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SITE-WORK DATE ID/SIG COMMENTS OWNER BIITI-DB DELCARATDN
<br />I lEi.l,y tiItrm uid.r Fnlhr of Fhry rh't I d ci.mfl rhh rlr Cod,d.u Lirnr U* for lh nnh*ina Eisn (sd ,1}1 Lt
<br />Burinc$ !d Pofcr\ion Cdc): Aiy Cty or Counry *hih rcquift\ d Firnil ro onnrud- alrcr- impotc, d.m'lrh or EPut lny
<br />{ocru.- ptr k, ih isue., ah. rquiE. rh. +pla.n! rn ruch Fmit l{, fiL . li3fti (d.fthr rh{ lr ot nE ir lim{d puNrnr
<br />ro rlE ImuhioB of rlE C.nrrror'r t,arned t e ( ctrfld 9. ConErin8 r nh S<ri'n r(tn or Diliion I 6I ilE Burimr .,n
<br />PNr.r.bnr Cort, ( rh.r lr drlE n cr.nli rhddmn r,i rlthd. r ilr dtS.d.rcqihi Ary vioLrionofsdbn 70ll thy.ny
<br />lllnlicllll for r Fmr {hj.{h rlE ipda.n o r ciril lErlr, or mr mJrc rhin fir. tundr.n d{nb3 ( ltmr
<br />-1.
<br />$ o*mr ol lh. In,Ftly, or m! .iPloy.c! eith *rs.t r! rh.t slc co6lE srion. *ill do rh. so* rd ll! iliElE G fr,|
<br />inrol(l.d oroficEn r( rE (S< 7044. BuriEr. ud P,Da6rhs C.d. TtE (li dol. Lt.nE ll* &E. fti {4ly ro owffi ol
<br />rlt FFny *tb trildr ( ilmB iIEFE .ri *tn &F uh kl hirelr or t.relt or rlmu3h hir d lEr o$r.ntllrr6,
<br />Frvil.n rhd *h ift+.rtrd! c fl, ir.i'r.d r olEGl tu ot.. lt lI,{lc. rlr tniBhg i, ir{mwftd ir r d *irih (r Ft
<br />of$qnanc rlt olF altb "ill i.E r,E hlrlor o, Fo\in* lhi rF d {E dn Nl hild n intFE dE fhFry ft, 'lr FrF*.i
<br />l. .r o*r. .r rlE F{rny. m .rctutiwly .onlrd in! wnh [Nnql conrrLlou ro .onnn&r rh pmj.{ (Sc 7l}l4. Bu$rcs
<br />.,n h.6si. C.d. Th. C. rrloi3 Lic.nE L.* &rr mr lll'ly ro rn f,skr .r ImFl, wtn blildr or itrpbv.r rtEmn.
<br />rnd \ts o Brr ro. trh FoF. wirh. CrdE d(,1i.$<d pur.un lorlE Codrd{r\ LitB tiw)
<br />I rn.rc'ntr trnd.r S.rrtrii
<br />lr{l( (hn.r
<br />\ltrl{t(t lL\' ((l\IPF \s,t1 lo\
<br />u.rllr&u,llJt
<br />I h.'.h\ r,ln urk, ti lr) of fx'J0!r,(k !,r rlI r,)ll!tr tllerl.nJrirN
<br />lh.rcandwillnuiniuinrCcdir-rrr(nfCof,{nrk)S.lllnrurfttrtrorkd!.unr.n\rt(trr.!\IrovidcitorhysdlionlT(x,olrhc
<br />ljhtr C,xi.. rorrh. F,l'nnuk ofihr Mn( n,$hthrlErsnri n n!u.d
<br />I h.E rid will mintlin *ork6 .oqrndbn in{r!r.. ( Eirnrl lty Sarhn l'r{L or rlE l,h, C.d., rd itE tE.flmNc.l
<br />i,:!#twy ..ihn,NnN tril ',n F
<br />a.
<br />@ lq )c:/ /1
<br />l..nrfyrhlr i. rh( Fiformm. orrh. trort for *i.i rhr IErm[ i\ r\u.{,Ithalln dl,lk,y!.yFsr h!n} tunffi
<br />q! Nn)hrnn. u$Fd n'lhc *orld cnnIFnrdion hs\ol Ctlrr.rnia. rftl rSNrhd ill rhlold tt omruhFr ('rlr
<br />trort.( comf.nsri,,n pmvhn,n\ ol SNr{ r l?U) of r h. ljh, C,'dc. l \hrll. hnh$iri omd, *irh rho$ F,vrio.\
<br />WARNINC F,srlxr. r' ccur. xtrkcB cnmpcnerhn u.\rrr8c i\ unfuslul, md rhall ruhjdr atr cmploF n, dmnd txturlri.\ rnd
<br />.'rir nn.( up kr o* hudrcd rhuqnd H [rD. h .JJiri(n, n) rhr..q (trrn(Enslion. domtcr $ pmviLtl iir rlr
<br />Seri'n :1076 of rlr Irntr (',xl.- inrdcn
<br />-*,4R{t4
<br />DISAMII!]N
<br />I trBhy.fE m !nj.r FMlryorFrrtrry rhd I m lirnel u"!.r Forkhn ol(luprcr I (onmmin8 wnh Sdnn ?O0O) of Dtnhn.l
<br />.r rh BuriE({n Pr'f6i6 Coik, rn ny ltc.s n in tull ro'ft rd.r[(r
<br />,,,,,,.,,,,-Tt{ LO.(4-6J,'.,.
<br />-,, $y{?/ t4 ..*f,.,N
<br />q 9z
<br />g)lslauclxt!..LrlDllc-acEN(I
<br />I hcriy .ilm ud.r Fndlry of Frruy lh{l rh<ft ir ! $nntu1nn t,dins .ssmy ror llt Frr,*mN of
<br />'lE
<br />wl tu whih rhi. Fmit k
<br />n$cd (Scc. l{)9'7. Civ C )l.Bkrr Nam'-
<br />APPI ICAN DECI AlrATI{'N
<br />llrnty r,limund.r fnfulry ot oorul) nk ol rhc li,ll('s nE ,lNllrl|i,tr,\
<br />Ixnllirln Pcrmir\ A\h.(os Noofi.dtrln trd.nl Rtruhrr{r r [irl..r). I'rn6,
<br />R.qunrd liir ol N{i 'fkrrxD
<br />lt:::,
<br />rly rhr! rlr t.(lr'rlrc3trlxrtrn\ kNx'Jtr,9 r.t\\n^,rnn^r r. n,,rrft) '.rh['r, rhr\ t,tr4.r
<br />&rt'ly u h.U Ciit lnd Co0nry
<br />.'hr. nrdk)md pn,F r ntr
<br />'\|)|llnr orA[or sixnnlu
<br />nlrev'C
<br />hr Cirylnl (irunrt h.nrd uF,n rrr
<br />, "AlL,/ n
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Subf loor/VenUl nsulation
<br />Roof Sheathinq
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lrilason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />Certifica ol u n
<br />Notes Re Etc
<br />.fkl<t/) /^r(
<br />BUILDING. INSPECTOR RECORD
<br />.ll &l)( n rh\r(i\rl
<br />SLAB Floor
<br />Shear Wall
<br />F|NAL llA / )^t-., 12 Llfi,t,t Lf
<br />./lzlro /t,(, I
<br />/12
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