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SITE.WORK DATE rD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUlnsul.
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL A Wtn )
<br />GertiflcateofOccuPancy lll-l' -
<br />Notes, Remarks, Etc.
<br />Ow-Builds D.cLdi.n
<br />I hd.bydfm hda pcuLy ofpdju.y th l u dopt fom tlE CoiR.6.tr'L@NU llw lor 6. follovhS I!&r (te70l1.5 BEiu,
<br />&d Prcfsbi Co&) Ary C'ty or County Edich rlqutc r p.rmn lo coBtruc(.td. nnp.o€. d.mlirh or rcp.n ay tLuclu., Fid ro.ir,
<br />irtuie, rLo rcqutd 1n6 .plliqnt for tuch pdEn to fi|. r rigEd ,Ltdlt th.r ls or .h. i. licca.! purul ro $. provirior ol th.
<br />Co ncr6r'r Lied.d Lrw (Ch|ptcr 9. Comnl@i!! with Sldbn ?000 of Divirion t or $c Bui@. .nd Pmlsio6 Con.) or thrr h! or
<br />ih. b q@pl lha.toh rid th. b.!ir for dE .llcscd q.mprbn . Any vbLio, of Selion 703 I 5 by .iy rpplk ir for . p.mh !!bj.cl' &.
<br />trpli{nr .o r .ivil p. lty of nor mG rt n 6v. hu.dr.d dolLr (1500)
<br />_1, & owd of d,. p,or.ny, or oy chployq wirh $r8e ri ihct roh .omp.Nrio\ will do th. @rk .nd lle .mdu. ir not int..d.d
<br />oro66cd fo..l. ( Sc.70.{4, BuriEt.nd ProftNrion Cod. TIE Contr.croi! Li@dc L.w do6.ol +ply ro r ohs of tlE propaty
<br />who buil.l! or inprda rhs@,\ rnd who do- rEh @rl hinrclfo. hct.lfor rhrough lir o. hd oM.mploya!, provid.d thrt ru.l
<br />improEm!.,r. rrc mr i,End.d or ofis.d ror ,.1.. I(, hoEvo, lh. blildiiS or imp'ov.6ot L slil srhi! oe ,qr of oBpl.tiol\ th.
<br />O@-Build.r sill hE rh. burd.n of provins thl h. or .h. mr build or mpros for d:o purpoEoaak)
<br />_1. a oMd of ih. ,epaly, .m dcluriv.ly @nir.ei.g wnll lk r.rl @nlr.cbr ro d lt!6 tlE poi..r ( S.c ,,Oa,l, Buins. md
<br />PDfdion Cod.: Tto Conri..t r'r Li..M trw dq Dt rpply lo M ow of FoFr, who bo,ldt or ihP.o6 t[d6,. .nd vho
<br />@.r.6 for tld p.oj.ar sin . Conttulo(, lidrcd pquIl 1o lt co naor'r Li6 . L* )
<br />_l u d6Pl urds S.ctioi
<br />D|r.: OMq:
<br />WAB6EEISOUTEIIAIIQN!TC!4BJIION
<br />I h.rcby rfrun unda ,cully .fpsjury otu ofth6 folbvi.s deLdb :
<br />_l hrv. rrd wiu mri .itr . C.ltifid. of Co .ir ro S.lf-IruG for srldr' 6npcBtio4 r proviLd for by Sciion lr0o of $.
<br />trbor Codc, lor tlE prforrn@ oa l,E srt for vhid th. pd6n ii isucd.
<br />_l h.vc .nd eitl tuinuiD wol&a' @mp.Mrion idu6n ., r r.{uir.d by S.crion lr0o 01lll. t bo, Cod., lor $. p.rforo.@ of 6c
<br />mrl for whhh th! pmir n i$u.d My workd 6EFN.nor inimne tria.id policy iumbs .rc:
<br />(Thir @don o..d mt b. @hpld.d iltlE pomit ir for OE hundr.d dol[ lsloo) o,lL,
<br />_I .dtify th.t in d!. psforDn* of rh. *ort fo. Et'id tht p6mi! ir it.ed, I .l'.ll .oi .Dp!.y rny !.en in nny DUn.r ro u io
<br />b..tn 3u6lod ro 6. e,ka 6,rr.Brtion hw! of Cdifor.i., !d .gra rl[t ifl rbould h.6m rubjdl 6 .lE wo (a'
<br />6fS..rion r?00 ofthc trbor Cod., I fo.0'wi{t @mply wiih th6. Fovn'otu .
<br />/,b ,..
<br />wAI ING: f.i[r. ro t@r. w6rk6 @Dp.6Iio, @sl.c n unL,tul, ad 3h.llrubj..r rn omploy.r io qiDlollohiB rnd oivil
<br />6rc tp to oi6 he&.d rfour.rd dolL.. (tl00,000),in.ddiron ro1h. @ or6hp rio( d!tugd ! p,ovidcd forlh. s.crb,3076 of
<br />1t L.bo, Con., inldat .nd lnon y'r f€.
<br />!ICI!!ID-CqNBAGIAEID!!.Ii&|IIhs.by.ffihundqpolyofp*ruyth.rImlie.dliddproelbnofChrptd9(6in.ncingwirhserion7000)orDivi.ion]of
<br />lh. Buri@.nd Prof*io Codc, .rd hy licac i. in tull fore rnd.fr6r
<br />",,. [4- / 1. y,. z-i ]
<br />Ihg.tyrfhu qp. ltyof psjuryth.t6q! ir. @Elru.lio. l.ndil8 rg4y 60r th.psfol n@ oath. M.l fot which rtu tqmh i!
<br />isu.d (Se loe?, Ci{ c ).
<br />APPLICANI' S DECLAIAIION
<br />D.mlitbn Psditt-Athdor Notiliqtion r.d.d A4lLtiou Onb 40, ?fi 6)
<br />_ R.qun.d klrs ofNo.iiiotbn
<br />_I qtlry th.! dB fGd{.| ,.guhbu EgidinS ub.xor r@onl .rc not .ppliqbl. lo |hir ,.oj.6
<br />-z< I @nify tlur I h|vc Bd di. .ppliqlb. .d xr. thrr rh. .b.v. irforE{on ir 6rcd. I lgra to @nply wiln .ll Ciry &d Cou.ty
<br />ordiunG &d Sbr. bu lo hlildinS @Ertuctiol\ Dd h.r.by NtnoriE r.pr6.ruriv.t oflhn Cny .fl| Coury ro ola lpon rhc
<br />.bov. n6t6&d piop..ry
<br />7
<br />frilgravt
<br />l
<br />BUILDING. INSPECTOR RECORD
<br />Brown Coat
<br />CONSTNI'CTIOI trIl\E
<br />--_T-
<br />tT
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