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SITE-WOHK DATE ID/SIG.COMMENTS OWNER AUILOER DELCARAT'ION
<br />I hcrchy rfinnr u.d$ !.nrlly of rrjury lh.l I amcxcmnl lmn rhc Conr.!.ros l-i.cnsc tlw ror rh. rdlbwin8 rcr\otr lse-.r01r.5
<br />Dusincs aM Proicssiotr Codc): An, Cily o! Counly which rcquircs ! pcmril h ..nslru.r, ah.!. inui'vc. dcmliah or rcprtr otry
<br />rrru.xrc. prior lo ns nsuane. aho requncs rhc applicul tusuch pcrnrir k, fikn siln.d {.kmnr thtt hcor she n liccn\ed puru,nl
<br />ro rh. ,rovisnr\ .r rh. conra.tols Licc.*d t q tc-haprcr L Conmrcncins uirh Scdion ?0(x) ot Divisi,n ll olrhc ausincsr{nd
<br />Prc,tssionsCodc)orthrl lrorshc is cxcmpl lhcrefrornmd lhchrsn ior rhc lllcgcd cxcDpri.i AnyviohiionofScdhn?03l.5hyrny
<br />,prlicrnrrnapcrntsul,jcchrhcappliconrbscililpcmlrynf.or'nmrhanfivchutrdNddollais1$500).
<br />l.!sowncrofrheIroIEnr.ormtcmtloyccswirh*rges rhcn vnc co'nPtNd nnr. will do lhr B r* and lhc srulurc i\ ior
<br />inr.ndLn or oflar.d for srl. (Sr ?(x4. Bu.iRs rtrd Prolis\id$ Cdc: r'hc Conrrrlr s l,i.cn\c lr( doc\ R, atPly h atr.wtr$ of
<br />rhcnml.n! wh huiis or nq,ror.\ rh.dr. aM wh) dds \och q & hi'n{lf or hcGcll or rhmuAh hn o! hcr own cmpki!d.\.
<br />[ovnlcd rh such imnmrcrmnF arc nol inlc .d orolitrcd thr srlc lt hoN.tr. rhc bnildin8 or i'nFnno.nr is sold wil[ir onc tcnr
<br />ofcomthrnrn. rhc Owocr Buikld *ill h!!c ih. burd.i ofpftrvii8 rhd h. or shc dil nor tiuill or irprovc lhc pmpcny f{n rlt purli){ol
<br />I. nr own$ .r rlr l](,l{nr. am cr.lusivcly conlncr irs wirI liansn cotrrracxn ro con{ru rhr ,6j.cr (s.c ?&4. Busnc$
<br />nnd,h,risinOrdc:ltcConrracr.iil-i..nrl-,w krnorrprlyu owncr or pro|xny who builds or nnpmrc\ rhcr.on.
<br />and who .oikn.Grur such t&Jc.h qirh rContra.ro(r ltu.rd purua rorhcConrdois l,tcnr tra)
<br />I rmcx.nDr und.r Sccr
<br />Iro.8f,E8s:lj()MtliN,SA1lll!
<br />DTCI.AAAIION
<br />I hcrcbrrnnnutrdcr pci{llyol lclJrtryoDcoillElollosirB Lrhn'lnnr\
<br />I hrvc rdwillmarnruinaGnificrrcofConscnrroSclilnsurcf.rwor*.6.o'nocnsdin.a\ tDlidM fttr by5(ri.n lT0Oolrhe
<br />tnbo! codc. hrrhct'.rrorermc orrhcwort for whichrhc!cnn[ n n cd
<br />rh. \ork larsh(h rhis Firnn is i*ncd Niys.*cri.. rtctrsrrof trNuntr.c ciri.r rndJxnirynun,hcr rc:
<br />Iccn,ryrhrr i.rheprrro trn&orrhc*.rkr(trnhkhrhl\Nrnrirni$ucd.Ishlllnorcnrdorrnyp.ro i,'a.yn'Mmr
<br />b ns k) hconrc subjd k,lhc workcG comncDralior h*s olChliromir rnd lgft. rhar irl $ould t[.o,E suh]cd lo rhc
<br />*oltcN coflrpctrsiionpnvnionsoiSrclt,n:lT0Ootrh.lrt rO ..l\h,ll,tunhanh.onrllywirhrhoslrorhions
<br />WARNING: Ftrihft b sur solkcr' comp.nsrion .ovcrn8c i( urhwn'|. otrd shall uh]ccr arr rmploy.r k, dlnin.l lictr.llir ind
<br />.ivil litr.s up h oi. nrndrcd rhousaM dolldn ($l(X)(x)O). in ndd iotr lolhccosl olcon]t.n\rrion. damrlcs rs truvidcd li)r rhe
<br />S.crnr.l(176olrhc litxr (.d., ificrcs.trd onry'( fcc(
<br />*-,tlrtqrg
<br />*f"
<br />u"" -7 Irtlr6 a.rr.""r".\
<br />C0NEISUCII!] .![BDlNCnGlrlI
<br />I hcrcny rrfinnridcr pc rlry orl.rjury rhnr rh.rc s..on{fl.r()n lcndir! r8ctrcy ir rhc pcrfonnarcc.rrh. work tur qhi'ih lhh Pclrnil is
<br />irslcd (Ss. 309?, Civ. C )t nd.is Namc
<br />-
<br />d.ETLICANLPECIASAIIA!
<br />IhcNhy!,limudspcnalryortcrjrryon.of rhc(,ll.wirgdc.har ns:
<br />DcmlirionPemirr AstrnosNoiificarion Fcdcral Rcs!larion\(Tirlc40. Pd6)
<br />-Rcqutcd
<br />trrrc! ot Norirraik'n
<br />l.dtililh rhc Lrlc' rcg di,,nrrgrnln! r\h.no\r.NtrrlUr mr lPtlic hlcr. rhf tot..l
<br />Icrdiltrharlhnr.r.rdrhi\lntli.r!.irelnnr.rhxrrhcrhr(iln ndi(r isco,rccl Irg'droconDlJ"wirhrl!CiryrmlCounry
<br />rk,vc nEnlion.d pn,pcny ll
<br />eC
<br />,^,il616
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation t
<br />Roof Sheathing 1 tu\tg ),u"t1fi\)
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/lason ry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />I
<br />FINAL 7 | \11 /U4Kfr
<br />Certil icate of Occupancy
<br />Noles, Remarks, Etc.
<br />)
<br />I z Vo
<br />lr"<.
<br />BUILDING. INSPECTOR RECORD
<br />Erection Pads
<br />'. f-,..tt fa*kt tz-<*t
<br />I hcrchy Jifirm utucr lr.nohr.rrcrjlrr rhd I rn li(n{d undcr 8)vnn,n orCh,Drcr'r (m,nntncirr! 'iih sccli.n 7m0).roivisid l
<br />ol ihc Busincssnd Pmlc$ionsCodc. lnd n,) liccn\c is in tullforcc ud cffftr
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