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SITE.WORK ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Subf loor/VenVlnsulation <br />Roof Sheathing <br />Shear Wall <br />{IY.wrilFramino Gi\il-zr-{i <br />lnsulation/Enerqy <br />Drywall ,t-zk-tK <br />Ext./lnt. Lath <br />l\4ason ry <br />Pool Fence <br />tf -2K1"Y-\4tJ4)1JJHandicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif . <br />2-41-1",FINAL <br />Certificate of Occupancv <br />Notes, Remarks, Etc <br />I u4)(t b I t6 <br />.{,4)J <br />OWNER EUILDIiR DELCA'r^NON <br />I h$chy afirm undcr lrcnully.r prrjury rhol I !n cxcnfl tr.rn lhc Conrracrod Lic.ns Los tor rh.folloqin-q,c,.'d ls{ 7011'5 <br />Bu\inc$ {.d Pmlcs\ion Cod.): Atry Cily or Counry whi.h rcquircs a Frmir kr .otrsrrucl. alrcr' iml.ovc. d.mlth o, [Prt 0trv <br />socrurc. prinh irr <br />^su!mc. <br />aho rcquirc\ rhc rnDli.lnr lor such lFmir r. fiha si8ncd darcmnr rhrr hcor xh. h li.cnscd Putsuonr <br />ro rhd fK,viqtuns of rhc Cnnracrois Li.cnsd tis (Chrnlcr 9, Connrrci.8 uirh Sdcrh. 70m ol Dirhirn:l oflh' Busincs\ 8nd <br />I\oL*nrns Codc)orrhar heorshc is cxcm lhcrck.mlhrl rhc ttr'sh iorlhc allcscd cxcmflion Anrviolarionofscclhn?0.r15'hvanv <br />apfli.0nllorop.lmirsubJr.krh.0lplicanlloa.nilp.tr.xlolnotmrcrhai6!.hu .cddollar (S5u)). <br />l. ns ownfi of rhc pmrEny. .r <br />'ny <br />cmDl.ylcs Birh *agcs ,\ rhct mlc .ompcn\ar ion. will do rhc *ort ud rh. indurc n nn <br />idudcd or oficrcd tur s.lc (ss.7(!14. Busincs ond Prorcsrn rs codc l hc Conlrdols !-iccn\e l-r* docs not olllvr' movmr oI <br />rhc rnFny who hoilds o! irpovF rtf,d.. tual who des rxh sork hnnscltor her{tfor rhf,tu3h ht or hd own cmPlovccs <br />provilcd rhrr slch nr{ftlt.Enh {re nor intc'Jcn oftci$d for st tt <br />'x,{trd. <br />lhc hoikling or inpmvoDnr is wrld wirhin onc )ear <br />;fcon!,lcrion. tlE owrcr Buiu.r will turrc thc t{dcn olpoGns rhlr h. or \h. dil mr huird or itru)Dk rh. poPcnv tor rhc ,nqm* ol <br />-1. <br />fl\n*ncr.frhcfiopcny. !mrtclusir.ly.ontacting silh li.rtr{dcotrl.tr.to6rocoa{tucr tlE Prclttr (Scc 7044.8tr\i'rcs <br />atul Pisnsshn Cod.: Th. Conkmrois Liccnsc t-rw do.s nor ryPly ro an osnf orF)Pcrrv wh() builds or inl,rrolts rhcrcon. <br />lnd {h..onr..klbrsuciI,(,j.