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<br />SITE.WORK DATE IDiSIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq /D /// //t AhDl*/o--
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Beq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />,l ,
<br />FINAL t0lls//*grvb/b lb-
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc.
<br />7
<br />OWNER AUILDER Dl]LCARATION
<br />I hcrcby aftrn undcr p.mlry (n Frrury rhar I m crctrp! lbD rhc Conrdr\' t,icensc liw ior ihc inbwing rca$tr (sL!.7011.5
<br />Ausincs rnd Profc$io. Codc): Any Cily or Couniy *hi.h requirc\ ! pcrmir b condru.r. ah&, nnprovc. dcnFlth or rcprn any
<br />{rucrure, I,norro ir( is{ance. uho Equncs rhc lpplicor ir suc\ pcnnir t,lllca siSncd sdcmnr thd heo! she h liccn\.d pu6ua.r
<br />fu thc ptur^tuns or 0f G)nt,crols Licc.{d Lrw (Cnrprcr 9, Connncrtrirs wilI Secrbn ?(xx) of Divisiotr ] olrhc Businc$ and
<br />Prorissions Codc) or rhat hcorshc hcxcmpl lhcrctionrrnd rhc hisi\ ror rhc trlldsdtl cx.mtliotr. ny viol.riotrofSccrioi 70.1I 5 by &y
<br />appli.a ruatLn,irsuhjccrsrh.nprli.tnrbncivilpc,hyorn.rfttrcrhm,ivchnndredd.llaF($500)
<br />-1.
<br />!s owncr oi rhc pmlcny. or my cmplolecs sirh srgcs rs rhrt $k R,nll.h{ n r, sill do rhc so* ord IIE srud@ i! frn
<br />imend.n or oficred for elc (Sd.7Ol4, Burin.sl ind Pof.rsin\ Cdlc Thc Co.hcM\ Liccns ti* dtrs not amly r. M owtrcr ol
<br />rhc pmpcny *ho builds or irpr)vcs rh.@n- s whodcs\kh*orlhnnrclforh.rsulfotrhmu8hhno.h.rown.mplorc.s,
<br />lrovidcd rhnr su.h irpmlcrEnN.rc mr r$d<l nrotlcEl lor slc ll h.NE. rhc huikling or inphrcrErt is $ld n i6in om jtr
<br />oi complclb.. rhc Osrcr Buiklcr will hnh th. hrrdcn or povin8 rhtrr rr or ft dil ret boill or inpmvc lhc pmFny ror rh. NrIn{ of
<br />L a\ owner of rhc pmp.ny. rn.r.lusivcly.onkrcrin! wirh lrcns.d c.Ma.lor ro condrucr rhcp j..r (sc.7(x4, Businc$
<br />and Prnltssi.nCodc:rheCon'EcroasLiccnrcl,awdo$trorrprlyrotnowncrolropcnr*hobuildsorinprolcrrhtrcon.
<br />r d who .onhcB ror su.h pmjccN with r Conra.lons) liccnscd puruanr ro rhc Cuntu.ktr\ Lkcne tjsl
<br />ll)&trlB$-lorlfElir ra!
<br />D[CtArdlrolt
<br />I hcrcby lrfirfr undcr pdndlryofpc4uryoN olrh.folk'wir! dolarmiotr\
<br />I hdvc indwill nEiririr dCc ific0lcolConccnrtoSclllJNtrc1,,sorlc's con[.isrrion. a( fmvidcd iorbySdion ]7(X)olrtt
<br />vcandwillnuirlairworkcs conrFnsrri,nr nrurrf.c. is rcquncd hyS..rii{ l7lx)., rhc L{ho! Codc- torrhc Pcrformnncc ol
<br />"hi.hrhjz.fr,'r htr.unl vyr,rq'p{T h:,r ' tr.u'J.1c.,..i,., r, !,''ct,'u'hktrcT*,t '/rutol
<br />v nLs Jq -67- a7
<br />lccnnirhar ir rhc |frtnnMrcc olrhc wo rdwhichr[tncnnili\i$tr.d.I\lrllioicnitk,yanytcsoninrnynr{rncr
<br />s. a\ ro hccom \ubjcci b rhc *{rkcB conDcn\d i,,n law\ of C,lirrrnir. Md nF cc th0t ii I should hftom \ubrccr b rh.
<br />workss.ory,.nsarn,npmvisionsorSocrtun]TmofrhcLrhtrQljc.l(qlllnnh*irhcomllywirhrihtphlh$trr
<br />WARNINC: t,ailurc ro ecurc sorkcrs dnnncN ion..rcrasc r\ un oFr h oiminxl r^-mlrr\ rnd
<br />diNrgc\ r\ pr)riJ.,l ktr rh..ivil fincs up ro oru hundrcd lnousrtrd dolln ($l
<br />SL{ion 1076ofrhc lrb.r CGlc idcrc{! nlktr
<br />,",,. - q' po- /t
<br />I hcnhy alfirnr trnd.r p.nnl'yorprjur! rl'Jr I q r.oNrrcming (irh S..rion 7{XI)rofDni\i,r:l
<br />ol rh. trusirc$.nd Prcic$ionsCodc. nl n,y liccn\c i\ in lnllfixcc x' cil..r
<br />I hcrcby arrm undcr pcn{lly of pcrjuiy rhal rhcE is a conslrucrion lcoding rgcncy rd rhc lcdnirmna of lhe wort for *hich rhh lxini' i\
<br />issucd (s(.:r(r97. ci!. c )
<br />AIII,I(AILDIILINAUON
<br />I h.rcby anian uM.r ncnlliyolpcriury onc.lrhc fdk,wins dcclmli,n,s
<br />Dc,tu,lntun Pcrnirs Ash,sos Norificrriotr F.{crrl RcEnhrirnN (lillc 4lr.li!'r6)
<br />Rcqutcd lrtrcr of Nolilical0.
<br />.cdilyrh r rhc fcJcril tuSUhrnlF rc.qndi08 nshssrl rc r,vil irc
<br />ily lh.t I h.vc rclld Ihk {f ion is.oEccr. I oBre r. conuly eirh all Cityand connly
<br />ri2c rcpr.s.nt3tivccCrhh City and Cornry'o cnrc. u|[n th.
<br />rtx)!. n{trrn)i.d pn)pcn! tur iN "24
<br />BUILDING- INSPECTOR RECORD
<br />/1
<br />In rcxc.rfl und$SNrion .B &PC turlhircason
<br />Codc, fdrhc pcrforinri.Lofrhc *ork r(r slri.h rhc !r'i ir i\r[d
<br />L.nicis Addrc$:
<br />-
<br />Sublloor/Vent/l nsulation
<br />Brown Coat
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