|
SITE-WORK DATE ID/SIG.COMMENTS OWNER I]UII,DER DILCARA'TION
<br />I hrr.hf nlftm !tu1.r firry (, Nrlury rh.r I rm cxcnrl lronr rhc Cnnrruclon' l,icctr{ lrw fu rhc tull,)sirrB rcJ&r (Scc.rlr:11.5
<br />Iltrsifcss rnd Proli$ion Codc): Any Cily or ADni, trhich rcluircs r Fnnir k, c.i{tu.r, rllcr, mProvc. dcnxri\h.r BPlir My
<br />(nr.rurc. r.ior b its k rncc. lho rcqutcs rh. rfpli.ur for\uch li.nnir t,liLr nlicd sdcnrtrr rhd hcor \hc i\ liccn\cl Nrsurnt
<br />b rhr pn)vi\n,.\ of rhc Cotrr .ror'1 Li.c.$d IrI lChnplcr 9. Connncrcir8 sirh Sccrion 7UX) of Divti(,n I .fuhc Businc\r and
<br />I'mlc\sionsColc)or rh{i lEorshc i\cxcmpr rhcrciro'nund lhc hr\i\ nrr,r rlfugdd dtcnUion Atryviolnri.nolsccrbnT0.ll5hyrny
<br />rp0lic!nr l,nrpcnnirsuhjc.rsrhc rfplionrt,r.ivilpcn lrrornrr nnrhrtr fivc Iundrcn d.]lrs lS5lx,)
<br />I.rs.sNrollhcpro|Eny.ornrycmtloyccs*ilhwrsc\a\lhcir$lcconrnrn\rri,,n.willdDrh.wort ld rlE(nrturc ir nol
<br />i.rlcd oroficred Inr *,lc lS$ ?Ol,i. ausincs\nnd ftdtssi NC(r]c:'Ihc Gdr&rtr's l-icensc lj*docsnor rpplyrornowrcrof
<br />rhcprl.ny wh. tnrld\ or i'npnns rlf,N)n. iu *lx,docs\!.h$lnkhms.lf..h.$cllorIh.oughhhorh.r.qn.mphyccs.
<br />nrcvnlL1t rhi such nn!n*$rnr\:uc nor inrcfrlcd or ollcrcd lor elc lt lnNscr, rhc hnilding.r in{,B{mm issoldrvithin,,nc )cr
<br />olonuhliu lhc Osncr BuiHcr q'i lh!r. rh. hurlctr olrovins rhrr h. or \hc dil r, bu*lor irrynrvc fic Pmpcny nn lhc Pqn{ or
<br />I.i\ostr$olrhclml]cdy-rmc\.Tusirclycontncrinssirhliccn\cdcoiktr.(tr\t)con(ru.lthctmiccllsc.7O.r4-Bu\inl\\
<br />a|/ h.L\\ion Codc Thc Co nt&kr'\ Li..nsc Lrs doc{ tror lptlyk) dn.wrcr ol propcny (ho I'uiU\ or nntrorcsrhc.c.n
<br />dtrd sh conlruch |or \u.h t,ojc.l\wirhaConirJck,(o lion\cd prr$rnr hrh.Cotrtrrc'ol\ l-[ctrsc l,a*l
<br />I rn.xctrrt, utri.r sccli0.
<br />Drre (rrn$
<br />]LliltBt_loNrrlt ltaN
<br />uru.l-8!rlt9!1
<br />I hcr.hyxiliirxn(I.' t--nxlr\ ol t).'r,,,yfn..l rhc lolk)$tr,8 ..h'nttrtr
<br />Ihuvc rl$illruinl(ir!Ccnill.trrcotCon*nrr)Sclllnsurcitr*orkcracolrnsrrion.a{!to!idcdiorhtS..ti(,nl?0(rolrhc
<br />l- hr C(xlc. f(r rh. Frfonnincc ol lhc*orL fnwhichrhc pcrn,ir i! i\\u.J
<br />thcs.rkl,rql,ichrhi\prnniri\,\\u.dl\lytrorkc.f..nrFr\rriorif\trrD.cc!rtrrrlE)li.t un$cr xr.
