|
SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Rool Sheathinq 9 it\1{',/*/,1.". 1,r r"il&. -dl,l paq/4Aas)
<br />Shear Wall
<br />Framing
<br />ln s u lation/E nerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL ,/ 2-/Z-t b 342 4)
<br />Certif icate of Occupancy
<br />Notgs,,Remarks, Etc
<br />7)-ll
<br />OWNER BUILDAR DEI,CARATiON
<br />I hcrcby.ifiirn undcr ncnrlly of periury rh l aner.mnr fro rhc clJnh.nB Li.cnsc liw aor lhc followin8 ra\,nlsL{rt}:tl5
<br />Blsincs\ and Pn,fcsi,,n Cul.) Any C y or (bunry shi.h rcquncs a ttnnir ro .on(tucr, rlrs. inlprovc. dcniohh or rcPJi? any
<br />{ru.rurc. prior ro ns issuancc. oko rcqutcsrhc alDlicanr l'or luch pcflnir h IL r si8rcd slorcrmflt Ihot he or ihc i\ liccn\.d Pursuarli
<br />16 rhc fovhions .frlf, Conrnclois Liccnscd li{ (Cfi{'rcr 0. Co,nmcncln8 wirh Sccrion 7fiXl of Divnn,n 3 of rlt Bo\i',r\\,nd
<br />l,mfcssions Codc)o.rhlr lEorsh. i\ cxcmpr rhtrcfR,h md lh.l,aris lnr rhcllLScdcxcarprion Anrrn,htimofsc.ronT0Sl5hyotry
<br />aptlica nrtrp.nnn subjccNrhc 0pplicanr lo tr.ililpctrrkyot.ot nFrc rirtr filc hun r.d dolla( (S5(Xr.
<br />-1.
<br />as owrcr of lhc prorErly. (t nry cn1l)kr)$\ wnh w.8c( .s rhct slc .onFtrririon. will do rhc wdk dxi rhc srmrm is mt
<br />inrcnLrt or ollcr.d f{n strlc (Se 7(}.l-1. Businc$ and Prcfcsions Codc: Thc Coik croi\ Li.cn\c lj* do.s nor.pply ro !n oencrof
<br />rh. pFI.ny who builds or inlpnrs rllrcn. and whr dcs {ch srk hinNclf or hcrell nr r hr.ugh hn or hcr o*. t trloyccs.
<br />nhvidcdrh.r such impmrcnrntl uc trn i.rcndci or oficBl for qrl. ll in,w.rci tlL hildi',B or imrsvc'rm is \old *ithir onc tto
<br />9rsn Lr.n. ttF Owncr Bu,tls * rll hlE rhc hurdcn uf pnNn3 lh.l hc or shc dil nor l ild or imt v! lnc polxny lor rhc purF,r of
<br />"tg'
<br />I. N owNr of thc ,tuFcny. amexclusivelyco racrins wirh liccnyd conti.r.6 ro otrnfld ltE pmF-t I Scc 7044. ausR$
<br />lnd h.ic$in Codc ThcConrnckn s Liccnsc Luw do.s .r tplytu an owmr of [olcrly *ho hrilisor imffovcslhcrmn
<br />rtrd wha onfds r(tr su.h pmirts qirn ! Co mdo(9 li.cnscd Ilu6oanr h rh.Conlr&ror's Liccnsc tiu)
<br />I n .xcfrpr xNlcr Sccxu
<br />l]!-8lil:ntlg.lilflilsrl.lM.N
<br />1.2[cLAAAt!tD
<br />I hcrcby illirrr un,lcr pcmlryoi|r{rjrry on. ofrhc rolL)qin! dcchrrriinr\:
<br />-l
<br />havc xluillnuinloin!C.nificurc.f(:on\c b sell lnsurc tJr workdc .omp.trsol inn. as pn,viicdfitrbysccrionlTln.flhc
<br />L{lxtr C(ic, tr lhc pcrlormarcc of rtc *o!k nn which rhc ,cnDir i\ is\ucd
<br />_lnrEa will uinrli'r work.r{ .. nrrcner ion iNurlrf,c.,s rcquncd byScclion-rT0Oolrhc hh.rcodu.lorrhc p.rionnuncc nr
<br />rhc ,ork forshich rhklErnrir ir i\sucd. My worktrC..nlctrsalior irNunmc curicr andioli.ynunrh.r dc:
<br />l.cnily rh.r in thc I'crfoirurcc oarh. Nork for *hich rhn Frmir t i\sucd. I shrll nar cmploy any ptron nt a.y mrnncr
<br />so Nt,hccorc srhj.rr brhc w.rkcs .onf.nsariod lrws ofcllloarir.ond asrlrrhrr il I shJuld h..o'ft suhjccl torh.
<br />*orlcB co'nf,cnlrri.n pbv*ions ofScti.n 37(nofrh. Lltu cod..Ishxll. tunh*irI coidy wlh rho* [ovhionshr.r x, rfl)lolc' r, (ri'ni 'l ttr'lri.. arl
<br />t, oDc l,und'cd rlr,u\nnd J.ll rtti,r, ,i
<br />(:Sc.ri(n, 1076 ofrhc L rtrCodc.)\
<br />I hcrcty rritr undcr Nnrlry oi rcrju,y rhdr l o liccnql unrrcr pr.lisiotr ol Clutrs 9 (conrnrrcins wirh s..ri 7uD) ol Divhio 1
<br />.I rhc Busirc$.trd P(ntsi.ns (idc, lRl 'ny liccnsc is i', fullforcc rii.t cl.
<br />I hcrchy rfltn udd$ N dhyofNduryr rhcrc isrcon(nrrir ld in!rgcic,nrdr.DcrlnrnrNcollhcsorltlarwhthrhhnrnrir$
<br />hsu.n (SE. 109?. Cit. C.)
<br />Lxndcrr Nam:
<br />-
<br />AIILICANIDECI,ANAITA!
<br />I H'yfiim undcr pcnrhy or p..j!ry onc or rh. rollow'n8 d.cl,rarhtrs:
<br />Dcnrhio. Pcirnits.AslEsios Nolillcarn,n Fcdcrul Rctuhrions ('I'irb 'r0. Pdn6)
<br />Rcquircd trlrcr ol Noriltarinr
<br />furnntrrgrd[! rstr{.r rc n,vrlrrc tr.r inplicanh h
<br />I agre rocomnly{irh rll cny,nd aoun'y
<br />rivcs ol rhir Ciryrtrl Counr, k) cnrd ufotr ln!
<br />I'v Rcrl,PtvsLce
<br />z14@
<br />BUILDING. INSPECTOR RECORD
<br />T-Bar
<br />tf,nd.is AddEs:
<br />-
<br />t---+---
|