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COMMENTSSITE-WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Depuly Final Report
<br />Enqineer Final Report
<br />Flood Zone Cedif .
<br />A
<br />FINAL g- \s-tg *4/-r0)
<br />Certifacate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWNER BT'tLDER DEI-CARATION
<br />I hcrchy rfiinn uodcr !.nrlry {)f perjlr, rh l un crdmfl rnnn rhc Cotrtrclori Liccnse L!, ftr rh. rr,llowifiS ,ss.n (Sc.70.ll 5
<br />Bu\incss nnd Profcssbn Codc) Any City .r Counry qiich rcquircs a pcnni! k, $Nfl.t. ,lrcr. itn[ovc. .lcmli\h .r mIEn rny
<br />stucrui.. trMb ns kuan c. flho rcqutc\ lhcappln nl 4,, so.hli.nnirtJ filcr siSncd (otcnrlr lior h.orsh. i{ l,ccnscd pu ua0r
<br />nJ rh. pr.virnrns of rh. Conincd \ Licnscd kw ( Chaprcr g. Commrnc ing s irh Sc.rion TmO nl Divnion :l of rht Briics Jdd '
<br />F oltssions Codc) or rhar tEor\hc isercnur rhcrcnon Jrhcb i\ for rh. nllca.l crcmnlion Anyvi,,hrn,ofsc.rionToll.Shyany
<br />alplic4r rin rrunnir suhjc.k rhc !ptlicrnrb r.ivilNr{lryofnol lnorrhnn llvc lr.dr.d dollnrs($5Ul)
<br />l.,sorvNrolrhcpmpcny.ornrycmploJccs{irh$rsc\!\rhcir\rc.onrr.nriri('n.willdnlhceorkandrht{tu1urci\nol
<br />idctrdcJ or olli,cd l'or srlc ( Sa ?(44- Bu\ircs rM Pmt \\nnN c( c Thc aontrlols l-iccnr lrw docs ior ,pply ro an owncr or
<br />rhcpn,Fny who frilds or i'1*,8 1116{ dld who des \u.h wl't him\clf or ncr*lf or rhn,uSh his or hcr owtr c rPloyc$.
<br />pn,vidcn thnl such i'npnrcnrnrr m nor inrc lcrl or ofi.nd tur sak tl ,i)!$cr. rhc hu ikltrB or iDPro\grni i\ v sirhi'ron.)rrr
<br />olc.nlPlcrion. lhc osrcr Buildc! sillh,rt rhc hu(hn otnmvi',3 rlrr hc or \)t dd tror huiil o. impovc rhe InFn! lh dr ftuqb{ of
<br />-1.
<br />a\owncr of rhc pn,Ii.dy. r cr.lusivclyconra.rirU wirh liccn\cd conrndor b con(tucr rhc pn,jc.r (SLt.7(Et- Busir'ust
<br />rnd RifssirnCodc:rhcCo.lacntrsl,iccn\cl.!w.lm\mrrppl,bdo{ncrotnronnyshobtrild\ornnprov.sthcrc.tr.
<br />and sho onrrack tu such !tui.r{ wilh r Conlrd.ttr(s) lic.nscd pu lutrlk,lhcCofircktrst-i.c tt-rR)
<br />lr errn,ni undfl Sc.ri(nr .ll & P( tur rhi\rcrln,
<br />Drl.: owner:
<br />wotxnrs cbrrlrrrsarrtur
<br />lEel^aatra!
<br />I hcrcby rflnmuMcr p.n.lly oI pcrJuly onc oirhc hlb$inE dNllrarn,n\l
<br />Ihrvc.nlwill.rrtrair!(tnr6.arcofG,n*nrr,,Scltln\nrcfrworkcri.onlrtrsari{,n,rs pmvidcd ior bts&rn :l7molrh.
