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SITE.WORK DATE ID/SIG.COMMENTS OWNET EUILDER DELCARATION
<br />I Hry llfm uftt , Fnrlry of F.iuy ,'., I 6 cxcrp' ion iE Co.ur.roE Li(nE bw for E lolhst llBn (S( 70ll ,
<br />BsiE$ .!n Prefc.si,n Cod.): Ary Ciry .r Cody whi.h rquim . Fmir ro onriM. .n6. if,pmE 4.m[ d cFi, er
<br />rlur@ ,rE lo ilr i'M...li. rEiuiEr ttE .ppltmt r .uch Fmr !o nk . ri!..d sr&mr rL lE or CE ir lasrd Ftr,d
<br />L llE Flltnx! of ltE Contr..ld's Litnsn L.v (c|Ipb 9. C.ltmEin! rih S-1i,. 7(m of Divnbr I of llE Bu.iEs r
<br />Pbfe$ionr Cod.) or thr li oBhc b.r.qr rhcfrcm rn i hir for rE rlLr.d.rdrgi, A!, vi,hrb. otsdrbn 701I tbra,
<br />apt'lk.nl ror r Fml sbFl3 tlE rFilicrnl lo..iril FEhyofd tlm dE fiy. lu'd,!rl doll,rr ('5m)
<br />-1.
<br />5 oIE oa rlr FDFny, tr ny.qrlorE *ith *l3B a llEt $L @nrtN.li,n. *iU & tlr *ql rd t. inai@ n bl
<br />idad.d co,f.Ed fq sl (Sa ?l!t. Burimls rnd Prcf6rioB Cnr.: TIE Co n.lolr Lio* L!, dxr rn {Fl} ro !n.wF of
<br />rll Fbr.ny wh. hrilrt! d itrp,wrrtEe( srd who drB chs hiNrot nd*lf d r|!@,h hi! 6rBorn..?rrtr-.
<br />provi.,.d rhrr llcfi inFDwnF e ml in ..kl dotu a sk Il rrME trEhlilirgd i,v.ottd n Fk nhmFr
<br />olonpLrbtr rh. Os6 Buildd wi! lir tlE htd., oa |'DvilE rL lr n tlE dd d ttri! d lqmE dE Fltsry ld rlE FIFE or
<br />_1. .ro*c ofd. Fopdry. Bdct,ivcly conrrrriry silh licclEd .oirucroE b oBltucr rlr rrbF<1 (S.i. ?Ora, B6iB
<br />rnd Msi. Codc, m. Conreloa r Liens. L.r &B nol ll,lly lo .n osE of tmFn, rho tuihs or i,!pm*! dt6n.
<br />and *tF onft.t fr uh F.Fs wnh I c{'ddon3) lif-d pulld ro ilE C.ffi i LirB L.s).
<br />_l .6 crmF ui&r Sdri,n_. S &PC forrhir llen.
<br />Drlr ()*n.r
<br />woRxtsn-s'c()ntPtlis,\Tr(h.,
<br />D!C|J&l]ls!
<br />I lr'.htafin uto,.r Fmlrt oflrrJrryom.frlf tulk)*in8 Jc_bnri)n\
<br />I h.w drl f,ill rornrair r Ccnifkar. ul Con*nr ti Scll l.\rc td *oAda $riinsdi,n. * IiovrLd fi, b, Serrn l7tx) ot rlE
<br />larx, C(dc, for lIE I'.rtDrnln.c D, rtr *on lor ytEh rt F,mit is nlud
<br />_lh.E.idwill idlin srla! L-,tENlio. imnr.. s EqdEd hySslbn 17(Il ofltE Lal$r CdL. tor ilEFrfGmE. ol
<br />rlE 6t fc *ttt tht F nu is hq,.d. My B(rss or{En[lbn inrunre c6is .d pol-y numb6 e:
<br />c _ zd a9
<br />-l.slif,
<br />rr indrFrfd E. oflh. mrt ld rhkh|nirFmi,r i$.d. I rlEI nor.rphyr.yp.m inu,ruE
<br />- rroh<oc bixt ro tlE ratdl onpcn!.rion h*r of Cllifomi.. ud rsr $tr if I rlldd t ofr n birr ro rh.
<br />wortcn coqEMtion prMlioB ol S.di@ 3?@ of dE Lrbd Co&. I arll tun x/irh onply rii rlD. poviriK
<br />i{ARNING: Fritua b tu wt .r omFmrion 6Ert. i! unLwtul !n nd sbid e s,pbFr lo ahind FE!-. !d
<br />civit nt3 !n b oE nodEd ll'ousn &!lIs l3lm.0@), in rdrlilbn lo ltE co.l of otrp.N.rhr drmgB B FoviLd for lh.
<br />s6rb. 1016 ot rlr t bor codc i!r4i !n rEry r li6
<br />*,,, ?-6- ZP - ^,on-" 4*-4'Lrffirrr crrvrrrclrt
<br />!&cL8Artra
<br />t h.,Elry drm !n&r Frlr, or Frr, $r I m liaid uD& FDvbbn ol Or.Ed 9 (ot:mm'ry wirh Sdion'r0@) of Division l
<br />of fi. EBiEs.rd PrDrsirB Co&.,n oy li.E ir i. tul lor.d.frel.
<br />B-.1 ??BA/67
<br />t\t,//--3-O-Ll- ,*,*'* Pef ,/ .?o1+*l €eryk""h
<br />coll(Tnl lc-n(x I r{Dnc IGF\cv
<br />I h.r.rry llrm udd Frly or Fr,,ry rhr rhor i! . onrr*dr lddilg .r.ry rd r& t?roirle. or dE fr,I r,r v,itn rhis trnjr i
<br />isrd ts( 1097, civ c.).
<br />AII'.ICANLDECIJf,AIIOd
<br />, hod,, .trm un<ld F h, of Flrry oE of rrE loll'wing &rLflr.nr:
<br />Oc@lirio. P$nnr-Ast{ or NorifEarioi tusll Rqul.ri,nr (Tnl {- Prn6r
<br />_R.q!i,rd L.drc. oa ttrifrarih
<br />l..diIyrhlr rhc f.J.n'lrr8xhri,,n\ (!udin8 a\Irios ,cnr)vrl rr. ft, !ppli.$k r{"hrsnn)F-i
<br />b (.aply *nh nl Cny.nd Courry
<br />rfthirCity.ri Counlylo c.l.r ul[n itE-l
<br />cdify th{ I lEv. r.d rht lm,lilhn dn i!r. rhd itE rhw info D. B $Rr I {rordirB .tn St.lc liwt ELtiry lo toildinS cm{dbtr !d h.nby .nlDrt EF*dlliB .
<br />.t E lmrirEd rmp.dy fa inqElDn pirp.sZ/z.c'tl;**1r",; fu *'. /'4:.29
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino 1 a Trhcvrr n:a* s'l
<br />Shear Wall \l
<br />Framing
<br />Insulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />0
<br />FINAL I l1 ,1.o TllsM-^xv1
<br />Certificate ol Occupancy t!
<br />BUILDING. INSPECTOR RECORD
<br />Rev 08-07 2015
<br />Flood Zone Certil.
<br />Notes, Remarks, Etc.
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