\hwnh0Gnrmcri,(9ltcn*diursuanrrorhcc()ntadoisL.iccn\eIl{). <br />_l rn.xcmlr u cr Sccrion <br />]IO8trETILCOMTEXSAIIQN <br />DEIIAXAII!]N <br />I h.rcby aflnm undc, pennlry.r p.rrury onc oflhc tollowing dNllEtion\: <br />-l <br />havc and wiu minranr s Cen irrare .r Conscfl lo Scll' lnsu,c for worlcn coq,c.rarion as lmlidcd for hv sccrion :17(n or rh' <br />tjl c(ldc. ior lhc I'crfnrnm.. of lh. sork for whi.h lh. Pcnnil is isslcd <br />-lhavca.duillmdinloinsolkcrr'compcnsari.trinrurtncc.a\nquircnbySccrionlT(DoflhcLlbnrc(d..lorthcnrform <br />cof <br />rhc Norl itrshr.hrhi\ pcflni h irsucd M trork.r' conrFn\ari,nr nNmncc.rricr rid tx,ltry umh.r:xc <br />olq <br />l.cnifylh.l inrh. pcrbrnrn cofrhc*ork tr shi.h rhirtcrmil is nrucd.l shallnor etopt v rtrvpcr$n ina v monrcr <br />D !s b hr.om subFcl lo lhc wo e6 .onllcnsnl ion laws ol Cdlirnnir. und 038 rhtrr ir I should hcoft subjcd lo lhe <br />sortc comFcnsolion pEvtions ofscrion 3700o,rhc ub.r Codc.I shxll fonhwnh catnplv sirh rlse Pmvisbns <br />WARNINC: iailue ro KlE Qork n com!.nsarion svcnec ir unh*ful. rnd shrll subier !n c'nploru tu diminal pculri.\ and <br />civil fincs ur lo onc hlndftd rhousand dolla^ (!jfi).flX)r, ir 0ddilion h rh. cost oi conD.nrarion. drnugcs * Pn)vi'l'd fi' ihc <br />Sn-tr.r n'?n or rr Llhtr Cndo. llcrc! ond un,'tr\'\ fE . <br />,-A7r' --o"".4."L) Jl. apprienr: ffi- <br />I,UINSELCONIBACIOI <br />ITCIIIEAIIA! <br />I h.rcby llfirm u ndcr rcnalry o r Edury lhsl I um li.ctr{d undcr Prolirn,nolChrptcr9(.ohmncinE wirhsecrbn7u )oiDiri\ion l <br />of rhc ausincss$d Pofcs\k,nsCoic. ond nryltcn{ i\ ir full loEc {rl.r1..r <br />RL (? c.i <br />-tn ELE4AL- t3Lt/ itnh Q <br />coNs,I.RU(-t.t()N LENt)tNc AGtiNCy <br />lhrr.byri6rflrundcrEnalryorr'.rjttryrhrlrhc.ci$sn{nrri(,nhndi'rsrtcrtrviorrh.FrroflMnccolrhc*oikiusii'hrni\Fnniris <br />is\led ts(.1097, civ cl. <br />AITLICANLI)ECI/8AIIO! <br />I rircby !flian uDdcr pcnllr y or t cijury onc oirtu rolk'wing dcclorarion\: <br />Dcmlitun Pcirnils.Ashc(os Norin alion FcdcralR.Cuhrn'n( (Title 40. Pan6) <br />_R.quift d t rtcr ol Nolifi crrion <br />l.cnifyrhal lhc tcdcrul rclnliliors rc8u inca\lxn.srcDn,v!lr.nornflli.rhler0rhi\Frlcci <br />l.Liiryrhltl I lnE rorlrln\ it,tili.rli,rrd (drt rh <br />orlirrIc\ rnd Sr.lc l]rw\ rchrin! r, ntriliirs (otr{tu.r <br />d rhc uhovc i',fonrtrr io. t corccr l nere ro smPly wir h all Cil y u.l c.u ry <br />hcrcbyrtrrhoriz. r.trc\ctrrrrivrs ofrhn ( irya C unly!rctrr{trF rh. <br />rhrv. nrnri(trrd fn)Inny li)r i'Nttcri(ri l11 {Appliunt or l*.nl SiAn.lure l@exto Ll:lt <br />BUILDING- INSPECTOR RECORD <br />1 <br />DATE <br />SLAB Floor <br />Brown Coat <br />/)-,; <br />T-Bar <br />>rllld( <br />lavt <br />LrnJ 'i 'lJ'rs <br />- <br />I