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SITE-WORK DATE COMMENTS OlINER BUILDER DI'I,CARATION
<br />I h.r.by rrlnnr trndn pcnxh, ot l(rjury rhdr L .rcn,pr rDm rhr Li)tua(t'c l-,.rn\c tjw kx rh. n bwm8 ft.s|n (s.c Torl J
<br />Rusn'e$ .l Pnrc$ion Cqlc) Atry Cir, or Cdunty whkh rcqurcs i pcmnl ro onsre.l, altcr, imlrovc, 'lcBrhh or rcnln any
<br />nturruc. prir t' ir! issoaNc. so rcqrEs rhc lpdirlnr lor suchlcmirb,llc a ngncd darcftnr rhar h.or lhc i! li..nsJ tuluanr
<br />t) rhc povkiurs of llE C:urlr..l,tr s Lacnscl Liw lchlpi$ 9. Connncncr8 wilh Scdi,'n ?UD oi Divisi{,n .l ot rhc Busims od
<br />P0nsnnx(-l'J.) o,rhalh(orshc n c\cmpr lhcrcrionrn! ihe t'!ri nlr llRlllc8cd cr.!,rri{r. Any!id3rtr'nol ScdKr 70:ll5 hyany
<br />imli.anl Lra P.mlr rubjc.rrhc rptlrrr b r.irilgrnrky.l noi nr.rhrn liv. hunJrcdJollus (1500).
<br />-1.asown...frhcpn,p.dy,,nny.nrployccsw
<br />hwrSc\rsrhci, !)lc .om!.ns!1nin, w'lldo rhc-iDiLrJ llr{,umsnol
<br />tric,xlcd or.fiircd n, sdc (SL!.7044. Bn\ircs dn.l Phlcsi(' Codcr lhcConrr.toas Liccnsc L.wdrEs trol rpply ro rn ownc! ol
<br />rhc nn'r'ry who hu'lds or ihtn,v.s dr()n. anJ who d,f,s n'.h ullk hrN.llor hc^dll orrhr{sh hr oi hcr own cnrlolcci
<br />F'vid.drhrr surh im0ru!.mnk r. rtn dcnlc,l or orlcRl tor saL lf.h.wcv..rh€hu linS or inr{mrtmnr i\q)lJ*irhin,,nc t{r
<br />ol !.nlptriu\ rhc owmr Eudlcr will h.v hc burJcn ol pr)viry tlur hc or slE drl n burljorrnrfl)vc rhc pn'I.ny ttrrhcpu{r,{or
<br />_1.r\owtr.ro,rh.afl)p.ny.ancreLu\ivdllconrrucii'r3wirh[.ctrscdcorrrnrbLon{ndrh.t],,jccr(s.c7(}l4,Bus,'cs,'rJ h.ic$imC.dcr'I hc (onrllc|,tr's t,ic.ns. t.!w docs n.r l{)ply n) !tr dwncr ol !r.t'cnywh,, huiltls or inrtovcr rh.rcon-
<br />hd who unri(k lor \uuh tn,jc(h w h a Conk&tn( 9 lmnr'l trf rd b rhc Conkrcntr \ LMnk Uw).
<br />!IE!L!B[IjO!
<br />I icrchyrllirmunlcr pcnllryol pctury.n ol rhc nnk'wre dcclr.h.trs
<br />Ih,v.rxtwillnrrnr{nrCcnili(arcolCoNedn)Sclll,Nurelorw.rkcr'd,mpctr\.rn,n.rrpn,vilt.Jn)rhySc.rrlnlTmolrh.
