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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMEN,S 'OWNER BUILDER DEL(ATiATION
<br />I ner.by allm undd pe.ally ofrriury that I dn cx€mpl liom Ihc conta.ro(' t,icene bw for rh€ lolloNin8 rwn {Sd.70.11.5
<br />Busin6s and Pof.sion codc): Any City or Cornly which r.quiG r pd'nil lo co.srrucr. nli6. i,nlmva ddnolish or E!€t ey
<br />sttudue pdor ro irs isu c.. also r.quic lhc al)plicar fo, suh !E ni ro 6L a sqncd nahd rhd he or she b lic$.d p6uel
<br />b rh. provisioB oalh. Conlrlcloas l-rc.lscd La! (Cha9ld 9, Connrencins s'th Sdlio. 7000 of Diekio. I ofrhe Ausins od
<br />Prol6sions Codc) or thar hc o! she is clenpt rlEdiiom od thc b6sir for rh. allcscd .rdprion Any violalionofs..lionTo.tl5 bre,
<br />applicair ror a D.rnit subj(krh. apdicantlo acivilp.naltyofnol morclhe fiv. hundred dollaB(5500).
<br />-1,
<br />.i o\id o lrh. lroFnr. or my .mplo)€6 $ ith $as6 s thcn eb compctudion. rill do rh. $ott 4d lh. sdduc is mt
<br />inlm& or ord.d for sl. (SE ?0.r4, Busi,s d ltol6sioN Cod. The contrsctol s Lic@ tnw do6 nor spplt lo & os.6 oa
<br />rh. popdiy sho bnild, or ihprove rh66n. dd NID do6 sucfi Kd hnns.lf or hd*lf or rhioulh his o! hd own .mp!oye6.
<br />provid.itrhal su.I inrovmls @ nor i.tmdol or ofidcd for elc. l[ howc\ (. ll-. hildins or itormv@d h sld wilhfi onc tw
<br />ofcompl.liorl fi€ Ownr Bdkk sill havc lh€ bordo olproviDs thd hc o, shc dA ml hild or inpmv. fi€ prcpqly lor lhc p!4F.. oa
<br />_1. as o\ ner oflh. Fopqly. @ er.lusNely conra.ri4 $ irh licm.d cont&1on ro conshrct rh. rroj(t (S( 704,1. Bum6
<br />a hlasim Cod. Thc Conlrscloi s License l,ov do6 nol apply Io u orend ol opcdy{ho buildsor imrrov€sthseon,
<br />an(t \ln conrftch nn surh nrojcct $irh.s) li.m.n puuunt torhc Conta.roi! l-icsc Lary)
<br />-4,--r-
<br />.\.01t[E!!!]l!]ur!s -lIgf!2!!ru!-8^.l!o!
<br />I hdcby.rum utrds p€nahy oapeiur, oncot
<br />Ihrv€edreill,noi ,io a acnificor. of CoBot ro Scl Eurc for Norkda conlp€nslion, as Fovided for by Sdion 1700 of rh€
<br />ldu cod., fo. rhe pdaomdce o f the solt lor whi.h rh. Fnn i isst.d
<br />_l har. and {ill mrinrai. work.6 .ompeNation i6rranc., 6 r.qrtcd by Sd ion 1700 ollhc L,bor code. lot thc pafom.ncc ol
<br />rhd *ork aor whiclr rhis p@it ie is,.d My workm comp€Nrion iMurancc .nE dd Erlicy numbd tr.:
<br />PolicyNumbd: Erpn6:
<br />-l
<br />c€ni& thar in lhc prfoman .oa$. *Drl foi $hich rhis pnnn is issueJ. I snoll not cmploy any p€Gon in any mdncr
<br />so a ro beonc aubjd to fie wo&6' ornpgs.lion lares ot Califomis. and .sre rhar ia l s,Euld h..o'n. subjet lo th€
<br />srrlm' .omFmario. prolisioB of Serion 3 700 of th€ tibor Code I shall. tonh$ ilh o,nply wirh rhos povisions.
<br />WARNINC: rlailur. ro <ue *orkm co6p.6ario. cormg. is unl^rlul, ud shall subjsl & flplols ro cirhi.nl peiaiie ud
<br />.tr,| l-'nd up
<br />'o otrc hundral rhouMJ doum l$10o.000),+ addirrn lo rh.ros oi ( rnp.ner$n. d.mE6 a p'o\idcd r.I rh.
<br />\r',,,n ,n,;.r,M,ih.n.r. -'-^' -.r hrC,.,^l ) l). /' -.r )(D.,r: \lr'*,-L
<br />- \ r tcrr-srrr cor rnt'ron/ \ DE(l..A8ArIl,tr
<br />I hRby amm unds poalr) olFJUry,lw I dn l'.ciE&l undd provGio. ofChaplo 9 (comnocins Nnh Sdion 7000) oaDnisio. S
<br />of lnc EusinN dd Proldsions Codc, dd ty lic.6e is in tull ro(e dd e1te.l.
<br />colllBllgl{}lLllDlNciclxcr
<br />I hcby amm undd Foalry o a pojor, rhat thc k a .odtudion kndine agdcy tor lhc pgtomecc of lhc $!rl fot shich this Fnil it
<br />issu.d(S(.1097. Civ C ).
<br />AffI.ICANfDIcl,AAAIlqN
<br />I ha$y .nim u.d& t nalr! of pdjory on. oalh. aollowinr ddlaai ioos
<br />D.dblnion Pdirs Asberos Norificarion Feddal Rcguhtio6 (Titl. 40, Pd6)
<br />Rcquircd Larr6oaNodfi c,liDt
<br />l l7(t3
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing /t/t<l+/V?/r)?
<br />Shear Wall
<br />Framing
<br />lnsulation/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 />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL // -z/-t fr ,4'?.<n ,sr2,.J.V.2)'
<br />c ertificate of Occupancy
<br />Notes Remarks Etc
<br />,"?a a2e 4.t-z
<br />LiccNc Clas:-Ltca NutE
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<br />L.ndo 3 Adts
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<br />C!,UyJll1
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