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SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h6.br.ftm un.Lr Fnrhy of p6l!ry
<br />'hd
<br />I m dmPl tum th. Coffi(B tiG L.p fo. rlE follosiB '@n (Sd.7oll5
<br />Bain63 lrd Profsion Co&): 4,, Cny or Costi' *trh.cqun6 ! Fmi ro olEnr1. .ltd. i,$.o!c daelan o, Ep.i. uy
<br />nncte Fir to "! 6l,te, .lo ,!qoi6 rlr Spli.6r fo, sch Fnil ro 6L a,9..d $ao6r inr h. or tlE i! li.cE d F@rn
<br />ro E Frvkioc of th. Co r&ols Lic6!.d trw ( h!pi6 9. CoMm.inB wirh Scrion 7000 or Divirmr I of rhl BuiId &d
<br />Pmf.shu Cod.) or rh.r lE o. dE i,r dcafl $q.ton dd rh. b6i. tor rh. ilL*.d a@FDi. Ary violaio. of Serb. ?0.t Lt b, &y
<br />.pplic. f.r ! p6mn .ubj<t! rh. .pplical io . ci! il Frny of mr mE rno 6r. hu.&.d &rll8 I um)
<br />I. . .*G oi rh. FoFrr. or oy c6pbrG *nh wrg€ a rhcn oh .omFGarior! will d6 rlE sorl dvl dE 'fue i! mt
<br />itr.i.d tr oII6.d for *1. (Sa 7044. Buird ud ftli6rbB Co&: Th. Co'irsrdi Lkou Ltw &6 br +pt lo d ow of
<br />ih. prnlHt *h. hrilll or "rpro6 OaEl! in $,b do6 i.n sd h@llor half or rl@uO hi! d lE om dpbtq
<br />pr.viLd rhd !c[ irqDrqEs E d iidri.d d .fad tu sL ll ho*ff. tt blildinS M inp.ov€rE n nt withh on. ,d
<br />oforlplcrE tlt O.E Brilda wn lllr dE hd., ol Fsvirl8 rhd h. or !h. did er bdlt or iqrcw $. FoFiy 6r ilE F,p@ of
<br />.,1*** "rru,,*r,- ^d(lctr.lr !odr&in! s h hcaE d conuddB ro otdfld thc Ftrrd (sc. 7(x4. rllrrtr
<br />!d ho&sih Co& T1E Co rlor'! L'.or. Lw do6 tul .9ply ro d oMd olFoFr, *ho buil& o. io}rcrd tha6(lnd who codndrfor rucfi F!jd3 mh ! CoMonr lkd.n FrRd lorlEcolf-In r Liue L.s)
<br />-l
<br />D crdpr u,<b Salion-
<br />D .,'CZ tt;- 2C)elu6.4,=-',1
<br />ECI.AAAIP!
<br />I hdcbt.mrd undd Fulyoarsjuryororrh. rolhsrs &.1- n6:
<br />. r h&. ed $,ill ruinr.b . C6lifEll. ofcotgr to S.lf- lNu. for work6 compaudbn, E l,ord.<l for by S..tion l7O0 of th.
<br />I$or C.d.. for rlE pqfolrlffi. orlh. wrt aor $,nth
<br />'lE
<br />pann ir iiocl
<br />I h^..rd rillEinr.inhrt6 (onp.tu{ion iBu&cr, a R rol hy Sclion :! 700 of ih. ribor Cod.. aor rh€ Ffollffi. oa
<br />lh. $orl lor which lhis Fnn B Gu.d. My *on6 comFMion iBffic 6ir td,Dla) nunbd e
<br />_l cqtii rhn in $. Fforn[rc of lh. \o.l lor nhth th! Fnit i! is.d, I thall oor @ploy dy pd$n in my (mF
<br />s a ro hft.m. luqal lo th. sod.d conlpaMio. l.wi 6f ( .lifortua md .gR th, if I .lbuld b.(om sbcl ro tlI
<br />worl6 <onp.Bdiotr povliou of sd6n 17m ol rt t hr Co&. I slslL fodhsih otrply rith lth- FovirioN.
<br />wAR|llNC F 'lw lo s@ wt6 onFurnr srqr8. it unh$tuL &d Csll sbi<t & onplo}q lo <minrl ddii rd
<br />lo oft hldir.d lhorBrd doU@ {ll00.u)0). rr ldd(ion lo
<br />'hc
<br />cot! ofcom Fern n. dmrs6 6 lro$dcd br rh.
<br />S{rrcn 3076 ofrh.lltFrCodc rtnd 6d
<br />o,", c2Z_Cs.ZO t ,/,
<br />I hdltr, amm un& Fulr, oa Ftur) lht I m li.d6.d ion ot(-h5li6 e (coolminr wilh Setiotr 70001olDivstun l
<br />of llE DulB tnd Prefsnrc ( od.. uj m,- ltoe ! i. lull hr.. &ld.rcr
<br />co!flf,uclloll.l!!!!(i.AcEll]
<br />I hdrb,.nm u.dd pquXy of Frrury lti |ha. b. @i3^rib. lddbe rSar for $. Ffoffi. of Ewrl 6r qticn fin Fnn i!
<br />i!$cd (Se. 1097. Ci!. C )
<br />dffrlcsdr.DEgaaAuo!
<br />I hr!b.! rn'm uldd Fslry of pdJury on. of thc fouo*'n! ddlo!! hn.
<br />D.trlnon P6mik-Arb6los Nolificol ion t.dsal R.3uLlnnslTnk40. Pd6)
<br />R.qurol ldrdoll{oti6dbn
<br />- I cdriry rhar rh. f.dBil rquhrioN EsEdrs 6bdos movrl s. dr +pl{rlrlc ro tha FoFr
<br />'Artat*.,a,ln6glqrio. rn iil.fir uE.torc ntomsr6D scotrEr Iasrrroompryw h.rr cny rnd coufiy
<br />odiM6 $d sr!. lru Eld ulg ro b4uin8 confudF( ad hd.b, ,nlFM EFEariit6 otrhn Chy rd Co6ry ro dc lryon $.
<br />ibo\c moroncd FoFa, ro, irrd4qfu,.e i
<br />^*^,-o*,,,w,"-f ?elr(.f €bz o.,.iz;'Q=- 2Q
<br />p.-hain on t, ,/,/, il.- H L{ l r-' ' 1 .t t- : -
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lns u latio n/E nergy
<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 />Ir - ^".1FINALLll7 lLt )l{+r6'I
<br />Certificate of Occupancy
<br />Notes, Rqmarks, Etc
<br />2<)?,tC CO
<br />lt
<br />BUILDING. INSPECTOR RECORD
<br />Forms/Steel/Holdowns
<br />Erection Pads
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