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SITE-WORK DATE ID/SIG.COMMENTS <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />[,4ason ry <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />FINAL 4l>olb (i,pwat 16) <br />Certificate of Occu n <br />Notes, Remarks, Etc <br />OWNER AUII,DER DELCARATION <br />I hsebr amrm under pmahy of perjtrry thal I m .r.ml]l iom <br />'hc <br />ConlracloN l-ten!. L.w lor the folloNinr Bon (5(.70]1.5 <br />BNinss and Profsion Code): Any Cily or Counlr which rcqutB a pdnril lo consind. ahq. improve. domlish or rcparr mJ <br />srtucru.. Fior lo irs issudcc. alro r.quir6 Uc applicdl for such Ilcmn io fiI. a sirnql rdmsl rhar h. or shc is licd.n pr6ua.r <br />ro the previsiore olthc Contacrorr Licetrs.d kw (Chaprs 9. Comnencins sirh Sdrion 7000 olDivision I oath. Busins and <br />ProfcsioNCod.)orrhalhcoish.isci.,nflrhdcEohddlh.b6.i!aorth.!ll.A.d.rmpnr.,\.tviolariooofsalionT0ll5bya.y <br />alpli.antlorapcnnitsubl*'slh..pplicmllorcivilp.nahyofnotmor.lhmfi\.hundEddollarl$500) <br />-1. <br />6 oM.r oilh. prcpaly. or 6y €nplorre silh was6 6 lh.ir sol€ conEnsalion. sill do th. rvort and the ntudrc is not <br />intaxicl or ofrftd aor el. (Sc.7044. Busin6 md ProlsioB Cod.: Th. Conlraclol s Lic* Law do6 nol aprly lo u o*rq ot <br />rhc popsly wl[ builde or nnprevG th6on. and who do6 sucn wtt himsclf or hwl I or lhroush I'is or hd ow, .dp,oy6. <br />prolidal <br />'hal <br />soch nnprovds m noi intodal o. orladl aor eL. Il how6s, rh. blildin3 or nnprorcmrn ir $6 wnhin on. Ja <br />orconplclio.! rh. Or-a tujll6 will haE rn. hlda ollrovi.r tha h. or sh. dd mr hrild or in!ro!. de FDFry for dE FiroF oa <br />_1, a o\wo or rh. propdrn d .r.llsively .onfading wirh liccBcd coota.roa ro .oBhrd th. !.ojet (S(. ?04,1. 8ai.* <br />ad PDlisioo Code Th. Conr4cloi! LiccN. La! do6 nor rpply to anowner ofprop.rry sho builds or iirrovG rhdon. <br />ad rho .odEcls lor such Fojccls *irh a Qrib&'o(, lictu.rl puBMr ro <br />'h. <br />Contudois Li.G ljw). <br />_I m .r.mpl undd Scrio. . B. & P.C for rhis l@n <br />Drl€: Om€r: <br />t!o3xE[s:ro!l8Et!saf!9! <br />DDIIAIAIIOII <br />I hd cb, !mir. utrder pcoahy oi pcrjury on.ollhe follo\rins d(ldalioB <br />-l <br />ha!€ od willm.n alnaCcnificateofConsolto Self-lNure for wo*.a' conrp€nerion, a poid.d lor brsdrionlT00oflhe <br />L.bo! Conc aor lhe pdfonwcc olrh€ $ort for which rhe p6mn is issucd <br />_l ha!. and $rll ,nainraii 1vork.re .ortmsari.n i6uran.e, 6 r.quned b, sdrion l?Ltr ol <br />'h. <br />l,bor Codc. fo. the Frol@.c of <br />rft \ork for vhich rhG Frh is is.d My wortem .ohp.Bation icuran.c cdid ed rRlicy numbs re <br />Poli.y Nu,nbd:_Erpne <br />I cenirylnd in Ihe pqfomanc€ oflhe Nork for *hich this r€rmil is sucd. I shallnor dnplo, ant pdsJn i,3n!,narn€r <br />$ a lo b.code 3ubjd r.r rlE voi{6 comr.Mtnr. h$! ol caliaoni,. dd +rd that il I shuld hcom. subjd to lhc <br />$0r[6 coopdsar]on ptuvisioroofsdlbn lT00oarhc tlh)r Code,I sl,.ll,forlh$irh comply wirn ihoE provisio.s <br />IVARN|NG: r,.iturc ro Kure workc coatpdsarion coremsc is unlawtui. u,j shsu subjer d cnpl(jy6 ro ri,nin.l penahi6 d <br />civil lin€s up kr one htrndred lhoMd <br />sarion 1076 oarh.llt.rcddc. inl.Br <br />cosr 6acomp.n$rioi. danagB a proridcd lor rhc <br />I hB.by ,mi,b u ndd p.nall, ol psjury lhal I an li.sscd provisionolchaptd 9 (conrmen ins with s..lioo 7000) olDivision l <br />ot lhc llusi,r6\od Pn)rssonsCo&. md n! h.c'Lsr is <br />'n <br />tulllor( oJ.fla{r <br />I hd.h, amm undd Fnalry oa pdjury l <br />isucd (Sd 1097.Civ. C ). <br />L.od.is Name <br />h@ k a con(o.ridn loding aucncy ao! the pdlonn cc oilhc wort tor $hth rht Fhn is <br />AI[LrcANfDICjiIAAUON <br />I lErtry allnn undtr renally olDdrury onc oalhe lolloNina de.ldalioN: <br />oenDlirion PcnnneAsb€ros Norificatio. F.d6al Rc8ulariofls {Tnt 40, Pa16) <br />Rcrri'cd l.(ncroiNorifididi <br />-l <br />cdily lh.l rhe f.nsal rcsulaiio6 Er-din8 6b6los roDoval aE nor opplicabl. to rhis projccl <br />,.+rr*,f^.,- <br />:#[T:"WF;; <br />arerhar rhc above rlofrdnJn k cor(t.I a8rd to comply Nilh all City and Counry <br />aurhonar.?rMtatn,6 olrhis City dd Countyro orr urlln thc <br />tl.tl: t8 <br />". r*o..,oi/, fu- E4a9 o <br />BUILDING- INSPECTOR RECORD <br />Set Backs <br />SLAB Floor <br />Subfloor/VenUl nsulation <br />Brown Coat <br />L.nrlear Addrs: _ <br />t-+- <br />I