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SITE.WORK DATE tD/stG.COMMENTS OWNEN BUIDER DELCARATION
<br />I h.rch, aflinr urd( FMhy .'f p.rjury thll I m .r.npr fmm lh. Conln(x,F Licnq Uw fo. tlE lnltrshs rclv,n (S..70.11 J
<br />Ilu!i(\\ aln ProfBrb. (irL) Any Cny or Cou.iy *hth Erluin< . Fm- ro onlur. .ls- nqr.E, &mntrh or EFt in,
<br />{ru.1u.. pritr h it irlurL: !k r.rl!i6 ih. rml.mr for.khFmr nr 6kr nrFd (lr.trd rhtl ,E or {E it liten Frud
<br />h th. nmvnn,n. or tlE Anrlftclori l,a.cnsd L,e ((hfl.r 9. C mmmin3 wirh sdli'ri 7(m or Divnion I ofrh. Burift( lnd
<br />PDfcsionr CuL, or rhar rE or rh. n.x.mpl ltF.fm'n !d rhc tE\n tu !h. llLg.d.r.nPrir" Anyriohri,nolsdrirn ?0115 hlt.,
<br />rmlk.nr ror . Fmn suhFlr rh. aflrli,nr t. r .i!il p.Eh! or n, 'mE lh!. fir. tu.&.n &,lLrs ( !nxl)
<br />-1,
<br />!\ owrr ol rlE IiDFny, or my .nrl,yes rilh *!s.s is llEtr a,lc drn{x.qrx'n, BiI & tlE *r,I dd rtE ndm il ml
<br />inrcnLi or oiLkd fo. sL (Sa.7O44. Boridss .nd t\ofirrion! Cd.: Tlk Ct,nrodn\ l-iccn€ ti* dixr n.. TI,ly k) .. owmr ot
<br />rh. FtFry *h' hrild! M iriF,r6 rh.ch. .rn wh dE uh *,I hiltMll or h.elf or rhn,ulh ht or hr om.il' hv..i.
<br />rrour&d rh.r qh irqFEdt m d id.ndcd., nlldld ft, rL ll ,*6q, rh. hillinS d irttN,rE i n $B *ih!. om Ff.
<br />or.oipLri,rh.owErBuilttrillhrr!h.h!dc.olF.vinsftnrrortEdndbildulrFstrhlnrlElyftrrLIIrFtnl
<br />l. !. osmr ol rlE FoFny. rnrkltriftlr ohrrrinB r nh lKnd cot rsxr b 6.<tur rlr Fiit rse.' 7{X'1. 368<
<br />uj h{:si, (ird.: Tn. Contalor r t-i..nic trw tnrr ml rnrly 11, !n o}m tf nrolEn y *h. huildl d ii'0D(r rlErsn.
<br />dnd wh..unr6cl<forruchPn,j.rrr*iihsG)nrr.ionnliin*dPrru.irorhcc.nldoi.Ltcncl,*r
<br />l nclrnnr und.r .rqLtnn-
<br />lrxk (rNn..
<br />]}ABKIiI.I]IAUIINIAIAN
<br />u[g.A.Br.rll)!