<br />IrtxtrC..lc. ru rhc ldrroflruRc ol rhc w.rk for qhich rhc |Nnnn i\ n\uc
<br />Ihavc.idsill.minlrir*orkcrlcon{Etrsrli{nrir\!rrrEc.asrrqutdhr_Sc.riotrl7(x)oIlhel,ab{trCodc,forrhcNrli)irniNcoi
<br />lhc *ork ld whi.h rhhF-mil is issusl Myw.rlcF .onpcDsrrnn in\uflr.c crricr rdlxilicy trunrhcr *c:
<br />Poh.yNunb.r Lr!'rcr
<br />I.cnifyrhar inrh. pcrtoir:trrcc ol ttE work lo! *hichrhnpcnnn k is\ued.I \hall n l cnDloyotrypcrrcn in triymrnkr
<br />so N to IENN srl,lccl lo lic sorkc^ conFnsarion lrw! orcalir(trni.. rtrd !8Ec lhlr itI \h,xld tt.om subjcd ro rhc
<br />workctr c.nEnsorion pmlnionsofSsrn,n l?ff)oaihc Ltrhr cklc.I nEll. fonh*ilh d,mpl, virh lhos Pmvisions.
<br />WARNINC Failurc ro KUrc w(trkcc comFnsariotr s'vcraAc ir unhwfLl. aftl shlll subFcl e. cmpk,ydr tu citritr.l Pcnalics aM
<br />.ivrl fims un ro onc hundrcd lhousand dollss (Sl(r),{no), in rdJirn,n l. rhc con oi compcnertu., dinqcs ns Pnvidcd for rh.
<br />S.cti.n 1076ol rhc hbor Codc. intcrcsl and !!rormr\ fecr
<br />Dole: Appll(ut:
<br />r rcrml,rx rr,',rrn r,crtx
<br />lECLAEdrQN
<br />I hcnby afllrmuodcr pcMltyolFrjury lh{r I !n liccnsd undcr povi\ion orCh{llcr 9 (conmetins *irh s..riotr 7m0) ol'Divtion l
<br />ol rhc Buriic( dM Ptur.srions Codc, (n my li.enrc t in lull lore ,rd crrccr.
<br />coNs rRU(:1lllN ! FNDTN(i A(iENCY
<br />I hcrby llinn unds l)enolry ol pcrjurr r har rtur. is a .onsd.rhn bndins ascncy fu rhc t rtormncc or rhc worl ror *hi.b rhil lc nit ii
<br />issu.dlS...3(p7, Civ. C )
<br />ATILICANLDECLAf,AUA!
<br />I horhyiliinnundcr pcnally.ipcrjtry onc.aihc f.lk,wiig dcclahriotrs:
<br />D.'ndlirion Pcnnirs.Asb.sros Norifi.ation FcdcRl RrEuhrti\ (Tirlc {o, PltrlO
<br />Rcqutcd L.ttcroiNolili. ion
<br />l.cniryrhd rhr rcdcnl rSulalionr Nsrdin8 a\hcdos'crreulrc noramli..blcto rhi\ projccl
<br />l.cnifyrlrrlh.vcrcadrhi\ippli.3riooDrxl{ar.rhrrdrcrhl!crnturnhrioni\c.trccr l:l8db.omplywirIrllCilyan Counry
<br />ordim.ccs rtrd SI0lc l,rws rclarllu r. huikling cointucrn,n. md hcrchyaulh.rizc r.rcrni,rivcs t,frhil Ciry nnd Coutrryro ctrrer trF n rhc
<br />ahovc mnii{,ncd pr.p.ny lor inspcclion purFNcs.
<br />Appfirnr or ArrDr sirnrt'rr
<br />I'emilee nonF l p.inI l:
<br />BUILDING. INSPECTOR RECORD
<br />Sublloor/Vent/l nsu lation
<br />Brown Coat
<br />ljnds s Nam
<br />-
<br />Lrido\ addr.(
<br />-
<br />I
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