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DATE ID/SIG.COMMENTS OWNER BUILDltN DEL(ARATIoN
<br />I h.rt, .lt'd un&. Fdlry ol Fr ry rhd I d.r,r{'r fmn rh. Co rBlm l-ianr Lrv ior rlE folk,*in8 R.$n rS& 7011 5
<br />BuriRs rrd ProL(r, Co&, Any C[y or Coudy *hth EqliE\ r Fd r. drn{M. .h6. iqrow. &mlFh or EFn .ny
<br />\lructur., ,rir lo irr nsurm.. uto rc1uirc! lh. .prlt{n! lor ruh F.mil rr fL tr siSkd {!l.Enr lh.l h. or lh. k liccnEn purs.nl
<br />k, rlr pn,tiri.ni ot r,t Co rrk, s l-k.nEd Llw roupr.i 9. ColIwEi.B *in Sdion 7(rx) .I Divirbn :r .r rhc aurinc$ d
<br />Pn,fcr.n.. C&Ll or rhd h. n rlE k.r.mrr rh.E(hn ml rlr lrii3,{r rtE rlkS.n.rci9rirn Any vbLrirnrsdn. T(,ll5by r.y
<br />.mlican! lnr r Fmil {bFll rh. lprlic.n' l. a civ il p.Exy or n mr. rh.n fiv. hundEald.lld! ($J{xJ)
<br />-l-
<br />a osE ol
<br />'lE ,mtEny. or my c,ribF.. wnh *{s 8 rrEt sh enp.nsrhtr :l do rlE edl 8l rlE rrlE r rn
<br />ad(*rl r of.Ert ltr rl (56 7lx,l- B.riEn.rd Ptrfdrirm (in : T,E Contdm r I-Enc ljs &B ml .oply lo x o*8. of
<br />rh. FFny rtb txikri d. iqx,B rh.6n. dd *lb dn tuh krl hirr.ltor h.rktf or rhmulh hn or thr o9.cqrkrdt,
<br />fovid.n rhrr 3kh irymffir t mr inrcn& ( otu for {L It hftE. rlE tuitlhs or irqn Erd t sld wiilin {E )&ofcrpLlin llE O*Br Auitl, willhE rlE n!nc..fFrviE r h.trnEdil d hil, iqFEll. Fr6, rn dE FrFEor
<br />I. r1 owEr of
<br />'h. Fnp.ny, u crcln{irly conrrrrinr *irh lnrncd cnnrr&1otr to $nnNcl rtl 'r'jd
<br />(s6 7(!.r. Bu.m$
<br />r.n hrt<ir Cod. TIE C.ntr&ror'r Lk..< L* d(* mr rptlt k' o*E drl'niFnr rt$ tuildr 6r mtha !h.ra ..nd sho otualr rm sh ror.d! *nh. Codmnnr) larncn pursd kr rlx (hntrd.ls l.Ens Lr*)
<br />I m.!.mDr unl$ sdi'n
<br />!)et. t)rn.r
<br />tvQ.Bf,[&r:(aurltts ltotl,u;rr$/utgr
<br />I lf,r.b\ rrlnnrufJ., |i rlr\ url{r,u^ rn LIih. i)lri\tr,! dNLrrrr\
<br />-l
<br />hlt ud * ill minrrin a Ccnilic!1. ol Crn€nl 1,, S.lr.lnsuE r,tr worl6. omp.nrllhn. &! Dn'vacd for nyScrir l7tx) ofrh.
<br />ljlnr (-.n..lm rtr Frf(ll1inr .l rhc uo fitr *hth rtF Frnir i\ krr.d
<br />lhrvcn lsillax'nr in sorkcri co'ryin\rli,,n i',wrtrcc. !\ r(ttrncnhyluc(ion:l7lr) lrh.li,h.r Ort. ntrt t^-rrortuf.orrl* $n'k n, *hich ihn p( nnir i\ n\md Nly $orkcA .otrtEnur ir)n rnsurlu ( !tricr rl n'liy nun,l\ I u.
<br />I c.niryrh,r i.rlt FfolmN.oritE *.rt for shah lhh F,mn n irx{.1rhall dtr crpb, ant Fr.n in.nymn'rr
<br />s' !s to lBrrnE sunFr lo th. work.s conaEnerio.Irwr ofCalinrnis, dnd dgEc rh, ill sk,uld ltcoe subjdr rorlE
<br />so.t6 ormpcnqr ir pmvni('nt of Sdlrr ]?m ot rlk bn, On . I rtDll (dhqnh.nmrly wnh rh,. pn,rranr.
<br />IIARNtrlC Frihr. ro <c wtc6 drqENrirn d,rm8 F unnrful. . snrll luhFl u drllhls t' qi,iul Flrnii rd
<br />.nil 6mt up ro ot horlEd rh,lsand dnler (Sllx).(xro), in r dilarn r{, ln ca{ orcorrEnqr$n. daNE r as ro! .n tur rlf
<br />s.crkrn 1076 of rh. ulnr cqle . intcrcd md ! orrcr'r lcc(
<br />lht.: Applol:
<br />r rcENsin ('0NTnaL-I(|R
<br />DICIAIAIA!
<br />I h.Eh, rinmud.r FMlryof IE lrry rhd I .n lian<d u.ns Fr thn.f (lEprd 9k\rmamrnt [irh SR1r,.7Ux]) ol l)irti'n:l
<br />I rhcautircs!. l}.fc.riinr ( o&. ml my lacn{ n n tullnni Mi.frd
<br />ro!$tlrcl1l8.lJlDllc-aalNll
<br />I hccby !flnm undn ltn{ltynl FrJury ihd rh.. h a.on{tudbn lcndin! l8rtuy for rlt Frfolfui.. olrh. sork ftr whrh rhk Fni n
<br />i(ud(s(.:tog?.civ c)
<br />I dily rh, rh. f.rLrrl R8{hrl,n< EaIdin! dr{or rcm,vll uc mi.0nlta},L k, rhn pmFl
<br />I ccdiltrhdt lhrvc rrdrl rhn iIflrdx.tr rl{ rcrhd rh. fi,vc ' lnsr€n,.onlllly * h rllCirrandtoonrt
<br />onlimft-c\ lnd Srsrc lr$ rclatltrt k' hrildi[.nn ri(r nl h(rhyrurhy'rc rrlrE{flrdnc\ ol rhn ( irya'rJ(i,oir!rn.nr.r qr rlf
<br />,(*lir nr !tr \xonl sisr rtrrr
<br />/I.{Fi +rQztL\C=X"4r4 ro
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />En ine er Final Report
<br />Flood Zone Certif .
<br />/^
<br />FINAL l -2-)-2o _FWI
<br />Certif icate ot Occupancy
<br />Notes Remarks , EtC.
<br />'lL H U1 ^/ o,4/rLv(V
<br />LI 7T
<br />7
<br />BUILDING. INSPECTOR RECORD
<br />SITE-WORK
<br />T-Bar
<br />AIIIIIANI.IIEOJAAI]Uj
<br />I hcrcty ulljnn undd Fndlly ottl.lJury otr. of rhc folk,winA dchrorion!
<br />l)..nlnrnr Pdnir$Arhnor Norfr.tb.ItLrrlRcsuhi)ns ll nk l()- P!n6)
<br />R.qutrcd Lcid ol Niriruri'fl
<br />I
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