje doci.oramlyto an owrcrol
<br />thc ptupcdy who lluil(lr or nr{sJv$ rllB)n. {d who 'l,E {'ch M,i( himscll or lrchclf Dr rln.uSh hi or hc' o*n cq{oy.cl.
<br />0rovidclt rh,r{'.h i'npmvcmnr rrcr, ir cndcd oroftcrql li)relc Il howcvci rhc hildin* or n\mvcm GsoB*irhino c,td
<br />ot &n{,lction. lh. Owrcr Builhr will haw rhc hrJcn or truhs rtul hc or shc dil !x,r h'ild or imln vc L\. lo,Ely ror lhc lutlbs of
<br />l,.sowncrol rlrc ompcdy. rn .rchsiv.ly c.nkr.rin! wrh lr.cnscdcodrr.l{,nbonn d rhc PhA.l (S.c. 7044. Ilulm$
<br />,nJ rh,fcsi G,Jc, Th. Contrkr's Li.cnsc l-aw locs nor rnply k' an owicr of norrny wh,) hu il& or improvci thcrcon,
<br />.nd who .onk.N,'n suchpn'ica w h icorkaut)(r) l'ccnscJtunuanr brlEContrktr'r Liccn\c La*).
<br />li & PC. ri!,rhr rcrk'n.%k-z KIliF*R rrrnruvr,rii,rl--_-Zfi , 'r .'r &il ',rN-I hcr.hy afttn und( ,c.rlry ol lojrtry orc ol rh.,i,Uowu! JccLBrnr\l
<br />I irvc and wrll turintrin ! Ctndl.atc or Con*nl r(, Scllln$rc tur work.F- coml,cnsariln. !s lx,)vilcd rnr hyS.crtr,n l70o orlhc
<br />Ij&n Cdc. t)rth. F-rtomancc ot rh. *drk li)rwhrh rhctxmx a issucJ
<br />_l havta J w'lt rn a$w rkcrs uompcn\rxon insunn... r\ r.quncJ hyS.cri,n rTUrolrhct-ahorC,ic.futrhc|c,l rnrnccol
<br />rhc work lor whi.hlhis p.rmil is siu.tl My *ork.r\' conrr.n\ardr insurlncc cadcr rJ F)l'.y nuhbcr ecl
<br />-l.cn,fydur
<br />inrh. pcnarn n c ol lhc work Inr whi.n rli\ p.nnir i\ isRd,I shdll not cmploy ,ny Frn,n in rny nrtrn t
<br />$ {s r) b&om suhjc.r t, rhc work n onlP.trrrDn l.ws otcrlllomia. J r8rcc rhar,l I ehould be(onE sutje.l lo(r
<br />sorkcr.oBpctr\ari,nrpovkn'nsofSccnonlTUrolrhcLrhnCi\jc.ld!ll.l,flhwirh.{nltllywilhltf,){novhirnr
<br />WARNINGT Fdrlurc b $.urc uorkcr' comlxnqrion .otcr4c is unl.w{ul. d dBU ru6rc.t cmtlorr k' dimral Fmlrrs ad
<br />h, one hu'IcJ rhou\rtrJ Joll6 ($l{D.0O0) h addfion h rh. .od ol (om!. artun, drtrrgcs 0s rovnhd nr rhc
<br />\,.!ri,,tr 10?6 | rh. Lr}rtr
<br />,,,,.,1L/zo / l4rr
<br />I lNchyrl1$trnn.r |tndry lIrrjuryrhJ linr l'.ualu t('vnd, ol ( h.rtn.r I ((otrn.n.n,! * hSc(ri(tr,7tXx)) ll)tvhx,n I
<br />ol rh. ausinc$ and Ptuli*ionsCc{c. d nry li.cn{ h ir lull li)rcc r.l clli{r
<br />lftzeu'4
<br />l-i.cn\. Ch$,-1.'.cn\. Nun,lxr:
<br />CANiIS!]EIIONIENDINGICENII
<br />I hcrchy arrn uiJcr F.ahy ol p.rjury lllal thcrc is a onslru.ti,,n lcndils rs.ncy tor tlE !.domnuc ol rhc work t, *hi.h rhis lErmil s
<br />issrc isa. -1097, Civ. C.)
<br />AELIgA$DESTABAION
<br />I Ltr$y an-nn un'lcr p.nrlry ol !.rluryonc ollhc tirllowinS Jc.lararions:
<br />l)cnrn n,n Pc.nnrrAshcnos No.ir$dn rcdcral Rclularnns (lillc 40. Ptlr6)
<br />Rcquirclt ltr(cr oI Norilluno
<br />l..nrlyrl r rhclcdcr ngnhrilrsrcSuJr! 3\h.dotr.trr'vxlarc mrrP|]luhlc n' rhtr P(*cr
<br />l.cnilyrhrr I tu!.rcaJrhr rpll(dbn drl {alc thir thc i'vc int).nDri"n Neon(r IiSrL!roomolywrrIrllCiryan,]Couhry
<br />rchyaudnxn r.F.scnl.rivcsof thisCiryrnJCounryloctrrcr trlonllE
<br />itrN nrnrn,n.'l I,('F-dy nx n\tr(ton pu
<br />Appli(rn( or A$nl Si*n trr.
<br />Set Backs l.ta | ,-----
<br />Erection Pads t^ l'tr;-,n i */t
<br />UFER Ground t// t2/.4/Uur
<br />SLAB Floor ./ t:
<br />Subf loorivenVl nsulation
<br />Roof Sheathino I
<br />Shear Wall /l^ -,,1*P-z
<br />Framinq I --t--Trl/rtt 4
<br />lnsulation/Energy 1
<br />Drywall ,l*/)r2 u-----"7
<br />Ext./lnt. Lath t/:;vE t.I/l,toV
<br />Brown Coat
<br />l\/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL 2.fi-z-o Et-r ro\
<br />Certilicate of Occupancy
<br />Notqs, nemarks, Etq.,1
<br />A<b 6Xrt
<br />BUILDING- INSPECTOR RECORD
<br />Atlwtr*rrr- LA-,o.-
<br />Forms/Steel/Holdowns
<br />Flood Zone Cenif .
<br />(,nj.. dcrcn xn,lrrnnrcy \ I!a\
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