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SITE-WOBK DATE tD/stG.COMMENTS
<br />Forms/Steeli Holdowns
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />sFramin
<br />lnsu lation/Energy
<br />Dj(wall
<br />(Ext)tnt. Latr /t- lt - lg
<br />Bf6wn coat \J
<br />l\/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif
<br />/i
<br />X\ll4tlFINAL)-1241
<br />Certiticate of Occu anc
<br />Notes, .Bemarkq, Etc.
<br />OWNER BUILDER DELCARATION
<br />I hcrcby nflrm undcr p.nally of rcrjury rh.r I m crr lpl rn,m rhc Conkrlo6 Liccnk tjw lor rhc n,lbwin8 reav,n (s...70115
<br />Busincs and Prolcsion Codc): Any Ciry or Counly which rcquncs i If,mir lo @n{tucr. olrer. inpovc. dcmlish or Epnir .ny
<br />srd.rr,c- r k,irs hslame. lho rcqniB\ rh. lpplta n, such r4rtoir t, fihrli8ncd nd.ftnr rhr ir o. sh. i( Iiccnrd luRuor
<br />to lhc pmvisiotrs of lhc Conrsctols Lianscd tiq (Chi cr9. Connncrcirs wilh Scction 70dr of Divnbn:l orrhc Busnrr: rnd
<br />Profc$i{,nr Code) or rhlr hc o, shc i\cic,hlr rhcrcrrodundrhr b,sis lor rhc dllcscdrxcnlnion Ant violarionotScdion 70.11.5 hylny
<br />rrplicdnt r.r a p.nnn suhjNa rhc {llicrnrlo.civilp.n.lryorno! x,rc rhnn firc hundrcd doll!( (5500).
<br />-l-orosncrollhcpropcny.ormycmpk',ccswilhw!-!csasrhcir\rlcc.nlPcn\rrion.willdorhcso
<br />Mdrhr{ndm1\ml
<br />inr..dcd or Dllcrd fff {lc (SN 7{}14. Busilcs Md hofc$n)nr C{x]c Thc c(,nt ttr's Liccn€ Law docs trot optly lo rn nwncr of
<br />rh.rmFny *,ho builds or inymv$ rhcrNn. and stF drs sEh trlir hnnscli or hcrrll or rhrough his or hcr .wn c Vloycc\-
<br />nmv idL\t r hnr $ch nnl, o!.nE s .rc mr ificfrldl or .ltutod tur sh. lr. lk)k\rr. rh. hrkl ilr3 or imtmvcnrnl is bkl wirhin , {c }rir
<br />or.odphri,n. rt O*n.r BuikLr will hxrt rh. t dcnofpdingrtd ltorshcJil nur buildorn\rDrc dr ptr'tity lh! lh. Ntx,$ ol
<br />I. \.*icr orrhc ln)tcdy. ancx.hsivrlycoftacri+ wnh liccisctl co rn lds r,.otrNnd Ihc ti(+rr (scc. ?01-{. Br\i"c,i
<br />md hrn6s\i,nCodc lhc Cinnracin \ t-iccr\c l-r* doc! nor rpnlyb !nostrcrolp(,p. ysho huildror nnF)vcs ihcrc.n.
<br />itrd who .onrtu.t tu su.h t6lc.h wirh r Co h.tr(,lnri\cdltrr\urtr(orhcLo.rNhisLi.cnsct,rN)
<br />-l
<br />omcxcnpt undcr Scclion-. B. & P.C. id lhk rc$on
<br />Drle: OPNr
<br />TOBIiE&T:TOUIENSAIIOX
<br />DECLA.SAIION
<br />I hcrchyalllr u d$ rcnrlryolpcrjDryotrcoflhc nnbwirEdc.l rin,ns:
<br />Ihrvca *ill'tuinrrinaCrDrlifi..rcof(l.trs. uS.ltlnsur. r work.rr..nrr. srrio.,trs p^rlidcdlorbyScclt'nlT0Oollhc
<br />Uh.i C{dc, tu rhc lcrfomkc.f rh. work fu whkh rlt Frmir ir i\\!cd
<br />_l harc lnd pillnuintoh pollcB compcnslriotr insuroncc,0s rcquncd hyScclion 3?O0olrhc Llhor Codc. rd rh. r.f.mu.c or
<br />rhc work lbr which rhn p!rn,ir i .,.!j..1 M\ {, ,r.1. at F.ti. ) 1r,trt{, rr*Sogtual conllat,,",",cyPilts siliurSuw c
<br />I crnify rhar in rhc pcrforroncc ofrh. qork l('r shich rhis r.rnir$ $ lo bcoN subjLrt ro thc works I .on{cnsai ion hws ol Crlihnri
<br />$ort.r\ c.nrtcnqrrion prcvisionsol S(riu l7(x)ol'lhc litnr Codc.
<br />ll4lt\l\rl I ',lr'" L. "run.u^'r.'. t'ip,lln\:ni '.1\fliEc \ u'
<br />i\ i\\ucd,I nrrll iorcndoya.yNRr inany manNr
<br />d. rnd rsrccrlnrill rhould licoN $hrcd t'rltr
<br />I shrll. lnnhwirh c.nrll, wirh I hor In)vhdtr
<br />c vil ,nr\ ut r) om hrnrl..d rhousJDri Jollr\ ls
<br />Sc.rtrr.1076ofrhc I rhtr C{iir, i' crc
<br />',,,,",1-2'l't6
<br />I hcrchy onifln !Ddc. rcnillyolncrjury I Irnr liccnscn u.iq lmvn ion ol'Chrprq 9(co'nnicncing sirhsccri{ Tuxrl.lDivNmnl
<br />ol rhr Bu\i,,.$ rtrJ I)'olc$trnn Codr, tu ry h.rf\c i\ n fuLllntu. xml.llc(r
<br />b
<br />q-d -l
<br />t hcrchy ar'ltD u.dcrynrllyof t'.Uury
<br />issucd (Scc 1097.Civ. C ).
<br />ruction lcndinE lscncy fix rhc r.rfommc ofrhc wort for wh,.h rhis If,flnil t
<br />dITUCAITDECLASAIII.}IY
<br />I hcEny afirn u ndc! !.nully ol pcrju.y onc olrhc nnbwin8 de.'lffalions
<br />Dcmhion PcrmirlAsbcslos Noliliqlion Fcdcral Rcsul0rions (Tnt.l0. P.n6)
<br />-Rcquncd
<br />Ll'cr of Nolifi cdion
<br />I (nilt ihrt rh. tudcrrl rrguhrntri\ r.!ddin! r\b.(o\ rrnn,qlrrc norrfpli.rhl. kJrh l)n,iccr
<br />!g!c bc.tr,ply Nnh all Cirya Coutrr!
<br />rivcs olrhir Cirydtul Cornryto cnrs upon rhr
<br />,,,," q-2Y-t6
<br />BUILDING. INSPECTOR RECOHD
<br />Set Backs
<br />t\
<br />0 -vl\o
<br />tJrd.r'\ AJdr..
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