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SITE-WORK COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns t)al, l, rz ,///tZ
<br />Erection Pads T'"t' lt q /(_/,/
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />/^\
<br />FINAL 5-77-t1 k,\lll:rl
<br />Certificate ol Occu n
<br />Notes, Remarks, Etc
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<br />, txr:lr "llll,il::r r:'il; jtt il i rI li*rxilil:l' ::ll'i'jill*:: :: I lri,t:tll r:r:i tn'ncrtr,c ffo' k) 1\ \n'xr.. xl\o '.qLi,c\ rl'..'tlni.x nt{nI|{nnik,liL.i]lgkrl!rr. rnr rhrrl'crr\lr. { r
<br />rrrli.rnikrxNrn'irv,l|..r\rlr.xprlnrnrn,x.tr'runr1\o1 rn nfur.rlrxn rrrd hu&lr.rldfllr\l\5lr)r
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<br />r\ oN&r ol lhc F,pcn y. {r n,y cnv,l,,rc\ wir h $qcs s\ lhct {n. co pcDs.rn'o.*illnoihcwolku rh.ntutuci{nor
<br />i cndcd or oltamd Ior Ml. (Se.7O14. Ausiftss Md Pr'ofd$t,ns (-{dc 'I hc Contadols l-iccrsc I !w do$ nor apply ro ?n n*rcr ol
<br />rhc pmlrn, *h) buil.l(.r iq)roE( rhcann. anrl !tu de\ su.h kr* himsclr.r hcn.lfor rhmush his or hcr osn cnplorc.s.
<br />,(,vidcd thsr\kh impmlcnr (trt mr inrc Ld oroilcrcd tor sk ll h*cvd, rh. tuiline or inDmvcmnl i1sll rnhin,'nc )r.r
<br />oi corylclior. lhc ORrcr Buildcr will h.rc ihc burdcn ol p$vir! rh,l h or shc dil rct huiil or iqrcvc fic pmp.ny fo! lhc lut$r ol
<br />I. i\ owncr or rhc ptuFny. rcr.lu\ivcly.onta.rirls wirh lidnrcd cotrtr.roN ro .on(flcl rrr projccl (Scc.7og, Sunne$
<br />nnd t\DfsshnCodc:rheConrraclolsl-i.cn\eljwd.c\noluD!lykinnowncroip.opcrry*hobuild\orinpri,v.\rh.r.oi,
<br />nd who.o mcB fitr su.h prejcct wirhn Cbnrrr.ttr(o licc.(d pununnr b rh. Q,nta.ror's Li.cn{ tiw)
<br />l,mcx.nrfl u.dcr Sccri
<br />uQBtrE[eiQl4ffNsaru!
<br />DEgLABAIION
<br />I hcrchy linDUndcr pc,llly ol pcrjury onc oirhc hll.*i"B dech,ltiotrs
<br />-l
<br />har dwillmint0inoCcnificlrcofconscnrroSclllnsurcforsr cr'compcn\ ion.as prcvidcd lq hy sccrion ]7m or rhc
<br />Lrbn Oxlc. for (hc Frfonnncc oflh. rork f.r uhi.hrhd pci,nir s isncd
<br />_lhrv.lndwillmainrain*orkcn'comncnsrtioninsunNc.rs.cquncdhySccrion:17(lt).irhcLihorCodc,fo.rhcFrforrorccof
<br />lhc work ,or Nfiich
<br />'his
<br />Frnrir is tsucd My sorkcr' $nrpcns(ion insuronc.c! cr ud Erlicynun$cra.
<br />,6"'* J'(O R€ ?r GL-t <-
<br />,</z)4nL /lt 7 9.Le*pi,""o (l
<br />I c.nifyrhar in rhepcrf{trmrneofrhc wor* forwhichrhi\ pcrdii i\ hs!.d,I sh l n.r cmtlorrnrl).rsun in rtryntanmr
<br />sr s lo bdonr sblccl ro rhc sortsl ompcns ion l.ws or Califomi( rtrd r8rcc rhd ifI snould hccom subjd rolhc
<br />wo*cB conr.nsrlion prcvnioasoiSe.-'ion l?molihc hbor Cric,I sh.ll. hnhwirh <'mply *ilh rl,,s provi\ion\
<br />WARNING: Ftrilur. h kur. w.rk * ..mFnsdnnr covcagc i\ unlnsful. md shall suhic.r 0n cmtlottr ro cimiMl pcmlrics ond
<br />.ivil turcs ut r, oR hundrcd (housand dollris ($llD,{XX)). ir 0ddiriotr to rhc con oi compcnsation. dflml8cs 0s lrovidcd tu rhc
<br />SNtinn 1i)76 nlth.lltnr (nd. inrc.c{rnds nnf,v ( f..,-";,;1;J;'-^,-",'-' 4*\ I u!Ex!lJ-!!Nlxa(r!R
<br />I hcrchy arlirmundc, pcnarry ot pcr*, ,no ,". u.-"* i*-*r{ffichtrpr6 c(comnrncins sirh seri,n ?oot}) .r Division l
<br />ol rhc Busi,rc$ md Pmfc$ions Codc. and myli.ensc t in lull lnre fld cr'Gcr
<br />. t.t**ct *' fi ' 3 c7{ I
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<br />.. t N /"aar lzal l s+zo>f i-
<br />!I')N[IA!.(:I!ONIIiNDINC-&A!N!:I
<br />I hcrchy Jllt rundcr pcnalryolprrjrry rhrr rhc'c il a d,n{ru.rion hmling r8cncy for rhc Jr-rbhr$.c olthc woik ltr *hi.h ihi\ t'cnni n
<br />isucd (Scc .1097. Civ C ).
<br />6ftLlCilNLIlEg"$AIlo!
<br />I lfuyrltmrndcr ptnrlryof tujrry onc of rhc rolk,wnrg dcrlurnnB:
<br />Dcmoliln)! Pcnnils As6csIo\ Norilicarn,n Fedcral Reruhlion\ (l illc 40. Prna,
<br />-l.quncd
<br />Lxrrc' ol Nolifi .rri(n,
<br />I ccnitirhalthc fcdcml rc3ul0liotrs rcBordin8.rbcsros rcnnt,l0rc norlpplicable lo rhisrmj(l
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<br />ccrrilirhrr I hNc rc rhirlpplicatnnr$d srarc rhrt
<br />ndinamcs Md Strrc tiws ElarinS ro buildir8conrnElio
<br />inhnn i0 iscotrccr I asreroi,nrpltsirhrll Ciryand Cuuhry
<br />r.hyrtrrh.rnc ft.In.\.nrrri!r\ olrhi\ {'ir} xtrd C.unl! ki. rrr utxrrrltr
<br />)'(c nf,nri{,ncd !R,p.ny fttr i'rnc.rtrri purfx,\c\
<br />genrslsholure r- _
<br />to;"t, // t rl .rt , ra<^," <-/trlrg
<br />BUILDING- INSPECTOR RECORD
<br />Subf loor/VenVlnsulation
<br />knd.ls Ad.lrcss.
<br />-
<br />I oare I rorslc.
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