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SITE.WORK IDiSIG.COMMENTS OWNF]R BUILDER DEI,CARATION
<br />I hcrcb, rlfirn uDdcr ncnallyolFrjuryrhar , nN.xcmnl fio,n rnc C.nkr.ro^ Liccnrc L!* rd rhc followin8 rc!\on rscc70:11.5!
<br />Bx\nr$ anJ Pdc$ion C{xl.): Ant cny ot Counr, whnh rcqriru\ , Ifrnir lo .onsrdcr, rllct. iDl'rorc. dcnrli\h ,tr tonJir a v .
<br />nrudnrc. Fior h ns n\uM.c. rho N]uncs rhc q,plica ftr \uch p.anir lo rilc a si8ncd sr,tcnttrr lhat hcor shc h li..nscd pur\urtrl I
<br />h rhc pmvisions ol rh. Conlracrois l-icc scd Lrw (Ch{'lcr 9. CohmdncinB unh Scdnn 7000 or Division:l olrh. Btr\incsr ind_
<br />PrncssionsCode)orrhd h.or{hc isctnlllihcrc[io mdrhch.sisloilhcalLgcd.r.mpliofl Anvviohrion.fs6tbn?0.]l5hyany
<br />arpli(rnr tur a pcnnit subjcchlhc appli.rnr ro rciviltcnaIyolnor nrorcrhdr nvc hundrcd dolhr\ (55u)).
<br />l.nsownc..ilhcpmpcny..rmycmploltcs*irhwr-!.\trsihcnsoh.otrrpctrtirii.$illdolh.$orknlrhc(trlurcisR
<br />inrcftlcd or otlcrcd fd srlc r s.r.?O,l,l- llu\in.s dnd Pi0fcs\n rs Cod. 'l hc Co dr's l i.cn\c L,w dN\ rcr rnPly io ii osrEr ol
<br />rlr. ls)ncny who huild\ o' in!rcvcr lh.ron. rxl *ho d(r\nd *rk hinscll'or hf{lfor rhoulh hn or hqowncnyloycc\'
<br />nrovd.d rhdr such i |rovcnrnrr c or inr$dcd or olicrd l'or {L 1l.lrwcvcr. rhc htriklnB or imPr*lrrcnr i\ $ld qirhi'ronc )tJr
<br />lf.onDLrion. rh. Os'E Burkts will havc rhc t rdcnofPi(,virrSrl hcor \tn diJ ftn huikl ot iml)Dt rh. PNFnv turhcPorP{ol
<br />L ns owncr oirhc prcpcny. nhcr.lusi!.iyconlnrri',g sirh I i(niLrl co trr rr.ron t,onnrud lh.,'njccr (SN 7lA'1. B6rncs
<br />rnd tlolltstnr Cod.: Thc contr.ktr s l-ittrsc lrtr docs tror.flly lo m oNncr ortro|Davshr huilds or mlrorcs rn.rcon
<br />!!d who cootr.B i(n iuch rr+d\ *nh. Co mck s) licctrsd nu^unr t' ltu Conlta.r{n r l-mnsc Lrsl
<br />B. & P.C for lh\ ''J'on
<br />DDte. O*r.r
<br />WORKERi dONIPENSA ION
<br />I]ECLABAIION
<br />I hcrct y Jrnflnxnd.r |xnrlryofpcdury.n. orrhc rull('sin8 dNlirali,,!s:
<br />-l
<br />halc and*ill hinrriniCcnilicllcof(i,nscnr!)s.lf-lnsurclor*ork.F.omlltN i'n-!\ Pnrvid.d forbvsc'rnn' 17lx)'rth'
<br />titor Codc. tur rh. p.rronnrncc oflhc wo for shi.h rhc rnnlt isn\td
<br />I hrvc rtrd will mrinllin workcrs conDens{lion in\lrancc. s. icquirc{ by Snln'n:l7lx) ofrhc lihor Codc for thc Pcrfonna'{' of
<br />rhc sork for $hich lhi{Frmit is nsuci. Mywork.6 conlcnst[ion iNuruncc cari.r dd rolicv nun]hcr rrc:
<br />,,,", -3(ato Vu,.J
<br />(l ccniry rrhr i rl[ !.rhnMn.. ol rhc *o ftn shi.h rhis Etmir n i\sucd. I \hrll nor cdPloy rny lt.6on nr lnv nrnkr
<br />so A ro hcconrc suh,cd h rhc sorksl corycns ion hwsofcrlilomr a a8rc hd irI sh.uld hcc.nr hjd.rtulh.
<br />$o,tcr\ .onrcnsrrionnr)risnnN of s.cr i(( l7(x) ol rh. l ,t'hn (ixlc, I nhll. lnn h\ irh co rlly s irh rh)s Pxn i\ir \
<br />wARNIN(: IiJilurL n, \..0rc *ork.rs .rnrF nrrior .rvtr L. xnd \hrll {'h}.r xn. ,Jnor_c' r).ri'ni'rxlF*nxLric\ rid
<br />rlr..on ol .onrBraxrnn,. ilr rgc\ !\ Pio\nfuJ lnr rl(.nil nnc\ up r, o c hutr rcl rhourrn(l di
<br />S..rtr,r rlrTr'rr rlr lrhtr(1!lr. .r.{nrl,tr
<br />*:---zfzelrh
<br />I hci.byamrmuMcr pcnallyorperiury rhar I sm lientn undcr l,ovirion ofChlPrcr 9 (omrmncinS wirh Sedion 7000) orDivisinn:l
<br />of rhe Blsiturs ,nd PoL$ions Codc. ad ny li.cns n in rull forcc und etrftr-.,
<br />lol4tz?'
<br />tk4r"1,a n*1\1*1
<br />STNIISIJSIIONIONDIITC.dGENII
<br />hrrd(Scc:ll)97,CN.C)
<br />AISLUANfIEQItsAUAN
<br />llEr$yrlllnnundc' pcirlryof fc{urynneolrhclollt,winEdc.lnnriur
<br />Dc mliri(,n Pernrils Ash.{os Norill.dion licdcrrl Rcauldid,\ ( lillc '10. Pin6r
<br />R.quird Ir cr or Norifi ciri({l
<br />-l
<br />ccnityrhat rhcfcdc.rlrcgrlali.n\ mgdding ash.qor rcnn,vrl lrc B lFrltr$lc ro lhh prcJ.{r
<br />Vl..rrnrrhd lr r. rc rhtrlll)r,lurtnr rhrrh,!c irrorm ioni\com.r lrgi.{hcooPlysirhrllCityrnd(i'unry
<br />n. md hcehy rhrizcrcprc\cnrarirc\olrhnCityrnd A,unlyt.cnlcrD|otrIIEordinrm\ nnl Sr c Lars rlari',gI
<br />hovc nrnlioncd pn,|ray lnr
<br />Applnsnl o. Axul SiA ilu
<br />rk An"\
<br />L4--444 1 ,.* afae{,r
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathinq
<br />Shear Wall A
<br />Framinq +-\"-ta ).V-il,ll
<br />lnsulation/Enerqy
<br />Drywall +'l*t1 k.Wtd
<br />Exl./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar 6-t7-t'?
<br />Handicap Beq
<br />Deputy Final Report
<br />Enqineer Final Report
<br />FINAL K-7/d'l\
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECOBD
<br />DATE
<br />Set Backs
<br />UFER Ground
<br />I
<br />Flood Zone Ceftif .
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