|
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/VenUl nsulation lf,
<br />Roof Sheathing q-7-zl y,tuf tun fiF'f
<br />Shear Wall u \,-,,t
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />-l t
<br />FINAL I t1 1,1 Dtqv'
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />J I Uv cot NI
<br />I
<br />OWNER BUILDER Df 1'ANAT()N
<br />unda p6!hy of pq!ry lhd I o dmF 6om rlE CoddoR Lt* L.w for llE followll3 lBn (Sa 70! I 5
<br />Cod.) A,y Cnt o. Coudy whth rcqun. . pdd ro odtu( .hq. inprove &elLh or Eflt sy
<br />r isuM.. .lo rc+t6 rhc +plicul for ruch Fnn to 6L. r{rEd niffil lhr lior it ir lko!.d F $er
<br />oa tlE Conlr*lori Lt..!.d bw (ChtF6 9, ComcNinS wiln Sdlion ?000 of Diriliof, 3 of th. BciIK ad
<br />or rh6r lE q rh. u .rdo rhc.6om ard llt tGn tor $. rlks.d d@f,En Any vFhrion ofs<rnn 701 I 5 by &y
<br />$6jr(]rrh. .p?li(m or.irilFElryof.olnDr.lhufi!.hundrddolld(1500)
<br />f th. protErr, or m, @plor6 sirh w+6 a lhcr $1. @mpdM(J[ will do $. trrt dd rh. snd@ b mr
<br />tor sL (Sa 7Or4, ABitB ed PDldioB Cod.: Tt Co"ldo t tx@ L.w &6 rcl Tpb lo e osE ol
<br />l! & or iiCrov6 l]1d@tr ed vho d.d $ch FrI h'ns.lf or hrelaor rhouah hr or ho oM oplorrd.
<br />oFo\ffi e mr idcrLd d ofrad tu d. l( ,r$-s. rlE tlildlB or lrsuffi u $ld rihin om !a
<br />otrnd llrndd wil Mv. $. htrd6 of F.vin{ lhd tE or sh. dd d bir.l or nqpo* iht popct, tu tlE 64e oa
<br />a'h. FFry, e d(lEi!.ly ..d.dDg *iih li.d!.d .otudou ro oBruci rlE Fsjdt (Se ?044, Bain6
<br />od.: Th. Co.relof3 Licos. L!* do6 nor.pply ro d 6w.d olFoFry *ho brildt or mpo6 rh6o.,
<br />Et! for su.h FoF1. sith . Co'nrdo(s) ltsE d poBMl lo lh. Codtulor! Licru Liw).
<br />yaaf,[8g,coMtEdtallItt
<br />DECIA8AIIA!
<br />un& F llty oa psju.y oE oflh. fouo$Iu d.cls.tioN
<br />ill roirrin r (dilEdcoacoM' lo Sdf-lEW aor rorl6 comrqsrrioG a Eovilcd for by S€lion 3700 oflhc
<br />lh. pafolruc. ot'h. mrt for *ikh rh. Fnn i! i!u.d.
<br />ll nlinrlin work6 .omr.6dFn iEumq B r.qu&d by SdrEr 17(10 of rtE Lrsor Cq,.. fo, E Ffalrje. of
<br />h rhi! Frnr i! isudl My workd corpo&lion irouruc. cMi6 ed rolicy o@bd e:
<br />A TL fUND _/
<br />-E,o*,
<br />< / z-2-I qqlz-1)
<br />m lh. pdforhan . ot rhc * orl for whrh lhi! Fn( I isn.( | ,ull mt onploy o, F$. i. ot lME
<br />$qd to llE $rrld oflFBdiotr l$! of C.lifomL &d .3r lhn if I Jsuld bdoe tubjel lo llE
<br />ion FDrLrioN of Sdon 1700 ofth. Ldor Co<L, l sldl ronhwilh compu wnh rb* FDTiEB
<br />F.ihrc t. s@ rorh6 .onrpo!.lion cova.sc
<br />ro oc hun&.d rho@d dolldr (S100,000). in
<br />i! u.bwlul md 3h,ll 3objc' M mploF ro
<br />rddiio. ro tlE .on of cotrlFE lir(
<br />t& kb.r Coda i"rqd Md arof,rr'! L6
<br />rl )\r'!,,\Lk! Lok
<br />DECI.AEATq!
<br />u'r& Fdy orFjury tllr I & li.q!.d ur& Fo6io! otcl'.pr6 9 (onjlt4ile win serbi 7000) of Dirilbo 3
<br />md PhisoB codc, and my n.G. as in tul| forft dkl €flar
<br />1
<br />t_
<br />46
<br />z
<br />g,NirauclrotLE[Dllc-&{iEx(r
<br />undr !qr2!y o I pcrjury rhar rtEc B a consrud6n Ldo8 r*tuy ro, ih. Frolr1@c oarh. *..I ror rnrh th6 p6ni 6
<br />7.Ci! C)
<br />ATTUCAXLDI:CI.AAAIAX
<br />u!d.r Frhy ol Fjurl oE olllE lollori4 &clsrl hE:
<br />irlAsb6ror Nol rfi..rion l;.d6.1 R.grlarFns (Tnl. t0, Prn6)
<br />rhd th. f.dd.l r.srhtr6 rsrdma atEro3 r@t.lM. mi rp?lf,.bk ro thb F.j.{
<br />I hrt. @d rhir egliaiio. ai .rd. rhl t $ov. infotubn i .old I *E h onpl, wirh .ll Cil) rd Coury
<br />Srdc IrNsrchrin-!t) build,nt coNrucr(n,. a h!:rl,v oarhr Cn, md Counl, to drc upon fic
<br />prorqly t cD.drn lrlrpos
<br />^,-,a,r-.^ ,(fuL a PBs.r-
<br />-,,,46/21
<br />BUILDING- INSPECTOR RE ORD
<br />tilillnl
<br />a-tui
<br />l/c/z t
<br />-**- (
|