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SITE.WORK DATE COMMENTS OWNET iUILDER DELCATATTON
<br />I hcrchy.flirm uftl.r tEnrlly of pcrjury rhst I m cxcmnt fn,m lhc (i)nlncrr6 Ltrcns. trw fdr rnc tu&,w6! r.s. (Se701,5
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<br />tr rh. l,n)vr-n! ol rlr Cortk(* r l-r.id lrw rchrt)l.r 0. Comturn! qnh Scton 7m0 o! Divni,, I o! rlE Bu\Rs ud
<br />Pnni$irnr aqL) !* th.r rr n o. tr.r.r{,r lh.Eli$m.,n rh. h.$ Ltr rh. .lk!.d.rcrrrDn A!, vMrnnorStrt,,r0lI5 by.ny
<br />rppl'.rd ntr,p.m {l,j.c( rhc applEnr b rdvill}.uxyornor nft rhr nvc hunJrcddoll-s (!50o).
<br />l. r\ o*rcr dl th. F{rny. or my cmtl'}rcs w(h *.Fci 3\ rh.r q,L !$mpcnr on. s l &i rrr kat lil rlr <Brm s nn
<br />0 ll.rl ,r.n.rJ ld ak rss.-7(144. Bx\m!\rnJ Pn'r.sionr (irl.:'l h. G,it*kx'i L..nB t:rdrrnd.pply6!owrrol
<br />rh FrtEny *h, hodl( d ,qn,F thr*h, *nl *tn rls qh *'lt hmrcl! or h.( ll .r rlm'rlh ntr o. lt, o$n.r4*,y6,
<br />r,v'J.d r hd surh mrn)rdd\ m nn mrcnLd or ort.ml ti,r tlk ll. h)*cKi rhc hnun! or mf(,hnr fq,u wihson. re
<br />o,.{trpldnr rk ()vxr llu lc, wil h.h rlr hd.n ol Imu! rh! hc s rlE ,irl rn 1a'! r rtn,E rh( Faldy ror tlt FrF,. of
<br />1..s.*Erol rh. pnFnr, d.rclun(!, uodr&rn! !ih lr:neJ.odBro. b (lnrBr rlr F'j(l (Sa 70ll/l. Alrds
<br />!d hn su Cotlc: Th. C.n!rr.ir'r l-r.ns.l-.* drxt Bx.Irply t, uoe..r orl)r,tiny *li, burltlr or rmttovc! rh.r.on,
<br />.nd uh, $dfuls ntr tuh F'irB *nh. O'nrRtmo lrtnd nlrd tu rh. aill rrnr'r Lie.nE Lr*t
<br />I dmc\cmnl und.r S.rr(,n
<br />l!986EBS:rAUEllArlA
<br />DE(IJAAIIO!
<br />I hcrchy ulltrnr uklcr J'.Mlry ol t'ctury oft ol rh. i.llowo! d(lnrarh)n\
<br />I hry. !n prll mdrr . C.n rrsr. nr Conc.t k' S.lf-lnruE tur k'lt6 sD{Enr.lp...t I'.vd.ai fttr b, Srr&n.}7u) ordr
<br />trhrGrk, rt rhc r.rfom strh. vork tor whrh rh. fEm,t n sru.d
<br />-l hlr ,ft] *rll mirnrar work(^' .omF iraron rn\urtR.,.r EqumJ hySe..rIn Ir(x)ol rh.lrhtr Cdlc, i ilr BalornuNc I
<br />!h k l{ whrh rhi! Frm! !! nt'Er My wortcr!' (,n{f,nsrfn inurl^.-'. rrthn tbhy numh.t m:,. ALLS AW 6PE I casuar-r.{ cmrPUr./
<br />',,,,,r,,,., FA@losoL g-15-t9
<br />Ilrnrlyth.r rllEIE lorruB. of llE *o.k ntr$h.hrhnFrn r BrEn.I rhall dn.rq'hy:ny Ftu. r ylMEr
<br />*, r\ ro h.$m ohjct (' (h. krk 6'umtxn\.rkr hwi ofCalrfoma. r.d 18@ (hai dI.h)ull tE oB ruhF.i to rlE
<br />qrt.r $mFnqt 6n lhvrihn. of SRli)n llUO .t rlE l2hx C,rl.. l rndl r,'nh* rr .or{'ly vilh rh)e pn,vBnn\
<br />WARNINC: FlluE r. .c@ *,Et.F .uqEnsirr (EnE( 6 unustuL .rl slull !u6j.ar u oi?loF k, t,)lMl Fols.d
<br />.1vrl lin s up lo on. hunlrc'l rhrusdd dollei (SI(li),(xJo). h .Jdilon lo rh. cor ol co.{xn\rrn,n. datur.r ar J,ovelcd i.r rh.
<br />*Lr$n {176 ol rh.lr Cnr.
<br />!,""2-6 -1ffi
<br />DEqaaAII(r!
<br />I h.Rby.Ilim unLr FMIy ol Frrirtrh,I m lunkl und.r F,vn.n of Ch.Illo9( orBiry lrh Sirln 7(l$) of O trbn.!
<br />or rl* Burdlr .rl Pn,f.(oh\ GxL, {rl my lx.n* n n tull n'( lrl .fl4\t
<br />,r..*,"., c.41
<br />\,,,, tko z.-t\ - 9,.,",*,".
<br />4sti14
<br />JOf coN frnuc ) rah
<br />g8srEllIlarEdDllli.lcEffta
<br />t h.Ehy slltm und.r Fn.llrol pcrjury ihll rh.c it ! qm{odln lcolor rg.tu, r,{ rh.,Erinrn1rN orrh. rork t)r wh.h rht Fml n
<br />truJ (sr v]97. c,r. c )
<br />AI8I,II]AILDECIdEAI(A
<br />I tEEty dlim und.r JEn.ltt ot rErjury o* ofrh.l{Uourn3 d.(l.nril).r
<br />rtdnn)n Pdmde^rh.{d t{i{JE.|.. FaL..l R.Iuldbnr r1{,.,1O. P.n6t
<br />Rcqukn brl.rofMr -ki,n
<br />lrc'r'lrrhrrrh.l.,l(rxrt.ltr]rin,n\'.rr'1tr'!r\l{n!\'.n'!rlrr.NrJt'd(xhl!'r,rhrt!',f.(
<br />I (cnny rhrr I hIT r.il rh^)pll(rk,,n,n. rhr rrf,rh'a.'nnna'ikin,\ !!'mLr I rtnr t) conrdy wnh rll ( yifrl(in'nry
<br />.rJarm.\ r'rl Sri. lrs\ ruLiry n, ho kr.hyrLrhtrr.r.ftrrrrn\.t(n rhr( rlnJ(,,unryro.nrduB,nrtu
<br />.h'w mnri,Ed pn,|t(y fir usrE
<br />?-B-9tApplic.nl r AEenl sirMluF I
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<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 />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Cerlif .
<br />rl
<br />FINAL .t u \+\--{
<br />Certiticate ot Occu anc t I lr-/'
<br />Notes Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />ID/SIG.
<br />Pool Fence
<br />I
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