<br />_lccniryrh!iDihcp.rbnntriccolrhcs.rkforwhichrhistcirnirisnslcd.I\hrllnoi.,pk,taytr6orinrnyntrnncr
<br />$ r{blmrrcsubFd to th. wo.lc6 qnnpcnsrriqr hs\ oicrlitnnia. trndr!rcc rh ill sh,uld hccont \utlccr I'rtr
<br />workcB.o.rNnsatlonlmvhionsolSccrior]70Oolrhcl,!hi,A)dc-lshnll.lanhsilh.omplywirhlhorpnvhn,n\
<br />WARNIN(;: l-aihrc ro {.urc qork r' conu.ns.hon c vcn8c i\ unlislll- lnd \hrll \u'J.rr an cmrl.ytr ro .rnninrl llcnrlii\ rfr1
<br />rivil ft'cs xp t, o c huidr.d rhouqnd dolhN (llllo.r[Xr). in addiliotr lo rlf con .f comFn\drdr. drnl3cs n\ pr)vidcd tnr rhc
<br />S..ri( :rl)76olrhc ljhor C-odc. mlcresl d alromyi iccr
<br />Lrl.: ApDllenl:
<br />L|(:FNSTT)(I|NiR CTOR
<br />DECI.Af,A.IIAN
<br />I hcEby.(tm undc. lcnollr ol pcrjor! rhs! I !n liccnaai undcr !tuvNn of chrpts 9 (connEmins sirh Sccr hn 7uD) of Dirsiotr 3
<br />ol rhc ausirors and PrcltsioN o)de. Bfrl nr, liccnsc n in tull fre ,nd .fl4.i
<br />I-i..i\d Clds:
<br />Dsie
<br />coNsl Rll(:T!()ii I FNDIN(; a(;IiNcl
<br />Ihcrchyiljlrnru crnnrlryolpcrJuryrhnrih$.Nr(otr{ru.ik kndirgrgcn.yi,trrhrpcrtunr rc.frhcsorktrshi.hrhhPcmir i\
<br />isucd lsc. 1097. Civ C )
<br />ATELUANLIIIITTBAIIO!
<br />I hcN{', llnnund.. pcnrlry ortcrjury otrc.rrh. rolk'wir! dc(lnrrl'of\:
<br />l)cnDlirion Pcnnir+Ashcnos Noiilicnrion rcdcrrl Rc!uldidr (Tirlc 40. Pan6)
<br />Rc!r iad lrrr.' .l Norili. [.n
<br />I .cnili rhd rhc lcJd il rcsulari,'n\ rcgu!irs a\6csro\ rcnrnrlxrc Nr rprli.rblc h rhis Prol..r
<br />I ccnilyrh l h3vc rcldrhn rppllcarioh rkt drc rhrrrh. ahk i nr.di.nis.onc.t.Iisrelo.omplysilhrll(irydtolCouiry
<br />ordiritrccs rtrd Slntc Lnwsrclditrsro hdildingco (tu.rioi-ttrxlhcrchyaurrkri2crctrc{nhrivcsoflhisCilyanrtCounr,k,cnrdupoirh.
<br />rtrrr. trtrLdMd prof.dy lor i.strrtion liurpo{s
<br />AU,licH r or A,rr.l Si*n.lure
<br />Forms/Steel/Holdowns /.-- D
<br />Erection Pads /t l/2i
<br />^t/l'rhr,4SLAB Floor 0)t'* | v
<br />SublloorVent/l nsulation '/,e-
<br />Roof Sheathing 5.r/o-tO-)&l{ru
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lVasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL 1-L-/8,Dztrlzt f*t)
<br />Certiticate ol Occupancy
<br />Notes, Remarks, Etc.
<br />BUILDING- INSPECTOR RECORD
<br />txnJci. Addrc$
<br />Set Backs
<br />UFER Ground
|