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SITE.WORK DATE ID/SIG.COMMENTS (MUR Bt ,t)Uli Dlll.( AR,\T(r\
<br />I h.r.$y altrm u $ pc.llry (il !,.dury th l {nr crcn,pr ti,n rlt cdnh.lor' l.i.cn{ Lrw lor lhc i'll,'win8 rcasn (Scc 70315
<br />aurtrcss anl ltonsio. culc): Any C y or Counry whEh rcqurcs a Frn lo .Dtr{ruui. altcr. inpov. dcmolih or rpxn 'n,
<br />sro.rurc. pru n, \ issuM{..ho rcqur.\ rh. rJ' rnnt lllrsu.hFdn kr lrlca sisncd (alcmnr rh^r lEor sh. i\ lid.s.d puButnt
<br />h) rhc F,vnkrN ol ih. Cont&ktr s Li.cn*'l hw lchrpr( 9, Conmrn.m8 * h S(botr 7(XX) oi Drvis n I oi lhc Busimss dd
<br />Pn,lcsions Co'lc)orrhrl h.o.rhc tcichpr rh.r.lb dndrh.btsisntrrh.rllcgcdcrcmpri.n Anyvnrlnlonots&rinr70.115 hvdtrv
<br />{tl'canr ra|Emir\ul,j.chrh.,rpli.lnll,,!cililp.nrnyornorm.rclhlnlirehun,l6ddollts(S500)
<br />l, ^ own.r oi rlE r,rurEn y, oi nry cnployes wilh wa8cs r! rh.n tuh Lonfcnsarn,n. w'll do th. $o* ul rh. irturuE is B,
<br />Dtcfilcd or oliclc'l lir sdlc (Se.?()44. Busine$ rod PRnasnJnr C,ric I hc A'nkr.u s l-(cnse tjw doc\ lor rpJ'lv l0 an o'tur ol
<br />rhc ll()pcny who hurlds o. in rlvcs rhcB,n. .rxl who dcs iu.h k)'l hnns.ll or hcscll or rhnrugh hil or hd osn cmllryccs.
<br />pr v klclt rh.r su.h ih|m)!.mnrs {rc n.r inrcBLtl r olttnd tu slc. li tuwcvcr, rh. buil]s! .r rPll,rmnr i: $kt w h,n orc rtr
<br />ol $mplctid\ llE Own.r tll lcr willharc lhe tudcn of poving rhdr h.orsltr did ru, huill nr ml'nE tlr,mlsry l.t rhc Puqr'{ ol
<br />-1,asown$orrhclmpcny,
<br />r.rcluq!.ly.oht.ctiu w h licnsc'l r.rncbN t) uon(tucr rlt rtuFcl (Se..7044, Btstr'cs
<br />and Pn)fssion Ct cr ThcCotrlroclo s Li.cn\.I-aw docs n.rrlTlyro ar o*hft of,rnlFn v wh{) huildr o mfruves rh'rcon.
<br />rnd wlN conr.uh lbr \uch ptuj.rts wilh a Cbnlra.b(n kcnscJ N uinl k, rhc Coht,cktr\ Liccnsc Lr*)
<br />_l &cx.nrl, utr,lcr Sc.r
<br />-c)4l a-s I zozc>
<br />I ccn',trh.rorhc n( ornunccofrhcw.rkf(trPhi.hlhirPcrmiri\,$tr.tl.lslDllnorchlloyrnvlcroninahymanmr
<br />si sto$.n,m $hJcd t, rhc wo*6i comPcnsrril)n lrri .f Calrbrni!, lnJ rgr.c rhd n I sh)Illj hc(orc {ihid t') rh.
<br />w.,lc6'c{mncn\arbnpn'vi{dnsolScuiion.ITOOoarh.llhtrCo.L,l\hlll.n,nhqirh(omllvwirhrh'{I)t)vsbns.
<br />IVARNINC: Failur. tu sm wotkcr' conFhiarion .ovco8c rs unh*lul. Md srtrll sutrirr d cnlrLvcr lo dimml FMlrts anJ
<br />.Nil turs ut n' onc hutrdrcl ll&trsnJ J.lhs (riltro.lxx)
<br />\.i rrr.n176,trrh. tjti{ t Glj trr.,cJJJ rrftr.J..cc\
<br />o2a
<br />lztrcla8aroN
<br />I hcrchyalltnr utrdcr pcnalryol tErrury rhar I am liensl uiJ.r povishn.lChxPr.r 9 (.ommncins wirh Sc.rb. ?0110)o'Divkion l
<br />ol rh. Busrcs lnd Prctsn n\ Codc. ini my licensc is ur luu tdtcc *l.tlc(r'
<br />57
<br />('r)l\sTItf (TloN l,ENDlN(; ACEN(l
<br />R\u.d (SN :1097. Crv. C.)
<br />t1*lo s AJ!rcs:
<br />-AFPLTCANT DIiCLARATION
<br />I lrrrt'y dlm uftlcr Fnrlry ot p.riury onc ollhc lolbwing dcclr.lions:
<br />rkrolnion Pcrmih-Ash+dos Noriti.ation lcncral Rcslhrtr,ns (Tirh 40. P.n6)
<br />Rcquirc.l lr(cr o, Nor Jldtnn
<br />I dily lh.l rhc lcderal rcpxhoons rcSdJrna &stE{o! En vxlnrc not rmli.abk ro rhN pmF_r
<br />U enily rlur I hNc rcdd lhs a!,rlicarion ud {,lc rhar nE at$vc intnrtulion is corcur.l asr td comtlv enh a[ cnv dtul courrv
<br />odin!rccs unl ShrctlwsElalin3 loblilJin! conslN.thn. lld hcrch, aurh,i2. rcl'rcsctrr0likr ofihr Citv !n! Colnrv u c.lcr uBrn thc
<br />dlrJvc ,tu'nrunl ,' o|Iny tur D\FcrnnIr4rK\
<br />Appli..trt.r l,lcnl sian.lu
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulationi Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />[/]ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />I I
<br />FINAL tl tu 1,1 t)ft-tflat_-fi-\2
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />Flood Zone Certif .
<br />Dnte:
<br />WORI(FRS' COIITPENSATION
<br />DSCtdlAno!
<br />I hcrchy alftm um.tcr peulry ot p..ju.y onc oI rhc tiluo*ins J.tliratbns:
<br />Ihaveurlwill@imain!ctniti.alcoiCon{nrbSclllnsurcbrworkcB.omFnsahn as p$vidcd ntr bvSccrion 1700 orrhc
<br />tjhtr Corlc. ttr rhc p.rfo,11rnc ol the wo tirr whtb rh. p.mir a\ L$ucd
<br />L?n*" ,, , r, ..^." ..rtcr' ohlr.nqr !,n Dtu,in(c. !\ eqoncr by s..tion ]?00 or rh. tjbor co'lc. for rh. t'crro,mn€ or
<br />;h. sdk Iur whrh rhF nemi \ n.ucJ M) trnrlftr .omP.n.rrn'q m<uran.c (amet uni lblx v numb{r d.
<br />*,,. r /z /z-,o
<br />I
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