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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER B!IIDER DI:L('^I{ITION
<br />I hd.L,y amm undq Fulry ol pdjury rhar I m .rmfl trcn rhc ('onleclo6 L'cense LaN tor rhe r.llosma r.Jn (se 7ol L5
<br />aBinss Md Proaeion cod.)r An, Cny or County \vhich roquir6 a reni ro anntud. ah6. nnprole ddnolth or ,.rBt y
<br />strucrur€. prior to its issuuc.. also r.qun6 rhe appli.er for smh pnf,n h fi1. a sisn.d slar.1mt lhal h. or 3h. n licNd pmtrdr
<br />b rh. !.o\isioB ofrh. aont,lcrofr Li..nsd tiw {Chaprs s, Coohco.i.s *nh sdlon 7m0 olDivision I oflhe BBinB dd
<br />PrcfNbns Codc) or lhat h. or shc is .x.6pr rhaclrcd ed rh. b4i5 for rh. all€t.d .roplion. Any violaltrn ofSelio.70ll.5 6y any
<br />applicar ror r pEfti subjrts rh. a?plicadr to a civil pemhy of nor ,no,e lh fiv. hund,ld dollds ($500)
<br />-1,
<br />s oNnd ofrh. !6Fny. or my dnployG with was6 6 ihcir sl. NmpsHlioo. Nill do lhc vork tnn fi. eruciu€ is ml
<br />ir ddcd or olTdcd for ele (56.7044. Busind dd Proksio6 Cod.: Tnc ao.tr.ctor's Licme ljw do6 nol epply ro d ownd ol
<br />ihcptup.dy *ho hildr or inl,ov6 thrcn. ad sno dos $ch sort himsellor heGclaor rhreush hG or h.r own.nlploycB.
<br />provided rhar such irprcvs oc e. nor i'rldddJ or or6€d lir ek Ir, ho$N6, rlE buildins or imploqnot is $ld wnhin dn. ,*
<br />of.ompldion, the Otrn€r BuildB will have ih. burd6 of pmviu lhd he or shc did nor build or impmv. (ne pBp€ry lor thc puFe ol
<br />-1.
<br />6 oNn6 ofrhc propdry. d cxcl6iv.l, codradinS wiln .68..1 cont dou lo codruci lhe prejcl {Scc. 7M4. BNUG
<br />d PlDftsiion Codc: Thc Conrrlclois Licasc Law do6 nor apply lo e osnd of prop.ny wno buil4s or inprcv6 thnen,
<br />md who.onh.r!forsuchFojdsqithoConlEcto(rlicas.dpuEuarroth.conkadoasLictu€tiw)
<br />I dn.xdnfl u.dd sR_rion .B &PC lorlh6red n
<br />_}l)a[EAS](!]UfIiN l.r,l!
<br />uEc!^&!-!a!
<br />I hc'cl,y aflnn trtrJLr pdrlryolpdlury onc ollM lolllN inr dc.lararn)N
<br />I nalc md will mai.iair a Cdlilicarc olconHt lo S€ll-lNur€ lor $orri.r! cdnrp.netidn, a Frovitled aor by Sdnrn 1700 ofthc
<br />Labor Cod.. lor rhc pafomDnc. ofrhc worl for which th. pcmn i! isucd
<br />l hlve and will mainlain work.ri comp.nsalion insurance- 6 r.qut d by s..rion 1700 ol'lhe kbor (ode. for lh.ldfome.t ol
<br />rhc vorl ro. which r his pcmir is Nudl. Mywo.k6r co,npmlrion irorMc.cmid rnd policy nunlbs rc:
<br />I cdify thar in th. pdformNc of lic s'ort for which tnis pmn is issu.d.l shallnor enploy my pdson in any mons
<br />$ a to b..om. subjd ro rhc *0r{6 o,npdsion la$ of Crlifomia md ryr lh,l if I should b..odc subj*t ro rh.
<br />$o 6'comp.nsrionprcvisionsofs..lion3T00ofthcLatorCodelslull.tonhwithcorplywiththo*pDlisiore.
<br />WAENINC: Failuic ro surc sort6 omFcaion co!@g. i. ulawful, dd stall subjel apLys lo qioinal Falri,s ed
<br />.nil finG up k, on. hun,tr.d (housMd dolltrs (he cost of compeNtion. danrg6 a provided lor rhe
<br />sc.li.n 1076 dlrhc Labr coJ.. inrdd and
<br />!.l[(.ll!llrllll
<br />I hr$y arfirin unds pcndryoaprjtrry rhat I dn li.os.d trndr lf,oviin,n dr ( hapro 9 (connnocirs \ilh Scclion 70001olDivisnr 1
<br />j,/&insud ProtdsionsCode. dd,ny liccGe is in lulllorc€ddcller
<br />'74?ar
<br />g)\:.tltt!.1!ot]a!Itc-tc!!(f
<br />I hmby amirn {nds p.flalty o I psjury thar lh6c is a coNrruclion lodins asd.y lor lhc p6lomd.c of (h. {ork for which lhis p.rnit G
<br />issued (SE 1097, Civ C ).
<br />AITLICANLDIS.AAAUO!
<br />I hdq afm und6 pcnalty of pdjury one of Oe follo* ins ddlrgtions:
<br />Demo[lion Pdnils-Asberos Nolification l-cdtral Rqulalions (1n1. 40. Pan6]
<br />-R<uted
<br />L.tt6 o I Nor ilicalion
<br />-l
<br />c6li8 ihal lhc leddal r.8ul.tioN .llledins Nb6ros rflord rre nol aoplicoblc to ltit prci.cl.
<br />l.dilyrf , hl..,@drlnsantli.dhDn di,ar.rh,rrh..borciilonn.rionrcoftd Ialrdtocomplywlhall(-rondCounly
<br />!r.tln4r6 4d srarc Lsr r.lar,ns ro hu'ld'ns grnsh.l'o( dd h6eby aurhoriz. r$rcF$riv6 ofrhis Cl, ed Counlylo dl6 upon th.::":,x:.::x::w Dc, //_/./-/B
<br />"",^t,",.,^/,*r.,,, -aat- =4-Vo2"/d O
<br />Forms/Steel/Holdowns [-CJ
<br />Erection Pads
<br />UFER Ground
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drylvall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />a lldrafr ld$l.le[/.I
<br />Certificate of Occu pancy { t \o\
<br />t-21-vN buttbZ w6
<br />Set Backs
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />FINAL
<br />Notes, Remarks. Etc.
<br />Lend.r'sAdd:6s:_
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