<br />I rr'.1,\ rllnn utrJ.r FrBl$ ol tE,ur\ otu olrh.loll(itrr'S (lnlrritrtr
<br />-lhovc0
<br />s ill roinrin ! c.nifEalr or consnr x' Sclt lnruE itr $o.k* d,i{r.eri)n,.{ F.liLd l.r by S..rir .17fi) ol rlE
<br />lihtr Codc, for rlE Frfortuft. or rr* eoA ror rhi.h th. Frnrir i i\rlcd
<br />Xh,r. rnd lill tuiihai rnrt6- ..irl'.Ntir rnrurtN. !( rcluird h, sftri'. r7(n.r rlE tjtn (-.d.. lor rrE Ffmre ol
<br />:;i\*.\fl.:t'l
<br />a,,,,., nr,r*, SJ-\rNMlf
<br />,iy tr ork.n' $firn{li,n in\ akc.Mtr dBnryNmt'q E
<br />c'rtS \\.L-!q
<br />-l
<br />c.nifyrh'r in rh. IxrlormE.of rh. s.rt lor *hi.hlnn p.nnn k irrud.l rhall.ol (nlt'l'yanyIr dnin.nyrunmr
<br />rr .1 i. trdift ruhF.l t, rhc $qtB drlrndi,n i,r 1 .f Cnlif.mi!. ..d rtR ihd ir I rh'uld h.(..r ruhFr lo rlr
<br />*1 si mnF.qrion Imlirirhr., Sdl rr ]7m of th. l rhr (iik. I \h!ll. fdhs nh n,r?ly r irh llrn- F(,virnB
<br />WARNINC rlilum ro s-'.ur. soikc annpenqriDn cottBrc is trihrrul, lnd slEll unFr 'n unt)n,Fr ro rimir.l FDrtr d
<br />civil linc\ ut ro om hurrthd lhousMd dollan (tllr).dr)). i. lddirion t, th( .o( oI con{Ensrnrn d!m8.s $ Pmridcd Lr lhc
<br />S(ri'n .1076 ol rrx lid Cdr.. i.r.r3r ad.rrirmr'! litr,"*9-rl-11 ^o,u-",. S,-2fu' x(I:NS[UroNrXrgQa
<br />ITECIAEAITON
<br />I lrEht rmrm uds p.NhrorFrirry rhd I rm liN.<n u.dci F( irim or CrriPrd s lo'nrmrin3 tirh Sdlb. nur r ol llivi\irn l
<br />of lhc Bu\iEsr lnd Pnr.i*,n. Codc. an nly li.n{ r in ltull lntr uri cfis.'l
<br />,,.,,,*.,,.. A*6*c!9r e{-6 ,tr.trr lLn,hl &oa7S
<br />,"," n-Ll-t1 ,-,*"* Sun Qoc^t=r
<br />C(NSINUC'TIO I T\DINI| GENCY
<br />LrcEl'y.lrrn !nd., FnrxyorFrur) th.r EEir. r{ru<lir HinC rBd y lor rlE Frirlrffi oarh.ffir ror shEhlhn Fn, ii
<br />n.ucd (s(.ln7. civ c )Ir lcis Nrft
<br />-
<br />/1PPl lcaN.r Dr(:l ln^r(lN
<br />I hftr'y.trmu l:r rEnrx, or Fru, or.l rlE fnlhrin8 !..|t,trii'nr
<br />l).mn irtr lt,m i AstEdor Ndifi.rrl,n lrtcnl R.fuLrirns lT l. {}. P!d6)
<br />-Rcqut.rj
<br />Irlr.r ol Mnilirriri
<br />-l.diry
<br />rh, rrE r.d.ml EguLli'nt Elrdins r{sb\ rcmrrl m d .fPlt.hl rn lhi I,DFr
<br />2(rniry rmr t uw rcra rti q,plt.ri{rn drl {,r. rh,r th. ah,r. innnmri'n n corccr I sFc ro sq,ly wirh all ( ir, rnd counry
<br />o,niMffi .td Sr.r. L.qr Elrins ro hrildint .on{o.ri,tr ad rEEby Nltnt. rcrddnn$ of rhir Ciry rd Counry ro ..rd
<br />'{r,tr
<br />rlE
<br />rtr EnrioEn I'n'Fdt L, i.<F
<br />Appll(sn! nr {!rnr SirnuluIJ
<br />n.-U--*,rnr,, f5 rao t-.q- \f,
<br />e/_t /_/?
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Ereclion Pads
<br />[JFER Ground
<br />SLAB Floor
<br />Roof Sheathino
<br />Shear Wall
<br />Framino
<br />lnsu lation/Energy
<br />Drywall
<br />Ext.i lnl. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone-Ce1if .17 <^/-.-- ;fu7^-4,-f /o ar-/1 /LC 2,?
<br />FINAL E/./-/,E 0,*'€rlos 4n
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />.BUILDING. INSPECTOR BECORD
<br />16&. r Ad&.$
<br />-
<br />Subf loor/VenVlnsulation
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