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SITE-WORK DATE tD/stG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Sublloor/VenVl nsu lation <br />Roof Sheathinq i hnltk rtAttotw lR1, <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lr/asonry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif . <br />( <br />FINAL Xlttlx Ftntru-lt?\? <br />Certif icate of Occupancy -T- 7r <br />Notes, Remarks, Etc <br />\ <br />OWNFJR B(JII,DER DELCARATION <br />I hir.hy !finn undcr pcnalrt ol p,rjury rh lancrcmlr [i.nr rrf, Q)nrm.!,s Lkcnsc tjw nx rhc lolk'wir8 rcanr (Scc.703l5 <br />Dusi.c$ lnd Pnlcssion Codc): Any Cily .r Counry *hich rcquncs tr Fmir ,o colnrcr. alrcr- i.npnt, dcRni\h or eprn my <br />ntu.rrir. rrnn b ir\ i\\!aNd. ako rqunrsrlr appli.mr for soch pcrmirt' lilc | \ie,rd ndcimnr rh.rtrdr shc i1|ccnscd !uB!.nr <br />b ihc ptuvi\n,ns.l'rhc Co.r8cftn\ l,icci\el Law (Ch3/cr 9. (innnrcrcing sirh Sc.rn,n TlxX) of Drvhio. I .f rhc BusiDc$ rnd <br />Pnnts$on\ GJd.) oi rhrr lr .r shc i\ cx. rrr rhcrcfdnand rhc hrin hr rh.xl[Ccdcrc'nprion AnyvioltrrionofSccrionT0.ll.5hyrny <br />(.plicunrnn.ncirnil$hjerrhcrff,licnnrro.cililpctr.lr!olMnmrcr[itrfivchu rcd dollrs (t5(x)). <br />I. $ .qmi .f rhc phFdt. or my cnlnloyLrs *nh wd!.x d rh.n \,h ..nrNtrsoootr. willdo thc Ro od llE sltrturc h ml <br />irlcrxN or oficlcd ld elc I SN 7044. Du{inc* and Eol'c$n r\ Codc Thc (tntra.toi s Liccnr Law doc\ floi trDply tu ,n owmr or <br />rhc inrFny vho buildr or i' ptuB rh.K{r. rkl qho ddr {ch s,rk hinr\clf or hc clf or r htuu8h hk .r lrcr oNtr cnDloyccs- <br />pR,yilcdrhd such iqrow.rnn m nn inbxlcrl orotlcrct l'or qh ll k)rcvcirlf hikling or inlpR*rtunr is $kl wnhhorc )qtr <br />ofcorqrLrr.. rh. Ownd Buiud will hlvc rhc bordcn of pioinC rlud h. or shc dil mr huild or ir{rok lhc pmFny lor ltr luqDs ot <br />-1.0\o*ncr.frhcI,rop.ny. <br />trr crclu\ivcly .onrra.ting with li.cnscd.onrrlcnrsh consrrucr rhc pmj..r (Sr. ?044. Bbif,c* <br />rl Fhfssinr Cod. Thc (nntra.ror s Li.cn\. Lrw docs n.r rlply t' di owmr of [orEny $ ho buinh or inrplovcs rhcron. <br />rn,i $ho conrrdcrsforsuchooFkwirhaConhcro(9li.cnscdlursuunrrorhcConrrdcroirLiccnrcLw) <br />_l rDcxc'nrr undcr Scclion-. B. & P.C. forrhi\ rc$on <br />IOB(I&::.COIITENSAIIAN <br />DICIJXAIII}N <br />I hcr.by trrfinnundcr pcn0lr] of pcrjury ooc olrhc l'ollon,iry dcclarrli,)n\ <br />-l <br />hlveud will roinrli, ! Ccnilklrc ot Con*nr ro S.ll ln\urc rnr w.rkc6 cory,..\rrion, as povid.d ror hrsc.rionlTu)orrh. <br />Ln&n Cnnc. lhrthcpcrlbnrunceollh.*o* tnrwhich lhc pcnnir ir issucd <br />lhr\c r d {illnrnn.id work$I comDctrnrriotr irNr.n.c. rs to!ri'cd hySc.ridr 37(Xrolrhc l-rhor (odc. lo. rhc p.rr.nuncc ol <br />lhc woik tu whi.hrhis pumir is n\ucd. My wor tcr l .o nrrcn\rr ion in$nkccrdcrrtrd poli.y trtrn$cr itrc <br />I" <br />),-", 1))-?otl <br />I ccnilr rhri in rh. pcrtornBncc ol rhc s.rk for {hth Ihis F rnir is i\sucd. I \hall nor cmr}ny,n! r.r$n ir rny mmmr <br />$ Nhhconrc blcd b rrE woirc( conrtcnerion lau\ orcalirun,r. rnd l8rc rharilI \hould hccom s"hici r. rtr <br />ao cr( omrDs io. ptuvnions ol Sation l?00 oi rhc Utr! Conc- I null. n'n h*irh comply wirh rlD{ povnidr <br />WARNINCT F:ailurc ro s.urc *.rkc6 .omlcn$rion covcnsc is unhwtul. x8l sh,ll \uhiNr an.mfhru ro dinnn.ltcn0lric! <br />.ivil Inrc$ up lo onc hundrcd lhotrsrnd dollnrs (Sl(x).ftro). ir uldilion n, thc co{ orconlPc ri{n,. dflng.! n\ nor cd li} rh. <br />Sc.rii 1076 ollhc khtr Cndc. inlcrc( m'l dktrrEy s ltcs. <br />05-tl-2ait 4pri*"r, <br />I hcrcbrrlrirdotulcrpcndryorl*rjury rhd I am liccnsd undd povision or chqrd 9(commncinE Birh Scclion TqlD ofDiri\ion:1 <br />oi lhe Busincssand Pmfcsions Codc. ud mylicens is in tull lorcc 0.d c,Iecr. <br />cJq ltlzz i <br />o5-Zt - zolt CBCZ <br />CONSTRT'CTII)N I F]ININ(; A(iENCY <br />I hcchy tirn undcr rcn{llyofpclury that lhcrc is r onstrucrion lcndins rsctrcy fff rhe prro@n c of'hd wor* tbr whichlhis rrrmil is <br />tru.d (Sc. 1097. Clv C ). <br />AITUIANLDECLANATON <br />IlrNbyril' !uM.rr.nrlr!of txrjny.DcofrhchllowinBdLrl di( \ <br />l)cnrliion Pcmrih Ashc\rnr Norilic ior l:cdclal RcE!hri{'n\ Ilitlc,10. Pd6) <br />Rcquncd htcr of Noriricari(n, <br />.horc Drnrioncd tmlEny for nsp.cron! <br />icnnl or ,\atnt skn,hrre <br />l.rtrqlo <br />o5-Z/:r/ <br />BUILDING- INSPECTOR RECORD <br />SLAB Floor <br />l.cnitr rhd rhc rcdcml rcSul.rions rcglrdin8 osbc{or rcm'vnl.rc noi {tlicoblc ro lhh pDjccr. <br />-l <br />cenilyrnrt I [rvc rcd rhn lpplEalion!.dnarerhar rtc otnrc inion'Rrio. n coftrr I agle ro.oqry enh ,ll Cny and Counry <br />ordiunccs and Sr e Laws rclarins ro huilding con{tucrion. and hcrch, aurh,i,cicpr.$nhriv.s.lrhis airy and Counryro cnrcr uton llE <br />I