|
RECORD
<br />N O\[1\ER BUILDER DEI.C4R TION
<br />r !n& Futy oi psju.y thd I d .rat4l to{ rla C.tu-d tide try lor llE folbviIl ld)r (56.7!r! |.J.
<br />ofdion Cod.) Any cny or Counl, which !.quic . F il lo co.ntud, .ts. irFow. dorclirh or cFn e,
<br />rtru.ru. FDr r. Il! irrl@r ,bo rqui6 0E @li..r'l for $.h Fnil h 6L. 3i8..d riml tl't h. or iE ir lic6!.d ,rr$t r
<br />ro rlE FovtioE of llE Conrrrroir l,aEa.d tl* (Cl!rF6 9, Co@i.s wnh Scrion 7000 ot Divilnn 1 of fi. &Bilg Ed
<br />Pblcsions Co!.) or th{ lE or 3h. n.rdnpr fid.ton md rh. b€!i! tor rh. lucsod.rdpion Any violiion ot Sdion 701Lt ty i,,
<br />qplk. for. Fhn stirerrt @pl'on ro r6r'lp@hyof 6r mrcrha 6r. huxLsl.b!ld (t50o)
<br />l. s NE of E FoFl,, m ny frpk lc rilh s'ra6 a lh.r Dlc @mFudio.. eill tL tll Pol !d tlE rndE i ml
<br />'dqd.d 6r ofia.d lor.L (s6 7o!4. a6i'E rd PEi66N Cod. TIE Comrlmt Lioe lrw &€ br +ply ro o osd of
<br />thc FoF1, *ra hrikh or nnF.s $a6l! rd *ho dE *h w* hinsll or lEElt or rkou3fi hit or na o*n.nploy6.
<br />Forid.d Er sh ll,.offi G d iidrLd d ofrsd 6. 'le l[ hoEs. dr h,ildut d q(saEr . $ld wilrs oc d
<br />of coslplrDi. dr ()*{6 B!i!6 viX h.E ltE bu{a ofFovrl{ tld lE or dE dn mt hilt s inPtot th. F.Fly tu tlt Frpo& of
<br />l. 6 dma oath. FoFry, u.rcluiv.lyconrdm8 wirh licd.d co,iEroE ft' coinrucr rlE Fnjan (s< 70a4, a6md
<br />sn h!6$ Co&: TlcCodrdor'r l,ice t * <b6 hr rppl, !o eou@ ol FoFty *ho hilds or inprc€ lhqof,.
<br />dnd lho onldr an su.h pr.tr! wnn r aoddo(, lrG.d puEMr ro lt Codr..ld r L(c@ Lr*)
<br />I m.rmpl u*t r Sdion
<br />D.l._ _ __Ornd:__\}oRiriS' coMrHra^roN
<br />DECI,AN TION
<br />I h6.6, .lTm unds F!.ny orFju.y oE ofrlE follovrg &ih.rFB:
<br />I h.r. sld will Nillle t Cdifxdc olcoNd b Sdf-lE4 f- *qlo onFBrion, N FoviLd 6r by Sdrion !700 of th.
<br />l,!or Codc tu rL Fforlte. of rh. sd id *nih $. Fnn it dx.d
<br />I hrt rnd will minri. wo 6 srtrFMion iN,uq s r.quEd br Sd$n l7m of th. Lrbo. cod.. for rh. Ffollffi. oa
<br />rh. *orl fq *hi.h lh! Fnil n is.d My sorkd comrENnion 6uft. @id dd pol.y nunbd E
<br />,
<br />I cdifyrhrl in1t Ffomtr.otrh.wort tor q'hkh fin rEhn ir isu.d, t ddl&l@91o,&,F$ninstnr.Ie
<br />$ 6 ro b.@r $bFt lo rlE *!rrd snFlrion l&! olcrlirom{ !i {E rhr il I nluld tr.oft $bj..l lo lL
<br />*o*a' compauilon pro"croB ol sdio; lToo of rh. Linrr Cod., ! ihll. ionhq'rh complr w h rhoc posioB.
<br />$'ARNING: F.ilm !o cU. $1116'@mFdhn tull sbj6,t D aipbF to oimin l FrlE..d
<br />o3 of .onFqxo,! drn e6 G Foril.d 6. lh.i(rl fin6 !p t' om hundrsl lhousd &lls (ll
<br />I h@by lftm undo Fdy ol Frory lh,l I m licas.n 6& Flvi'ion otcnldE 9 (tun1jr*i.s wiu Sfilbn 7000) of DivsDn l
<br />of ll* BsiB rd irct6b6 Co&. nd oy li.oB ir b tull fom -d .fian
<br />,,r*rr* ! -, 3f
<br />".,, 141q1 .icdc N:grr //oob. o /7<
<br />I h@by .flrm u.dd Full, of Frjury lh, rhR L . otrdruc'i,tr ttrlins .g6cy for lh. pcfotrMc. of lh. srt ft,r *'fiih l[i! FEi a
<br />is!.d (Sa 1097, Civ C.).
<br />L.n& r \m.
<br />AIIIICANLDESJAAIIO!
<br />I hdq rllm u.dd F6.hy otpojury on. of rhc following d<lmren.:
<br />Dqmlni.n PcIils-Arbdo! Non6.dFn r.d6rl R.suld6a (Tnk 40, Pd6)
<br />Rcquir.d Ldld ol Nodi.lrion
<br />I (di9 thd rh. 6crsl r.ruldioB Essdiry sbgtoe rtuv.l &. .ol .ppliclblc ro fin pqsl.
<br />_-l .qiry rid I h.E lad rt6 rpplk{io. ,n n.r. tnr dE .hov. inforndion n .o.rel. I erc lo o,qly whh .I Cily ad CoEny
<br />ordiiaEd dd srarc tt*! Eld[l t. boildi.e.o evl hccb aulh.rn. rqr* riv6 of lhs Ciry md Counir ro 6ld uB'n r5'-
<br />//J f .Ropt€Po
<br />SITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation I
<br />Roof Sheathing I DIVYJc
<br />Shear Wall lf
<br />Framing
<br />lnsulation/Enerqy
<br />Drpvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL I \\u P}T/YJ t LWi-l
<br />Certificate of Occupancy t,
<br />Notes, Remarks, Etc
<br />-1 L
<br />, ltL "rL -d
<br />tt,
<br />;*:*rr t>/tc /z ot,
<br />/fuuoc
<br />rl-
|