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SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />rt>-L2))Forms/Steel/Holdowns 6-tL,tg ('-&crv
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulalion
<br />Rool Sheathinq
<br />Shear Wall 7'n-/U z '.rf- L1 )
<br />Framinq
<br />lnsu lation/Eneroy
<br />Drywall
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />-_) l
<br />FINAL //19, lt t,4a -,TT/
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />-t
<br />OWNI]R BUILDER I'T]I,CARA loN
<br />I her-by,firn undcr pcnalry ol P.rjury rh l m cxcn{ fror. rhc Contrdos Li.ensc Llw r.r rhc rollowio! tcatun (s.t 70ll5
<br />ausirrs lnd Prorcsi,,n Cnrcr: An! Cny or Couly which rcquirs I |f nrir ro co.( cr' rlrd. nnlrort. dcnolM or rcl),n anv
<br />srtucrur.. prin ro irs i$uancc.0l$ rcqln$rhc 4pli.rtrr fd su.h l'cflnilh filc a \igncd sl cnEnt lhrr hcor shc is lftnsd pursllrr
<br />ro rhc Drovnio"s ofrtf, Contr.ttr\ Lictrscd Uu lchatlcr'r. Co'hn:cn.nr8 wirh Sccrion TtxD Dr Division I or rh' Bn(i'!'s inn
<br />Pmicsion\ Codc)orrhrr rLor shc kcrc ltt thcrcfrod snd rh. bn\i( hrthcallcscdcrrmfln,n Anvliolarion.rs..rionTi).ll5hvanv
<br />ryplica nxap.hril suhj$is lhc flprrlicrnr t, r.ivil|xnillyofnolnDrerhan fiv. hxndrcd dolla*($501))
<br />-1.
<br />N o*tur .f r l[ Fn)l)cny. or my cmnk,,ces wirh w Bc\ as rhcn qnc conrll. "ario.. sill do lhe worl axl th. stnElutr i! ftn
<br />imcndcd or nf.rcd l'or {lc ( S(.7O14, Busirrcs r Prt)fcrsbisC(xtc lhc O)nrrmkn ! Li.cns. tiwdmsn i 0lPlv ro an o$ncr of
<br />rhc pmpcny Rho h{ilds or improt\ rh.N[ ud who d,xs sNh *or* hinx.llor hcnclfor rhmu8h ht or hc. oRn.'npk)!ccs.
<br />Fi.vidcrl rhar su.h innnMntm m nor inrcnd.rl or oftcrcd fd $lc I( ho*cE. rh. hoil,lins or imrmvcDnr i\ sld withir' "m )!n
<br />or.onfhrid:, rhc O*ncr lruihcr *illhrv. ihc bn'l.n of tovins ln r hc or \h. did d ldil'l or illlmrc rhc Polrcn, nn rhc l[{bsnr
<br />l. i\otrncroirhcpmp.dt, nNcxclusivclyconr'r.ri',3 wirh li.ctrs.d .onl.i&,r n, cod{nrcr rlrc projccr(s.. ?(!-1. Burm$
<br />nd tbf.asbn Co(|.: l hc Cotrlrri, s l-i.ctr\c Lis docs nol ipPly ro rn osNr ol rn,pcny trh,, huilds or imlovc\ rh.rcotr
<br />Md rvho c.nkrc( Lr su.h t, ojcch wnh a a)nrrmn,d s) licc'r\cd Nrsuor k, rhc (bnttttr\ l-icensc l-rw )
<br />l.mcrcnpr utrdtrs..riotr-
<br />\hich rhis Nrnril i isurl M!
