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SITE-WORK ID/SIG COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing ,t 7-1- t6 J).{#r (9
<br />Shear Wall T
<br />Framinq 5 s-1 - to.D"{oh TO
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath ?.1-/B J ),lzbr 'r/l)
<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 />/,.-..\
<br />FINAL il-E-ttr Y,
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />tw)
<br />OWNIlR BUILDER DDLCAR TION
<br />I hcehy ,lfirnr undn Fn.hy oi lcrju.y lhal I am crcmpl fmm lhc Conrrrrm l.iccne lis for 'ht f{,lhwins rcR)n (S(.7o115
<br />Busincss rnd Pro,t$iotr Codc): Any Cily o, Co!trry $hich requircs a pclmir h .unitud. l.i improv.. dc mlkh ot rcpan ony
<br />\rrudurc. prior to irs hsuance. also Gqutc\ rh. applicanr tor such rErmir r. lilc a sitncd {at'm.r thd hc or shc is liccnscd rruanr
<br />ro rhc Frv^iotrs ol rtE Conrrrcror's Liccn*d Law (Chlt'rcr 9. Conmcncina sirh sccri{n 7fiD of Divhn 3 ofth! ausincss ond
<br />Ptr)lc$ions Co'lc) or rhar h€orshc i\cxcdpr rhcrcrrofl dd rhcho\t ltlrrhcall+cd cxcmfli{,n. Any violationofSation?0.11.5 h, lny
<br />rytlic,nr rom tl.nnn suh.jNGrhc a,)plicant ro acivilpcnrxyornor mrc'hon livc hu rcndouan(S5tro)
<br />L a\ owncr or rhc pn,Fdr. r my . ltlole\ wirh wdgc\ tr\ rh.r v,h ..np.tr{riotr. will do lnc wolt and lhc nu1@ i\ nor
<br />idcndcd oroll.rd ntr\rlc (SLr 7()14. ausinc$nnd Pmfc$io.s Codc: Thc Conrracror'\Liccnsc ljwdocato amlyroanowBol
<br />rhcpmFny *lF huilds or ir{'m6 rheff)n, fll *ho dms such *rrl him\cll or hc*clf.r rhmueh hk ot hct own cmployccs.
<br />nrovnhd rhor such improrcmnls u c mr inrcndcd n otrcrcd fo. siL lf. howcvcr. rhc t[ildin8 or improrNnt is v,ld *irhin unc )tr
<br />of.oq)lcri,n. llr Own$ Bui $ will hrv. rfu bunlcn of pmvins rh lE or shc dil mt lllill or irq,mE rhc pR,If,nr lor rlt purlb$.f
<br />-l-r\osncrolrhcprrcn),r,crclu\ivcl)rront"cringwirhli.ctr{d.orn.ttr\ro.oNrnrrlhcl).ojcd(Scc7(!,1.Busncsr*i B!fc$( Codo lhc Contncnr's l-iccnsc tiw (,oc\ rorrffly!) rno*ncr ofproncny qho $uilJ\ ornnrn^c\ rhurcon,
<br />rrd *hn conhcls tu such pri.cr\ wirh r Al r .hn\) ltrtr\.d prr\ur b rhcco trcrr-s Li.c$r hw)
<br />-l
<br />.m cxcmfl lndcr Sdion-. B. & P C tol rhh rc{son
<br />Dals ()*n..:
<br />}i!AtrI8CI;OUEENTAI9N
<br />DIII.ABAUAtr
<br />I hcrcby ollt'nundcr |xn.lryoipc,jurronc of rhc lolli'wing dcclnarions
<br />IluvcaiilsillnrinrainrCcnilicarcofC.nscmroSclflrsurcf{trw.rkoi('con!nns{ion..snovidcdirbySccrtunlT00ofrhc
<br />labrCodc.lnrrhcpc.nrnEiccofrhcworkforwhichrhcpc'nrir isilstrcd
<br />Ihrv.and*ill'ndi' lir workcrl.omp.nsrni!'n iNtrrancc..x rcqutcd hy Sccr ion :l?fi) nf rhc tih.r Codc. fd rlr. Pcrlbmkftr oI
<br />&iiffiits'*"ts*+yrpcn\nri({ nr\urr&r crri.r rJ t{licJ_ trutr$cr r.
<br />o0K4ollo L brl rt
<br />-lccnifyrh.r
<br />in rhc pc oirmnccoflhcworklorwhichrhispcmil is i$dcd,I shatl nor
<br />v, * b b.com su$jtrr tD lhr sorkcN $mpctrsdion l,*s ol crlironria. md aBrcc rhar if I
<br />$ rtl^ qtrhn.Nrn,i tmvar{r,,fSccw^xNlNr:.r,Il'r L, .{xre !,trLn\
<br />.",r n*. ,. 'J,." r,-l-.r ,r,"*-.r
<br />\,:nrm nl]6 orlh. r-,hoJ.dh inkrcd
<br />,.," U ll"P lrl
<br />rii lT0ofrllk l-rlir (irl.. I slrxll. ntrlhN rlr j.q
<br />lo)rr b.nn,inrl |f,mlric\ rnJ
<br />IIICLAf,AII9]T
<br />I hcft$ydfinn uidcr Fnrlry.f!.!uryrlrr I {D lrcncd undd pmvrlon olCh!flcr q lconnrcncing wirh sc.rion 71D0) ofDivisiotr l
<br />ol rhc 8u\incs d Pnl$si{,o\ Codr. rrl my licn\c i\ in tullnx.{ md crfc.r
<br />7 3 ,fl
<br />Ll It l6
<br />I hcrcby nflnm und$ !.mhy.l pcrjtrry rhd lhcrc is r cotriru.liotr hflninS !Sch-^! f.r rhc po f(rnDn c ofrhc work hr which lhn Pcmrir i\
<br />i\\trcd (Scc :lor7, Cit C )
<br />AIELIIANLDIC!}AAIIAN
<br />Irr'r'htrmn uiJrrFnrlrtol pcrjffy.tr.ollhcftllowin8dcchrariors:
<br />IrcBnir6n Pcrnrir\ A$c o\ Norifi.aln,n Fcd$rl Rcgul rions (Tirlc.l0. Prn6r
<br />Rcqun.{l l.rrcr ol Norifi.xrinr
<br />-I.cnify$d
<br />rl'c fcdc.al Esulorions EErninE rsbc{os
<br />I ccnil.Yrhxr lh rc r. r[n xtt]
<br />oalinrmr\rnll Srrrc lr\r\ rcldni! rr
<br />xhiv. nrcfriqrcd fr)Fny li)r i'np.cl
<br />..rd.i lrsrst,co rdy
<br />ADpli.$l or ,lgent SiAnnltrrc
<br />ulqa p €e
<br />.,rc.u,y'r,,,{,u.tr,r,.
<br />Clu l, r
<br />BUILDING. INSPECTOR BECORD
<br />DATE
<br />Dllt
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