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ID/SIG.SITE-WORK DATE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathin
<br />Shear Wall
<br />Framin
<br />lnsulation/Ener
<br />Dr all
<br />Ext./lnt. Lath
<br />l\4aso n
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />D U Final Re ort
<br />ineer Final Re ortE
<br />Flood Zone Certil
<br />FINAL
<br />Certificate of Occu nc
<br />Notes, R emarks E
<br />-5-eJE
<br />()\!Nt,]t Irt ll l)IiR tril,(,\ri I l()N
<br />I hcrchy 0r'ltm u cr,'rnilly (,t pcrjury rh ldcxcmnl ftoh rh- C{,trlEcktrr LEctrsc li* iar rhc rollowi'8 (io' (Sec?oll5
<br />Businc$ and Prclcsion C{dc): Any Cny .r counlv whi.h rcquncs r Fn l b on\iflcl' allcr' iq'ovc' dd'mlish or (I)dn an'
<br />slfucllr€.lrjolroilsi\$rcc.lhorcquircslhcupllic'trllolsuchFnnnlofilc,siSncnslalcftlhnlhcorshcnliccn\cdntrNlnl
<br />tJlh.pnNnion\oflncconra.loisl,icch{db!(chaPlcrg.comotftnlEl'ilts..li.tr?o()tlofDivnion:roflh.Businc$ond
<br />prore!;i{nNcodc)orrh hcor sh. h.rcmtl rtrcrcfnnrdd rh.}{sis ior rheathscd.xcinprn,n Atryviohrn,n.isccri,iT0Sl.5hyany
<br />+tti.nnlior a pei,nir subjccrsrhc smlicanr lo d.ivilPcnrllvorn.r morcrhd nvc hundrcddollrs (S50o)'
<br />-1.
<br />!\ o*trc!oilncnmpcny.or ry cnDloyecs silh wrecs as lhcn \rb conrPL sal ion- qill do thc work and rhc nurs' i mr
<br />t=r.na. * nrr".a r* *r" li-.7oil, B;si;c.' d,l ft.f;sioN Cod.: The Gritacrois l'tcn{ tjw do8 nol alDl, b xnowncr or
<br />rhc pRlf,ny sh, huilds or iq,n,v.s rhc@n. turd who des \!ch mlk himsclfor hcr\clfor rhrcu8h hn 'r hcr ow'cmplovec\'
<br />p",iida riur ",.t i'nFmvc'mn!rcfrn inrc ndcd or oirercd lnr$lc ll howNtr. rhct{iklir8 oriml,t'v'nEnr isqnd wilhirr"nc ttrr
<br />;lcon{,Lrion. rhc osmr suitld $ill tnh $c burdctr ol''forniB rh.l hc or \hc did m ild or i|rllrew dt FnDdv r'r rrE Puqr\c or
<br />-l,
<br />asoqftroirnc nnr|xny. amcr.lu{ivc,ycontsdirrg wirh liccn\cd conkart'f r. connru'r rhc fmjc'r (Sc' 7(}44 8 'incs
<br />ia p.t .r,. Cna", i i'" C"n",cror'l Lic.ns. LrPd@\ nor {llvro otro*n$ ol trcp'flv who l ildsorimlovcsrhctron'
<br />and {ho conrr!.( f(, such nrcjers wnh ! Contncbnn kcntd flsuitr rorhc co'tra'roi\ Li'cnsc tlw)'
<br />-t
<br />xncxcDfl undcr sccti'
<br />Date: (hner:
<br />wonxtls' LtttltptNs,t'utltt
<br />I'EILAXAUON
<br />I h.rcby 0liimundcr Nnalry.fP.rjuryonc ofrhc rollo*in8 d.clririo.s:
<br />-lhnvc,klwillmlinlainrCcnificarcorConrnrxrs.lr'lnsurei(nworlcnconP'ns'rionaslmvidedldbvSccrioilTtx)ot'hclnbo!Cnl.. Io.rhcpcrtorturccof rhcworkforqfiichlh. Pcanil ir isiutd
<br />-lhrvc
<br />aftl sillmlinroi. s.rkcrr'comPcnsarnrn in\u.rmc. as rcqui(ihySccrion3?00ollheljborCodc for th' P'rronrrn ol
<br />Itrc work rorshichrhn p.nnir is i$tcd My workcls .onpcmnrion in\unmcccuicr u policv nun'bcrarc
<br />n urcolrhcwork lor whk[ rhis0crmir i\ i\ruc'].1shnlltrot.,nPk'y Mv Pcso i'an, mMtrcr
<br />v, I: r,lEonr nrhic(1ro l hctrorl.r{..n,])tn\rr(rrh*s,)l(rlinnni. xn{lroc.11 r il I \hfnltl l)ccotrrc n'hl"r n) rhc
<br />tr.rkds .otr'tr urur Dm vi\nrNol Sccrnn,l?(X)ollhc l ltx)r Crxlc. I shrll LniLvirh .onrplv wirh rho* l]rovi\ion\
<br />WARNIN(; lj.ihtrc n, {cuic uorlcs .onncr\rri{nr o\cfu!. ir ud!rtr1i']. ral \hnll \ycr t, (riDiml,f,Mlrics rtr
<br />) rry'I
<br />itolli^ r1l(x)l(rOr. tri ,lLl o ni EUN(drtrx,gc{ ns nn)unlcd ntr rh.
<br />=DICIABAIION
<br />I hcrcby rltirn undcr l{nally or p.rjry rhd t am licctrcd lntur pmvistrn or Ch{tircr9l$.nr*ncing$irhS..ri( 7Ux))ol Divi!otr:]
<br />.i rh. Bu\itu's\ rtr,ll"ulcsin'N Co c.Mlnryhrc \cs n tulltutucu(l'llr'r
<br />t/r/Z
<br />I lr'cht illlrNUfd.r lf,m!ry ol I)cljrY lhr! rht,c it r.oD{nn1is l(\rh. pcrinrnnnrcc ollhc work for shi.h rhi\ lrirnil is
<br />is cd (Sc. 1(})7, Civ C )
<br />Lrndci\ Nrtrr
<br />-ATTI.ICANLITECI.d&IIION
<br />I h.niby aliinn und.r Fn,lty nlpcrjury orc of rh. rollosins d(lfrridr
<br />Ocmlirn,n Pcflnih Astrios Nolificarn l'cderll Rcsxluliotrs (Tirl.'10. Pan6)
<br />Rcquncd lxtrcr orNoriltarin'
<br />rvuirhrll cirvrtrl cotrnir
<br />ryrnd Counryk,cnro trF rlf
<br />t1alu
<br />BUILDING- INSPECTOR HECOBD
<br />COMMENTS
<br />Brown Coat
<br />bnd.' (
<br />^ddrc\
<br />-l.cn,li
<br />rhrr rhc lcd.rrl rc-tul.rions r.Erdirl
<br />1..n'lrrlir I []!c'rxdrhr\xftil'cn.f
<br />ordinatur\ d Stilc ljw\rcl irsro
<br />rbvc rmnrnnnl pofnyin
<br />Appli(Nl {. Agenl SiaMlure
<br />Pem rN nanre(pnnl):
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