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IDiSIG.COMMENTSSITE.WORK DATE
<br />Set Backs
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation *blRoof Sheathino tl t',DtNot
<br />Shear Wall 1
<br />Framinq
<br />lnsulationi Energy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />,l IthsaFINALtl t4t'a.,)1.4,itfi\
<br />Certificate oI Occupancy t I
<br />Notes, Remarks, Etc.
<br />OWNF:T BUN-DER OEI-C RATION
<br />I h.r.6, a,rrn unJ& pcn,lry {,1 pcrjL'ry rhdr I m crcnrfl lilm thc Cirnrra.t,u' L'ccnsc tiw ti}r rlr n)llo*ie .c,$n (Se 70.11 5
<br />Bu\rcss rnl Pnnissi.n clxl.): Any C y or Cotrnly *h!h rcqutcr r Fm( k, con(d.i. alr.r. imriov.. dcmolnh or (rxn any
<br />sru.turc, prittrn, irs il\udn c. rl{r rcqnircs rh. r0pl(hr,i,i such !.rn n) Illc i rgncJ nd.mni lhal h.or sh. il hc.n*d ptrFuanr
<br />b thc t'bvktrns or rhc Conr ror'1Li.cnsi Lr, (Ch,prcr,, Coh'hcne s wilh Scurion 7mo or Divi$o l ollh' Btr{n'(\ rn{l
<br />Pn,lcr\i()n\ C(xlc) or rh{r hc or slE is c\cnrr rhcrcfron d rhc brs\ li).rhc allcscJ.rcnPtbn Aryvi(,lrrionofS.crion?0.115hv!n,
<br />,pll,crnrfd, FmilruhjccB rh. intli.rnt l. acivillrcnaltyoifr, norc rhm lrv. hnnl,rcJ 'lollrs($500)
<br />t. rs own.r ol rlr arolEny. or my cmtlole\ * h walcs r( rhcr snc d'mPcnirk'n, wdl Jo lhc worl r,xl rh. (B1N ir mr
<br />'nr.ni&l .r oflcrcd Inr et (S\.' 7044, axsrc$ md Pnni$ions C{rlc l hc Ornricttr s l iccne hw dd\ nol Jrplv ro an own.r .l
<br />rhcpn,pcny who buil'k o nfnn$ rh.B)n. lrl wk' J(f,s sur[ *'lk hi.scll.r hcrclfor Ihn{Ch his or hcr own cmlloyccs
<br />pruvdcJ rlfu such n|]n)vcnrnc rc noi hr.trdcdorollarcJ ta.s!lc.Il ho*cv.i r[c nuik]in! or impovomnt Nn)kl*i(hinnnc rr
<br />ol.oflrlLrin,, lhcOwncr Auillq willhnt rh. hntJd of l)rt)vn! lhil lE o, sh. did fr h{rld.r iryrolc rhc pR,r.ny tur lhc ptrrlx'Eol
<br />l,.sownrrofrhc ptr,pcny. rn.rchFiv.ly..trr.a.iirl8 *rrh li.cnscd c.MacbF b.onntucr rh. f'nlcd (Scc. 7O{4. Bunn*(
<br />ml Pn,lc\\i,n Cod.: Thc C.nrr&tri l-(cnsc L.w diEs n.r apply b rnown$ ol P.or.ny wh,) hild\ or inrPovcs rhcrcon,
<br />dnd wh...trrra.hlorru.htnUccrxwnhaConrrrct(rhchrc,lpu*u n, rhc Contncttr's Ltcre lj*).
<br />l rmc\.irl]l un,l.r S..r
<br />WORKtrRS' COI\IPENSATION
<br />DEC!A8AI!O!
