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SITE-WORK DATE ID/SIG.COMMENTS
<br />l. I ou(r of rhc popcny, or dy cmploy.cl wirh wrg.\ a\ rhcir qn. .onrycnsar ion. sill do ltE $olk and rhr {tuim n rn
<br />inrcndcd or offcr.d ror $lc (Sc.70.1,1- Busirc$ md Profcsiotrs Cod. l hr Orll,a.rors l,icctrr l:w dm\ nor ,t'/y ro rn owncr ol
<br />rh. tmpcny ,b }l{ildl or iapn)vcs rhcNxl i' whi de\ skh rork h i'N.ll or hcr$lf or rhough his or hcr o*n .rpht..s.
<br />nrovided lhlt such inprolemnh m nor inrcBlcd o, oficrcd lbr {h lf, hN.\rr, rhc huilding or hrr(,rcnrnt is Y,ll lirllin .'f, )tJr
<br />or.umplcrion. th. osmr BuilLtr will hNc tlt burdfl ol provins lhar hc or shc dil nol build or inlPmk rhc toFry ro hc lurlx'e ol
<br />l. ,\ owrr of ihu l)(),rny. nncr.lusiv.lycotrr..ring f,nh li.cn\ud c.tuncron r. connnd rhc pn,Jc.r {s.c 7(}rl. Brir$l
<br />r h)llsh. Codc t hc Conrrct(n\ l -ic.nsd l -!w Joc\ nor rpply ro r osn( of non ny sho hn ilds o, impnnrs rhrr.otr.
<br />lnd wh. cotrtr(rs fd nrch pmjccF $irh n Conrmcron s ) licc.sal puisurnr rorhcConrrctr's Liccn{ tjs)
<br />-l
<br />arcxc$pr undcr Scdion-. B &PC nnlhisrca\on
<br />Dnic: Osn€.:
<br />WORI(DRS,L-OIIIP}.NSATI()N
<br />IIECL$A.IION
<br />I hcr.by rftrnnxndcr p..!lryotpcrjuryrnc oflht nnb*in8 dc.lniliuN:
<br />_l n,vc rnn will mtri rinaCcniturrc.lCdhsrnrhSclaln\rrclbrworlc-.omp.trs0riotr.osF,vidcdtorbySNiionlT00.frhc
<br />lilxtr C.'lc.lor rhc pcrfo nnc.oflhc worl larwhi.hrhc p.rnir i\ is\ucd.
<br />lhrvcnnd will nridrir workcrl conDcnsiiior lnsurnn.c. is rcquncn hy S..ri{)n l7l[)ol rh.l-rhorCod.. nr rlr
<br />N1\
<br />\I YU4
<br />-l
<br />cenil, ihal ir rhc pcnhrnuncc oflhc work lbr shich rhn rcnnir i\ tsurJ. I shrll nor.trlPl(iy rny pcron in !n, mani.'
<br />{i trs k, btconE \uhjccr t, rhe *urkc^ co'npcnsdi,)n lass orCnlifonrii. Mdi3rcc lhil il I \lnrl(l6ccoN sthlccr !Jrlt.
<br />workc^.a,mpcn\arn,nfiovktunsolSc.rnrlTU)orrhcLrlriA)dc.lshrll.ionhwi(hcon,!lyeirhrho*Ptuvili.rs
<br />IVARNING ,'nilurc l,) ccurc sorkcr .onrB tr\ i .orsrgc i\ trnn'wful. .nd \hill $hjcd r cnrfloF. lo criarinrl lrnahics rnd
<br />civil fincs l1I] r. onc hundrcd rhor\Ln dollan lslfi).0(Xr). in:kLlni(r h rhc.os ofcotnt^-.ns{lion. d!m38es r\ pn,vid.d ntr rhc
<br />SNrt,n:1076 ol rhc hhn (ixlc- inr.rcd rn artrrcy\ f.cs
<br />Ir.le: /\ppllc.nl:
<br />I I(:TNSTD C('NTRACTON
<br />I'EgI,Af,AIION
<br />I hcrby,rfinn undf Ntrrliy or p.riury rl[r I m li.cnsd undd lorisn ofChlurcr9(omntE-'inswnhsccri.n7000)olDivistin3
<br />ol rhc Busincsr nd Profcs\ions Codc- ,nd mv li..nsc is in rxll nrd d{l cft6.-i.
<br />b
<br />.*,*.*, .S4\!Y
<br />raNirxlJcuglLENluNc.&G[Ncr
<br />I hcrhy afinn undcr |ENlry or Frjnry rhdr rh.r k r consfl.rirtr lc diIB r8cncy lor lhc pcriorroncc oi rh. rqk t tr whi.h rhn lEmtn i(
<br />^{( lsc. 1(,7.(r\ ( )
<br />dTIIIC]dNfIII,ILIaAIION
<br />I h.r+,y !Utnr unlcr pcn!lry ofpcrjrry onc ofrhc ft)lk,sinA dccl rrrn,n\
<br />Dctr$liriotr Pcfln[!A\hc(or Noril].dian l:.dc'rl Rcsuhnnr\ r-l irlcll). PMO
<br />Rcquncn Lcrrq oi Noliriclrion
<br />I crnilirhrrrhe lcdc'alrc8uhrnff rcg rdnrg r\h.no(rcnx,vrl c tr.r,rmlic{hlc r,' lhnlrr)l.cl
<br />nrdiumcs alld Stdc hw(rcldin8 ro huildir8 c.trlrru.r lnd hcrchyrtrrlrrizc rclrrc\rnrrrnr\ ofrhi\ Ciy rtrd C.uDr! r).rr.r trtrr rlt
<br />rh,( rntoncd f()trnr- nn i'nltr.riir
<br />,\Dplirnnl or,\,runl SiB. ltrrr bpl \?'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Frnal Report
<br />Engineer Final Report
<br />FINAL T/23,/p A*.
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />OWNNR AUII,DER DELCARATION
<br />I lucb, afinn uM.r l,]ndlrt or rf,rjury rhnr I d'n cxcdB rro'n rhc annr.dor' Licctrrc tnw 16r rhc iollosins rcav,n lscc 70.11 5
<br />Bu\inc$ aFn Prolcsion Code): Any Cily or Counry $hth rcquircr o p.rmir ro mndtu.r. dlb. nnPbvc, dcnnnish or tcPat an,
<br />\rdcr!E- p.itr ra irs hsuh--e. aho rcqrircs rhc,pplicanr ror \fthFrnrir t, fil.a\igncd ndc,mnr rhar hc or shc h liccned rdnuart
<br />to thc pmvisiois or rhc cont,clor's Liccnscd Liw (chapr.r 9. c.nnncrcir8 wilh Scdi{nr ?000 oi Divtbn :l .r rrt Busirts ntrd
<br />Polt$ io.s Codc) or ihrl h.o!shc iscrcnrpr ihcrcliomMd lhc h$i( irlhc lllcscdctnfrn,n Any violdrionol Scdion?rr:11.5 hya.,
<br />rtflicnnt for d pcrmir srhi trh. +rlicr k, r.ivilp.Mlryornorn$crhrn fnc hundrcddoll06 (3500)
<br />ab 2c
<br />Erection Pads
<br />Flood Zone Cerlif .
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