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SITE-WORK DATE ID/SIG.COMMENTS OWNM BUILDER DEI,CARATION
<br />I hcrhy {rrnd undcr l).ndiy of I<r,]ry rh,r I m.nmpr fbn rhc Conrscion Lt.ns. t * lor lh. followhr M$n (Se.70.115
<br />Bnrinc* rl Pmrc$i Cod.): ny Cny or O,unry whth rcquiEs s lf,mil ro con(Ml- alq. impDE, dcmlhh n.',r!n &ry
<br />dBrurc- nrin r, ir\ i\\uuc. xl$ EquiEsrtf, Dllplicdr rorsxchF mr tu fiLasemd st{emnt lh.t lEor shc n lic.nEd iurso
<br />h rh{ F)vnion\ nr ilt Cont,crtr r La.nsd hw (ch8rr.r 9. Commi.S with S<ion ?000 of Division:l otlh. B!!iE$ md
<br />Pn,r.$r,nr (ixlc ) .r rhr ltorsh. L\ cxc,rpr rtErcrmm s th tEsis lor $c alk8cd crmpt ion Anyvi.lirirnorsdri,nToll5bym,
<br />lnrlionl for 0 p.rmir \uhrtil rhc lmlicor ro ! civil p.rolry 6r n,r mt thM fi\t hulldkn do as ($51x)).
<br />_1. !s o$M of rhc FUFny, d my cnlpb,@s wirh e.8a a rlEn sk enF.srion. qil & rlE qot ord dE iralE n B
<br />[rodcd or ofrcEd for qlc lsa.7o4,r. Busim$ md PDtc.!i,6 Cnd.] Th. Conudrt LiH* l,w dcs ml .r'rly lo an oqrcr oI
<br />tlEImrEly wln hrilti or ir{mB rrEEtr rrn who dB tun sdj. hirelf or lrMlf or rhDueh hk c h.r own.rl,'by.B.
<br />prcvnd rh.r sEh iqmEEir. E d illai.d qoftuEd forsL.lf.lbftE, rlE biEirE or inti$wd i $ld uttin tr Jd,
<br />ol $q,LtiE tlE OuEr Builds wiu hE tlE hrrk{ ol FDvilE thd tl o, {E dd d hild or tt+.!w tlE FtFry for IE prIDE of
<br />I. a\ owE of rlE ttuFnr. rh.r.[siwl, .oMin8 wirh liansd .onlrElou lo otrsl.uct rh. psFl (S< 7014. Bu\irs
<br />..d t,rfisnCod.: Thc Gdrrroa! Ltrnc t B do.r mi +ply to eoqF of prcFny *lF blildr or inpmEr rh.@n.
<br />md *hl conrrrlr fm {cl FJc<r3*in. C-l Ilo(s) li.tnsn Fllrld b tlrC.tur.lot tictrE Lt*r.
<br />_l !n.rmo und.r Se
<br />!!8f,II5:qAUrEtAIIlN
<br />DDCIJAAITI]N
<br />I rErcby rffim uD.,.r Jrnrhy or Frury or ol tlE folk'qhg &.Lr.lhns
<br />I h,E rn urll mi,re. C.nirrtr. of Cornr ro S.lflnsw f( wi6r orltBrk'L FviLd ld by Serio.l7m of dE
<br />lin Gd.. fq rt tEf(ffi of l,t lqt to. wnidt rlE Fnir i\ su.d
<br />I h.E rd ulll minr.in NrkcB .!trpcnnli,n itsurc- s 'q!nd by Sdrbn 170 of dF tibd C!il., fn tlE FldrlIn! or
<br />th. *rnt nn wnth lnn Fmi n nrxd. My *(t6 otrp. didn ilffi 6ir .d poliy numb.r @:
<br />Ll-l cd'$ ilrr in rlE Frf{mN ntrtE hrr ror un.h rhir Fnt n iisL4I rtrll d.nploy.n, Frs ir uy lfuEtQ* h l!flft obrd ro llE rdr6' 6np.rg b. Lsi ol Cdrfo4u rn rsE lhd rI I itpld h..im {6Fd ri rrE
<br />Nllda orlEurion Fo\rlioB oasdin lro0 of 'lE L.E C.<1. I adL rdh*irh 6n ly rirh rlE- Povtin3.
<br />wARNfNe rrihtr ro iie wL^ onFndion ovd.8! i. uhwtuL .rd nr[ $hFl s oq,bJtr lo nlnr] Frli!.id
<br />DEqIAAIIAN
<br />I lErby .rm uid.r Fnly or Frry rtrn t m tiaca uraJ;in;iolprs 9 (mEils vin sdbn ?@) or Df,ani,n l
<br />or E aBilK .rd Prof6b6 Cod.. !n hy li.E ir in tuI rod ttd .ltcr
<br />a y',t 7rz+
<br />nn ( 1 .t - 1z).-,*..* -,' --/.t-#r"e-
<br />CONIIAIqIIN.IEDEEIqIUCI
<br />I lErby drm ud.r FEll, or Frjory lhr dE ir r onrrEriln Lrdng l3.ry rq rlE FfolIId of rlE h.l to. ]ti.h rht Fmt it
<br />ir$cd rse. lo97- civ. c. )
<br />aPpr r(]rNr nFcI rnaTtoN
<br />I H,y afi'm lndd ,Erhy ol I,6]{r, om of llE folbwiry {k&,rlions:
<br />Dcrulirbn P.rmnr^sh.ia Ndi8.iir. ffddll R.gokrbns (Tik/l1). Ps6)
<br />-RcqoiEd
<br />Llllcr or No.ia..rion
<br />-."'e,Fcn,ry rhr rrr fcJc, rl rEU b' i,.nr r$dins r.h{ !rm!.1
<br />t,/*dnv ta t trq rc a,t rrtN nlrrrmnut {ar.rhr rhc rrr'v. d70 finr to .\ rrrl Sltrr. l r* r rhnlB ro hu 'hl'.s .i 'nndrrr rrd h.rcb
<br />!trr. nEnrn,rcnrmFn, fo. inrp.cli.n prFcs
<br />e d r!?la.bk ro rhi! rmr61.
<br />fomrbn is uotu.I .3r b.orpry *nh nl Cily.nd C.utrly
<br />ol rhn ( iryJtr,l(i'utrr! r).Dkr utrrrh.
<br />/\ ppli.snt .r ,\tol Satn{lufu
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall I
<br />Framing '111 Q ,?,d DI\,rn.t,*v
<br />lnsulation/Energy vt:
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handrcap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil
<br />tL
<br />FINAL Lol b '^0 DA'tf's7
<br />Certilicate of Occupancy
<br />Nqtes, Fentarks, Etc
<br />L
<br />J I I
<br />-J
<br />BUILDING- INSPECTOR RECORD
<br />Rev. 0B 07 2015
<br />Polt, ttuf,tG: Erphs:
<br />B
<br />!a Hs lrfW" ED 7t:tl*3
<br />2.2"r#st
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