<br />i hcrhy rfi irnrnder E.alryolpcrjoryoncof rhc bl!'*in! dcclsrrion\:
<br />I hrvc rklw'll nrinl.m iCcnilulrcolCon:. b S.llln c titr *orkcf' cont|tNiron. !s Prov .d krhvSccrbn lTXlol rhc
<br />L.txtr(,r1.,rnrrhdpc orm.tuc ol lhc woti lhr *hieh rtu rnn 'ssnEd.
<br />-lhav.rnJwrllnurnriin*orkcr\'oml.nsarbnnsurrn.,rsrcquncJbySccrdrl?0OoirhcLahorCi'tlcntrlhc0rirmxi'orrlt sork ntr shrh rhs |Irnnr tr sug]uP0kqrc n nsurdcc MEr el pl'cy hunlxr m
<br />A.) (
<br />7 Z-.2-7 3U
<br />I ccn i rhar in rh. l.rfornEtuc ol lhc work lnr wh'ch rh6 Brnri s Fsuc'l.l \hall nor cqll,)yrnyP.6on inrnvnunrcr
<br />\o * kr h.$m xuhjccr ro rhc wor*.n .onEns.tn,n hrs olCalitumin. $d alG (hal irl sl$uld tt.om slbj&r ro rh.
<br />wo*ss unnEnsari'n ptuvsons .l sNril). l?00 ol rhc Lnh, codc. I sh.ll, lnnhrirh.d.{ y wiih lhE 0r,ririo .
<br />WARNIN(:: Fnlhrc t) $curc wolkcn ohpcn'di)n cdv.ntc is unh{ful, anJ drall rul'Jcrr tq}I,,v.. !, djmm,lltMlrn a l
<br />crvil lincs ut 1,, otrc iutulrcJ rhou\rnd doll61ll00,([ )
<br />s,!rtr,n nr/6,,r rl.cLibn coJr,dr.F{ rdntr{r) \ Icc\
<br />dlru[cs as ptuvr]cd li'r lh.
<br />"",../-'7-/,a u.1-rll-c!t-!]Dl&!!-r0B
<br />I hcEby rl irb loJcr p.n lry or p.rjury lhal I !n ticctr*l !tolr nmvftun ol Chnflr 9 (comncins *irh S&iiot 7000) ol Diltn,n :l
<br />ol rhc Busirc$ and Pn,Lson\ GrL, ,n my li.cnsc t !n ttll toc ann cit.r.
<br />/-l-z-a
<br />CONSTRUCTION LENDING ACENCY
<br />I hcahy afiirm u lft Fmlry ol F.rru.y rhd rh.rc as , c.n(Nclmn hnJiog nSctuy f.r rhc Peri)lrr@. of rhc *ork fN whth rhi( |Emit is
<br />n$cd (Scc. J097. Clv. c ).
<br />ArjUgANLOECIAS.dIIIN
<br />I MD rtlim un'lcr pcnahyof F_rjfiy onc ot Ihc,nI{,winr Jc.lr,ri,ns:
<br />D.nrlirM PcrnrillAsh.sros Notil(itnn Fcderrl Rc3uhbN (Tirl. 40. Prn6)
<br />Rcqunr!t (x(.rol Nor'li.rior
<br />I cd'ly rh.r rhc lc'lcrrl Egllat ions rcp&dina asbcnos rcm'vd ac frr ,l'di..blc ro rhis pe,j.u
<br />I ccnrI rhrr I luv.r.drh'r 3!Plt.rrranl d]rc rharr1[rh
<br />.nlrndn.es !nJ Srrrc bw\ rlarii,S r' hu dtrr3 uonnn'rri'nr. uJ
<br />)v. nromtro. N uotrcrt l,Cr@ lo.oqiy wnh aU Cn, ani Counly
<br />.urhtrtre rcprcs.nrrhvcs oflhis Ciry {n'l Counryh cnlcr ut,n lhe
<br />rhovc nxnlon d pNpcny lir
<br />/-ADpli.xnl .r Asctrt SisNl tr
<br />'-22
<br />BUILDING. INSPECTOR RECORD
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />//- /L/-z-a
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