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SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />It/ason {y
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Ceftif .
<br />sruta1-zFINALqhlttt 1U >)
<br />Certilicate ol Occupancy t arI
<br />Notes, Remarks, Etc.
<br />OWNER BUILDEN DELCARATION
<br />I hcEhy imrnr undcr !.nahy oi |{ jry rhir I !m e\cnlllr tiom thc Ci,nrmcl{m t,icensc ljw lhr rhc lnll'wils ra$n (S.c,70.}l5
<br />Busin.s Md Polcsnrn c(dcl: Any C y o' Coonry wh(h rcqutcs r lxmir b co nd.r, drd. inllov., dcmlnh or rcrair.oy
<br />nrucrur.. ptur b \ nruancc. dlnr cqut.\ lh. arplicrnr fd nrch trmir rr lilc { siSmd st|tcmnt lhll hc or shc ir liccns,l I)UNanr
<br />ro lhc pnvtn rs ol rhc Conlr..ntr s LiccnscJ L.w (Cha/cr 9, Conmcnuins *irh S.crion r(x) or oivi$on I ot rhc Busincss Md
<br />Prncsn,nsG c)orrh.r he or\h. ist{cnur ihcrclrom and rhc hasis,,trrh. allcscd.rcnIxDn Anyvir.rionofScclbn70115hyany
<br />|tl'c,d t)ru p.mnr su hjeG rh. rrplic,nr b a crvrl rcnrlr y.l nor nr)rc (hM hvc hu ed dollrr (Ss(x,).
<br />_1. * own.r.f rhc IF,Irdy. ,, n, dntloyc.s *[h wrgcs ns rhcn w,h Lofrtttndon. w'I d) itr wo, k r] lhc nmr@ n ftn
<br />i crkJ or oflrr.J ldr srlc ( SN.10,14. Bus,us atui PbLsio.s codcr Thc Cin ra.r,tr s Lrcnsc trw does nor llplt b .n own r .t
<br />rhcl!,Fny {ln' huilds or impn,rcs rh.G,n, lrl *ho&Es\'(hu)* him\cll orh.Eclrorrhn,ush hG or h.r own cnl'tlo]ccs.
<br />I,rovd.'l rhar ruch monNrmft e mr hrc,r,cd .r ollarcd lir s.L ll. how.si rhc iuiLlire or m{'mrcnE.r is $l'l wirhin nnc }cr
<br />ol corphl Dn. tlr Owncr Auluci w l hrvc (h. burJcn ot rtuvin! rhd hc or rhc dil Dl hlill or hrl'mvc rh. poFny lor rlE ITTFJT ol
<br />l. N .wncr .l rhc pn)p.n y. iB c(lNiFly .onrrn nn8 w( h lL!trsc,l .on@.i)r n' .on(d.r rhc FoJ.cr (s.c ?u14, Burms
<br />.ul }\!L\M'hCoJ.r Tl[Cotrk.c(r-\ I-r.trr LaE d(r! tur nftlyl,, rtrrwncr.l tlr.nc y*h,, buills orimpovcs rh.rcon.
<br />rod *h. conlEuts li,r uch nroFrh wirh ! Coorricn)(,l!.ns.J plrur nr rhc Conkrk,'i Lrn* Ijw).
<br />I an cxcapr un,lcr Scrli,n & PC. ntrr[r r.rn]n
<br />!]llaxEBstloutlls InN!rE!!t3dM!
<br />I hcrhy rlltrnrundcryrnrlryol leiJurr_rn..l rlr tull,'*nr! n..Ln rk,n\
<br />_lhavcr will roinrain r Ccnilicdic .f con$nr r, S.ll ln\urc ktr w.rk.( onl0.nsr (D, rs $)vkicd {d hy Se..r on l7(x) ol rhc
<br />trhtr O'dc.li)!Ihc p. i)runcc of{hc w.rl l{truhf,hrhcFmn ( i\\u.J
<br />_l l,rv. in.l willh nra'n work.B'conDr sarnr nur.f.., A rcqutrcd h!S.{ron lr(X)olrhe l-atxtrCo c.larrhcpc.rnminicor
<br />(hr work tffwh(h rhi\Fmi i\ rsmd Myworkcra ohFnld,oi,n{trnn c .Mrcr ,nl }rry n!.nh.r rc:
<br />D{t.:_ Appll@
<br />LICENSED CONTRACTOR
<br />DECI.Af,AIlaT
<br />t hcEhyaiirmunncr pcnallyolpcrju,y rhir I am lnusd !tulcr prcvisn)n orCha/.r9 (.onmtuing wirh scdn'n ?llo) oiDivisnrn l
<br />ol thc Busincsr ed Pmf.sio,r Co'lc, antl my li.cnsc $ n tull r,tr ! {r.l cllccr.
<br />(-.ONSTRIICTION I,ENDIN(i AGENCY
<br />I hcrchy illtm unJcr lcnilty ol pcrjury rhat lhcrc n ! .on(rudion Endin3 a8cNy lor rhc pdrotrMc. or rhc work lor wnah thl\ Prnil is
<br />isrucd 1Sc.. 1097.C,v. C ).
<br />a.EPftgSNl.peclaaaMl!
<br />I LE-hy lnim u nd.r lcdllry ol tcrjury onc ot rlrc followi.E dc.L.at ions:
<br />Dctunin,n Pcrnirs-Arhc{o\ Nlrificrio. Fcd.rdl Rc8uhri('ns(T lc 40, Pd6l
<br />-Rcquncd
<br />Ix(crolMi icdirn
<br />I rnilyrhi rM lt'lcnlr.BuLronsr.-!rning rsh.no\ r.DovJlrrc mr xppli(rhk !, rh^ pn)jc.(
<br />onl rn..!rtrJ Sir.l-r*s\-L
<br />'ng
<br />(,rn'n. dr*l h.Nby rurhorrc rcprc*nlitircs ol ihn Cily and
<br />(rn,,**
<br />tnnrcl po!.ny tu in\lrcd
<br />0
<br />I
<br />BUILDING. INSPECTOR HECORD
<br />ID/SIG.
<br />Policy Nomhcr:-ExpiE*
<br />-
<br />_Ic.rlilyrhar inlh. p.ibrmrn..olrhc work turwhklr rhr pftmn r isucd.l shall nol cmtloyanyt'cl$n inanytuMncr
<br />$ $ r) ne'k- sut'Frr lo I)E w,,te^ d,mpctrrlnon ldws ol Crliltmi.. !ni 4E rhar rt! sh,rLt h..om \ub]i{' ro lhc
<br />*o*cr' conlpcnration povisins oi Sccrion lrl)0 ol rhc Lihr Ct Jc. I dull bnhwnh con,tl, w h th.$ ln,vnrns.
<br />WARNING: Fdhrc b sccuft wo cn comp.nrartr,n covcragc ,r rnhwtul, ,nd \hdl subicd an c.Ilbyc, ro (nmi,al pcnaLi.s rnd
<br />c,v'l lincs up b otu hrft]r.d rhouend dollar\ ($l{x).(lx]), i. rddnoi ro rhc co{ of.onllf,trsrlion. dama8es as pn,viJed j{tr thc
<br />Sc.ron.1(l?6ofrhc trhr Crod.. dcr.\t rnd.tromy s t ci
<br />kBlcai AJrlre$
<br />_I ccdrfy rhd I hrv. r.al rhis.ft'lilion arl {arc Ihd rhr.bv. rfornl1tx'n ir.otr6-.r.I a8re nr coryrly wnh aU Cirya lCornry
<br />Forms/Steel/Holdowns
<br />Ext./lnt. Lath
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