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SITE.WORK DATE rD/srG.COMMENTS <br />Set Backs <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenVl 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 />Handica p Req <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certlf <br />FINAL t-4-t1 \./[ir) <br />Certificate of Occu pancy <br />Notes Remarks , Etc <br />OWNER BUtI,DER DEI,('ARATION <br />I hd€by artrm uod6 p€nally oa p6ju.y rh.l I m erchpr aiom lh. Conrraclo^ Lic.nsc ljw aor rhe aollowin-! r.Mn (Ss 701 I 5 <br />Ilusio6s and Profsion Codc) Any Ciry o, Coud) which r€qut6 s p..mn ro cotrrruct. ahs. imprort, dnolish or (p6tr ey <br />srtudue rior ro il' isud.., also rcqut6 rhc applicdr for sucn penni ro nl. a liBn d eatmd ihar lE or slE G lics.d plmei <br />ro rhc povnioE of lhe Co.ra.bas Lic..srd Llrv (Chaflr 9. Comnc.cior wirh S..1ion 7000 or Divisid. I oflh. BBinB ed <br />Prcfsioro Cod€) or rhd lE or sh. is d.mpr thftEon dd rhc bab 16r rhc.lL8cd eranprioo Ary viold ion of Sstion 70.11 5 by any <br />applicanlaoraponitsubrdslhcapplicanttoacivilp€nallyofnotmo,eth fivc hundr€d dollars ($500). <br />I, a oqnsoarhcrolEny, oi rly.nrplorM {irh {as6 ar r[en $h conrpcnsdion, \villdo dr. $o,l dd rh. sln(1ue is not <br />inhd.d or olter€d for silc (Ss.?tr44, Uusins and &oassio.s Codcr The ( onrra.roir t,ic6w Lav do6 nol trpply k, d owns or <br />rhc plpdy who builds or ituptu!6 th&on. dd who do6 su.h x)rk hi'nsdror hmlf oi thrcqh his or hs ow. employe6. <br />providcd rlrar su.h ihlirdvdncnts ae 6r imfiddl 6. offerd tu elc I I hosn d, rlr buildir8 oi irhpo\ dncd is $ld within onc }!- <br />ofcomrElnn. thc Oxoer lluilds Bill hav. !h€ butn orpro ns tha h€ or shc d'd ful hoild or in[mre rh. pNto9 lor rh. pu4rs oa <br />-1. <br />d oM6 oflh€ p.opcny, an qcluivcly contB.lins Nnh lic.rrd c.nrracroF ro .o (ruc1 rh€ rro.jd (Sd 7014. BBins <br />a.d hrf66. Cod.: Th. Conl.rciols Licmc L.w do6 nor rpplyro M ownd of prop.ny *ho builds or nnprovdln6s.. <br />and who conlDcls tor $ch proj.<ls sith a Conrrscro(s) licos€d pucuur lo rhccontacrors l-rce lrw) <br />ld. eierpt u.dcr Sdio a & P.c aor Ihis rcason. <br />Dtrr. Orn€r <br />1!Aa[]ru]!UrrNt!tt9! <br />DE!LI-8 r!9! <br />I lucb) affi'Drutrder $nillyol pdjr-}oneotlhc foll.\rinr decla'iln)r <br />- <br />I har€ od *ill mainrain a Ccniicar. olcoMr to Selr'tNur€ f$ sork.re' oNpdr.tnnr 6 Flvid.d Lr by sdion 1700 o f ihe <br />I ihtr Code. for lh€ pslomuce ol lhc wrl lor shich the pd'nit is issued. <br />('and willmainrain wort.rs .ompcBarion i6urec..6 cquncd br- ssr ion 1700 oathc bbo. Cod., lor lhc p6lbm c.ol <br />io' $h(hrhBflm '<(,nr \a "r <br />Op/: U) c.o tS CC.,at9 /'- <br />r,,.yr,., ;;y'1|7@o fk, / 8- ./9 <br />Iceni&thatintheperlonnanceolrheworkaor{hichlhispcnniiisissued.lshallnol <br />$ asb b(om suhj.rl lorhc\o'krs cotrpcns ri.n la\sofcilir(nni( rnd.t!rL{ thd illshonld b... rts'biccrroth. <br />sf't.ri unpen{l Lon |mr isn,ns ol SNrn)n 1700 ol rhe Lrlnr ( ( c.. a.nh$ilh conpll $irh rlms prorisions <br />WARNINC: F.ilurc lo suc sorkns co'npmsdion .ovdrge <br />nundrcn thotrsn dollars ($100.000). <br />afftrm undd lEnahyoiptriurr lhar l0r prulisbn of(-hapt( 9 (onnndciqr sith Seri,rn 7000)orDivision l <br />of the uusirisud Prof6sions (nde. dmyli.enseis <br />?A <br />!ots-l811-r1D_Lr-!Ll.Ltl]_ttifttr <br />I h6cby amm und6 p..ahy ol p6ju.y rhar lhsc is a oLnruclion Endins aBdcy lor rhe dfomdc. oarh. \orl for whi.h rhis l6nit b <br />iss!.d (S(.3097, Ci!. C.) <br />atfrtc .aLDlctaarrol <br />I hottry afrm undd petr.hyofNrjury oneoilhe iolloNinB dclmlions <br />DcnDlnion Pe,nns s&xrds Notificai ion Fcd6al Rcstldio.s{lnE40. Pan6) <br />Rcquten tdr.r olNori6carirn <br />-lcmiS <br />lhal ttu ledqal rcsul.lrcns remo\al ar€ not applicatrlc to IhB projsl <br />I.dili rhir I hh. nerl rlii(lhd th. ah.ve inlonniinrn is mftdt IarreloconDlywnhallCityandCounry <br />ordln.ncG and Srate tjws rclalinr I urN\ r n,.nl(,nrJ tn,Ina\ nn <br />AIDri.htrr or \,!cnl si,!nrt <br />€ <br />horizc rq)r6olatn6 oII Citr, Md Counrt ro €nl6 urnn lhc <br />BUILDING- INSPECTOR RECORD <br />Forms/Steel/Holdowns <br />UFER Ground <br />/r-l <br />,<9t/9 <br />o*", t4 3n-xt1+ru{) <br />tt <br />I