<br />Dalr: Osn..:
<br />rvonxrns' trtntPtttiartrtl
<br />IITI;LIAAIION
<br />I herc$y rrfirnnndfi pcmllyoincrjury onc urrhc lolhwnr8 de.larirn,n\:
<br />-,
<br />tulc rtui will nDint.in a Ccniftar..r Conscnl b Sclf,'rurc lor worr.n compcnsolion.as pr.vidcd fot bv Ss'n,n l70o olihc
<br />tibor Codc. for rh. p.rroirorcc oi rhe work foi shbh thc ,rmn is tsucd
<br />-l h!!c,nd will nrai ain *orkc^ cor!*ns,rion n$utrrEc-.s rcqun d byscdiotr:lT()0ollhc tf,bor Cod.. for rhc !'ini'Mtr" 'rsarion in\oran.. .anin ani F)licy nlobd m
<br />S.crion 1076 of(hc biu Codc- inrcdi itrd.rionrcrl l!c\
<br />C
<br />2-zo-r9 nr,r'"rrrtY&
<br />I c.diiyrhrl in lhc F.rionnrn.cofihc sork lot shichrhi\ n nrn ( issrcd.l \hr!l orc rrhvrnvP.r{ in rnynrinncr
<br />so s r.lEort sbj.d kr rhc w<trkc6 conrp.fidi,n lt*\ ol(.lifornir. rnd lgnc thd ifl should h.( t subid brhc
<br />Mrt.rs' co'npcisrri()n lr)visror\ ol Sccr i(D l70O .l Ih. Lrhr Codc. I shrll. fonhsith .orlly w irh rho$ I'lovnnnr
<br />WARNINC Failurc to s.trrc workcr .o Pcn{riotr.rvcn-(c i\ nnh*tu|. rnd d l {blccr 3n cn{'l.ycr !J nninrl lrmliil ind
<br />ciril finc\ up b onu hundrca lhou\an{t doll.r\ (il(x).lr00r- in rddni.n b rhc.o\l olcomltn\rrioi. dama8cs rs lhv'ricd lor rhc
<br />IICINIEDI:ANIAgIOB
<br />DECI,IMIION
<br />I hcrcb, uiltmu cr Fndht ol Frjury rhd I anr li.c.*d undct Imvision ol Chrtrci 9 (conrmncins wirhsccrion?O0O)orDivi\ionl
<br />of rhc Busircsssnd P&fdssions Codc- and myliccn{ is i. full lar.c rnd c{cct.
<br />-", .7-!c'i i8
<br />(l()NsTRUCl',lON LENnIN(l /t(;lli\Cl
<br />I hctuby dflirm undc. Nnrllyofp.rjttr! rlu rhcr t r.on(rdnm [ndin! ascncy in rhc rrt,iruncc ollh€ sork rln s[ich rni\ Pcnrir ir
<br />i\(urd rslr 1097. crv c )
<br />APPI ICAN'I DF(]I.ARATloN
<br />I rbr$y,fin nr undcr ncnllry orEdury o.c olllrc r'ollowin8 dcclaruri6ns
<br />DcnDlirion P.nnit*Asb.stos Noliaicdnnr Ftd.ml Rcgulations ( l irlc,l0- t'd6)
<br />Rcqui'cd Lo(cr of Nolilicali,n,
<br />ityrh3( rhc rcdcBl rcguhrions Egt'din8 Nltnosrcnnrvalrrc 0.ltrPpli.$h h rhh nroJcci
<br />ifyrhd I hr!cictul rhtrmli.rriora,klr r.rhtrrrtc.borc idbnnrrion i\.ofr{ l4rNroconrdyairhallCirvamtCorirv
<br />rid$rlrc ltr,w\ rclding tu huildin8 conntudion. d hrrchy authoriTc rop$. arivcs oithn Cn, and coutrrv to cnlcr uBrn rh'
<br />.'h^c tr.nr'.*.lnn,mnv 1., in a
<br />o,,,,*.,,,"o*".,,,".",,* x ,fJ A xl'l't-^-: ,^,13o-tl
<br />n"-u,* n"..,rn,,, K €D ACoegqr'
<br />BUILDING- INSPECTOR RECORD
<br />Ext./lnt. Lath
<br />.,*"*"r,, . B t.tr{i(l ,_,"""""fqqqL>q^{e4!4J
<br />I
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