|
SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />ffrl,torttRoof Sheathing 4/u /t,(- /n2,---
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL qhL/tp €v']4n72/)/n'2--'
<br />Certificate of Occupancy
<br />Notes, Remarks, Elc
<br />OWNi'R BUII,DER DELCANATloN
<br />I hcrcby irfifln uM.r p.Mlty ol ,icrjury lh.l I ofl cxcmpl fmrn lnc Conrrrcton Liccn{ tiN for rhe ftnhsing ftav ' (Sc. 70.r 1 5
<br />Busincss and Profcsion Codc): Any Cily or County whi.h Equncs 0 pcrmn r{' condtucl- ahdr, imnrovc. dcnDlnh or Ep0t .n,
<br />ddcruc. Fior ro irs tsunc.. dho rcquift rh. drrrlica fin \!ch Fdir ro filc a signcd rarcmnr thal hc or sh. is lienscd rurousnl
<br />Io Ihc pmvisions of 0E Conlroctols Liccn*d ti* (Chaptcr 9, Conrmcncins *ilfi Sccrion 70OO or Divkion .l or th. Businrss rtrd
<br />I'r.lc$i(,nr Codc) or rlEi rror!h. kcr.mpr rhcrcrr.nandrhcb!\i\ turrhc lcgcd cx.m/io. AtryviolarionotSedion70.)1.5hy!.y
<br />!mh.a br,r.rmn suhjcurhc aFtlicatrr Io,civiltcn,lryofnor mrc thin fivc hun'lrcd dollas(S500)
<br />-l.os
<br />o*ncroarhcpmIrnr-ormycmph)ccs$irh*a8csuslhctn,lcc.ntcn\ation.willd.dtRork drhcsMrutoi\fr{
<br />inrcnd.d or oficr.d lff qle I Sd.7(x1. Bu\in.$ Md Piof.\\n,ns Cdi. Th. C.ikrtr's Liccn$ tjw docs ml apply h ro*nsof
<br />rhc nmlEny who $lilds or inrrorE rhcrl{n. dxi $ho dms sEl' wo't hnns.lfor hcrrlfor rhfl,u8h hk or h.r ostr cmlrloycc!,
<br />ptov cd rhar such inltrornrnls arc nor inl.rlLal or olTcE{ nn sb lt ho$Tvc!. rb. hikli.g or inpmkoEnr i\ &,kl wirhin on! }!rr
<br />or.omdcri,n. rtr O*nf Buitl.r willhnrc dr hu,ncn.fpiovin8 rtu! h. or \hc dA mr huild or inlorcrc lhc pFlrny for rh. ru{r,{of
<br />I. N o*tur or rh. Ft)pdy. .n cxclusivcly.ontacrilt wirh li.c scd cotrtlcr(tr{ ro.otreruct lhc ptrIrrr (Scc 701.1.8u\in .\
<br />a,'d Ps'au$ionCodc,thcContuck,sl-iccn\cl-r*d.csnoropplyhnnosncrorprorcnywhobuildsorinrrovcsrhcrcon.
<br />rtrd qho onlnds r'or such nmicls wirh tr Conlrudo(() liccnscd pursurnr to lhc G)nrrmtr'r Liccnsc rjw).
<br />I nncxcmnr undcr Scction-. B. & P C torthis.c!$n
<br />()sDe.
<br />W(IRKF.RS' (I(}MPFNSATIoN
<br />DLELAXAII9X
<br />I hrrby alnnnunder lc.dlr! ofl)crjurrotrc ofrhc f(,llownr8 dc.lndrnrrs:
<br />Ihr\cr willmrint.in!CcnificllcolConscnrt'Sclflnsurcn,worlcncory)c.s{nrn.aitorid.drrtrhyScdiM17(x)oflhc
<br />I r.r rhc n dormflccoflhc qorl tnrshich lhc Fnnir n hsucJ
<br />in rorkcm cor.pcnsrriotr in as requncd bySc.rn,n]Ttuolrhe tixtr codc. rot rhc lcilonutrrc ol
<br />p.mrit is hskaj Myvortcn im in\rotrcccr .r JJxi F,lic, n! $.r rcl
<br />a
<br />I ccnifrrhrr inrhe lcrlormnr.ofrh. u.* Lr shi.hrhis l,cnn,l is isncd,l \h.ll norcmpkry anytc6nn in rny nrtri.r
<br />$ d\ tu t*.m sublc.r ro rhc workLrs Ln |xNdnr hws .i Caliri)rnir. rndisrcc lhlrirl \}xrld b.( f,subidrorhc
<br />work s ompctrs,rn,n provnionsrlSc.lion lT(Doith.lrho, (ixrc.l shill. fonhwirh c-mpl,
<br />,cr t, dnind JEnnhics rmlWARNING rJlud b sur. Borkcrs'.onrtcnsdi(in covcr0fc h utrla*
<br />tu um hu rcd rhouslnJ d.lhrs (Sl(x).oq)). {ddir
<br />I lNrhyllli.murdcr |rnrlryoll]crjury 9 (.onnrcncirB wirh Ssrion 70(x)) oltlivnion l
<br />or r[c ausinc$ nnd Profcsiorr
<br />I hcrthy rrft'n und.r pcnalryor!.rjuryr s r.otrsrudhtr kMin! oEemy lor ric pcrio!romc orrh. *ork nir snich rhi\ Itnni n
<br />tr\u.(tisc. ro97 civ c i
<br />4&LEANLITECI.ABAI]QN
<br />I hcrdy u,Irnr !ndcr pcnalr, orpcrjury onc or rhc rolk,widB dcclarariontl
<br />DcnnnirioD Pcnnih-Asbcstos Norilicnrion tcdcrul,{c3ul!ri{n$ (lirlc.l0. Pr 6)
<br />-Rcquncd
<br />tarrcr ot Norifi cari,n
<br />\rcgrkli',8 r\h.{o\ r.Drvxlrc tror ptlr blr k, dnr l)n,l..r
<br />ion h.ond. lagra r. comply*irh rllCiryrtrd Coutrry
<br />aurl.rizc rcDrc$ntllivcs oirhis Ciry and Cou ryrocnrd uFJnrhc
<br />BUILDING- INSPECTOR RECORD
<br />and Dylicctrrc n i'r i,lllbr.c andcllc.r
<br />1@7f1w
<br />kndP' Addres
<br />-
<br />I
<br />I
<br />*,",Q-zf ',1tr
<br />--------r------
<br />-f------
|