<br />l,ahtr GLtc. br lhc pcriornunue .l l hc w)* lir whi.h rhc F.mnr Ls isrued
<br />I hrvc a will 'minr!'n sorkcr! .on,pcn\lrion Nurf.c, r\ FquircJ hySc.ron:17(X)ol rhc Lrhor c{ .,lttrrltr FdarnrNo.frh work tur wl'rl, r hi! ,(rnnr i\ ,s rd My workr' \' .onrpctr!3rin rtrnD.. l:f'cr inl i,l'cy nu.,t).r d.:
<br />I ccnilyrhll in lhcI.rlorronrcol llE work lor*h(h lhis l].nni is nsucn.l itull.or cmpl,,yaorFrson inanynwncr
<br />!r ,(ro h.com suhj.cr ro rh. *olkcF $np.nrarn)n hwr DlCanLmia, atrJ a8r.. rhar il I shruld h.coft suhjet ri,lhc
<br />$*.r.omfcns.!orlrovsonsofScuDnIT(JOolrhrIjhtrCodc,l<hrll.hnh*(h.Implywlhth)rpovisons.
<br />IVARNIN(; l:r'lu( n, {.urc witrkc comrn\rrkrn !l)vc
<br />.'rn lnr\ rn r, onr hundrcd (hou\rnd dolles rllm.(I)o)
<br />E utrh*lul. m'l stull strhj.d rn.mtloltr !'.rn$!l |xnilris md
<br />n,,r ddnrt.s rs povidcd li)r rk\
<br />trJ.rF-nah,ol prrjryrhxr I anr h..tr{duni.. pruvsk,nol(l prcr 9 (connmNinl wnh S{rx,n ?m0, ot DNNo,r :l
<br />ol rhe Busincsnnd Pdc$inN Cqjc. dJ nylicctrs. r m,ull Inruc Mdcll!.i
<br />Drl€: Conlm(
<br />CONSTITU(]TION LENOINC ACENCY
<br />I h.r.by aftn und.r Foslry ot pciury r har rh.rc is a consrruclbn lcn'liDs 4cncy ror rh€ l.rLrndcc or rhc work lbr wh!.h thh lEmir s
<br />issuc{ (Scc. .}(n7, Civ. C.)
<br />^ftucalllEl! Bl![loN
<br />I h.Esy arlio utrJ.r l].nalry., r.rjury onc olrh. tull,,wrn-s dcul!!ali,)n\:
<br />DcnlnnDn Pcirnn$ shc(o\ N.uh.drtr kd.rrl R.euldn,nr lTnlc 40. Pd6)
<br />Rc{urcdI.llcrof N{nrh. otr
<br />l .clllly rhrt rltr fcd.ral rcpnlo('ns rcgddin8 d\lreos rr [vrl drc hr rt'dE.blc kr lhk !,mjct
<br />-l.cn'ryrlurIlErrc,'lrhnaml'.rronrndnarcrlDrr[.trh]v.n,lornBltrn,r.om.r
<br />ll3r-n,.ondyw hrllCny.ndCounr!
<br />onn xn.c\ 3nJ Srrr.lir\ rchtry b hu'lduf .on(ru.rn,,
<br />rlxrc mnrorJl]n|p.nvi[
<br />Apptn, r o. ]\[ont si[ rru
<br />hcrcbrrurhtr,c rcprcurrr,v.\ (n rh'\ C y rnd Coutrry
<br />Set Backs
<br />Forms/Steel/Holdowns \
<br />Erection Pads )r4 ^ -t IwJ-='
<br />UFER Ground r,lE\ ( ri/,d ivl
<br />SLAB Floor 7 llu V
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing g[ zlrq A47c? lot
<br />Shear Wall elcc/r,,tu /o9
<br />Framing -<.r,t-- |
<br />lnsulation/Eneroy 'tl.vLv'l v'lw?\:_-)-
<br />tywall q/tt t tc Dtug /o)
<br />Ext-/lnt. Lath tlnht stra loz
<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 />>4*{Ui llztle aB td tA
<br />W*t ge--xt €*,.a-lr - l?-tc
<br />FINAL'ilr/,lp -A)
<br />Certificate of Occu nc
<br />Notes, Remarks , Etc.
<br />BUILDING- INSPECTOR RECORD
<br />ID/SIG.
<br />LiN . Cks:_Liccn{ Numb.r:-
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