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SITE.WORK DATE ID/SIG.COMMENTS OWNEN BUILDER DEI.CARATION
<br />I lE by.rlm u!.r, FBty of poJlry rhd I m d@F nlh !h. CoffioE Lile Lrw lor t fouoei.8 l!&n (Se7011.,
<br />BNh6r &d P.oa..sio. Co&)r Any Cny or Cody whth Equn6 . Foi to @rd,kl. dta, ir$.Dve d.Elil' or r9.t D,
<br />suctE Fi,r |o n! is@a. do rqui6 $. 4plkul 6r ru.h FTi ro 61. . risn.d stdffil llld h. or sh. b hca!.d pluun
<br />b rh. FovtioB ofdE Conrsroi3 Li6r.d trw ((t+rd 9. Comtr'n8 wnh Salib ?0@ ol Diviti)! I of lh. BdiB dd
<br />Pref*iod Cod.) or dd lE or ih. i d.npl lheEom ud th. bdtL for 0E slkgcl danFion Any vioLlion of Sdbn 7011.5 by ey
<br />+pllrer for. Fmn rubrrll tlE .pphtur ro . drilpo.lr, of rc' mE th5 lir! hu.dd doll6 (1500).
<br />l, s ow oarh. FlFry, or my dployG s'llh wrg6 a rhcn bE codtEsdion. *ii do 0E wrt .!d tn. n rElw b mt
<br />irod.d or olIord fd d. (!iE.?Or,l. oGita &d PDfBnd co.L TIE Condd r Liu& Lrw d€ Eor +9l, io o 6g@ of
<br />rh. FoFty *ho hril& orunpmE rtEon. rd who dod $cl Nrl hm!.laot h#lldr rnm4h hi! or hd oE .o9hycq
<br />provii.d 0[l .uch i&FosEr! e 6l iidn d r olErd &. $1. l( lDl^!E. tlE hiLlrg m irFDEdl i nld wiht on. )d
<br />ofonplaioi. U. O*.d Buildc wil baE l|. hrkn ofFovirs thr lE or llE dil rl hild or i't4rcv. tlE FoFly for dt F{po,c of
<br />-t.
<br />s o*E otll! FoFry. d cr.lar.l, @ftdrs Mh li.aa.d cotu*1oE ro connrud dE Foj61(Se 7044. B{mB
<br />ad Pb[si.. Co&] Th. ConrEror'r Lkru L!* &6 ml .ppl] lo a ownd ol proFry who b{il& or iEF.E lh6@n.
<br />5nd *ho @itrtl3 60, 3u.h FDJr.l! qrfi ! Cotu clo(, lkddl p6urn to llE Corlr.cloas LtdM t w)
<br />-l
<br />m.xdpl urd6 S..rion ,D & l'C. forrhis r.en
<br />l)Nrr
<br />noaf,ESti:(aMfasallo!
<br />DECIJAAUq!
<br />I lE*,y rtfm un& F rh,otFJUryon.of rh. follovi,s d.cltrioN:
<br />I toE od *ill ruidu t Cdifrn. of CoNq b Ht"l6e fd srl6 comFE{ion, B Fovid.d for by Serion l?00 ofth.
<br />L.bo Coda for lnc Ffoffi. of d. *st for whth lL Fdn a itie4
<br />fr h.v.."d sru rui! .in KrLd cotnpaB.rDr 6uraq ! .ctliEd by sds.l7m olrlE t bor Co<!. 6r lh. FIolllllE or
<br />wo't for which this Fr a iecd My porL6 codFllion iNurmc. cei6 &rl polky nuhbd dc:
<br />,*,. HC -!.fuEtLtd-y'
<br />,^n"*, o, !,),LaC(" 7 g o C 33 1,*,- 3f4+A
<br />_l.diryrhr in rh. Ffo,M. of dE *rrl fd whih thi! FEd ir is.{ I dull Er n pb, ry Fen i. r, M
<br />b sro hEomc rubjcr rorh.w d snpdrdion la*. ofc.lifomia udllrlhd if I d,ould htotu $bjd b t
<br />s*d' o&pd.rbn Fovsb6 oas.dion 1700 of rll t td Code I i.ll, frlhwnh @dpb wnh ibt FDGioB
<br />WABNINGi Flilu.lo sw srt6' comFsdior .o!6.s. i! uh*tu|..d tt![ $bjer u @plo]q lo aiEiDn FE!6 !n
<br />.ril fr6 !p ro om t!r!.d thoulrd d.[B (tlm,ooo). i! ..En!. lo lh. .oi of coopddiotL &"186 s Fovncd for llE
<br />sdtbn 3076 Dfrh.l$or Code inl6.sl ed.lrorEyi i€.qt/P(Applot_
<br />ucl!trD_(]r!r&(laaD[(l"!&[rcl
<br />,,**r*", R
<br />^,. flilr,Lo233t
<br />catflBlcua!..LEuDllG-6c[lq
<br />I tElly lflm und Fulry ol Fj!.y (r, thd . . odtucbn l6dos .8dy tor llt Ffo|rla. onlE Ed 6t qlti
<br />'h! Fni ir
<br />$u.d (Se 3097, Civ C.).
<br />I add.r Ne.
<br />I
<br />AIII,ICANIDICI.AXAIIO!
<br />I hdtt .trm un& Flny of Firy oN of llE rotbeir8 dthrilioB:
<br />Oablirio P6nire^$dot tJoriaqrb. F..lE l i.8lLrioN Gnk,l0. Pr16)
<br />, _R.qu!.d Ldrd of Noritr ib.
<br />e*ffift*ffiffi ;,ffi ffi Hls'"#ii.*'j'#"*
<br />.h'v. malrcrcd pFp(ly for ictdrioi
<br />,tnrlictrnr or,\q0r siqMh'rr "*,+l/br
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL z/,,t/2,Ltt{a
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />L.__
<br />I hdlty llTm uffts pa.hy of p<Jury thd I dD licat!.d un&r rmvlio. of Cn pE I (comtrin8 wilh Sdion 7000) ot Dilnni :t
<br />6l th. B6i.B."d PrcksbE Co&. !d ny ltqe ir in nrI foM nd.il*t.
<br />/ L"-'
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