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BUILDING- INSPECTOR HECORD
<br />SITE.WORK DATE ID/SIG.OWNER BTIILDER DET,CARATION
<br />I hcrchy riltr undd ,.n.hy.it tury rhd I am ciempr tom rhc Conrr.clos Ltcn\c L!tr hr lh€ follo*ing reosn (Ss?0315
<br />Businc$ rnn Pr.rtsion Codc) Ant Ciry or C.unry $hich rctuic\ a Frmit ro con(ruct. .ltcr. iEirorc. dc.,olhh o' rcIlJtr rny
<br />srrucrurc. friitrh ns nsu.ncc- aho requncs lhc qrdi.ani rorsu.h pcrnir h fihr \iEn.d irrc'mnr rhlr h€o, shc n l:cnscd pumuanl
<br />ro rh. pR,visions oI rh. Conrr0.lor's t-r.cn*d Law (Chaprcr 9, ConmencinB wirh Secrion ?(xx) or Divnion 3 of thc Busi"c$ and
<br />PmlcsionsCodc)orlh h.orsh. iscx.'ntr rhcrciron! thchrsi\fitrrlrc.llcsqlcxcn'Drnnr.AnyviotnrionofserionTosl5h!rny
<br />nptli.dtrr lnr a l*qnir su$jechrhc lorliconr ro.civilrcn,xyornormmrhM fik hu drsl dnllais ($50(r)
<br />L r\ olvNr ol rh. ,rroFny. or nry cmpk)yc.s wirh wrgr\ r\ rhct soh co'ry.nslr ion- rill do thc *!rk ffd rh. (ururc n nor
<br />i.lckl.d .r olTcrcd iitr slc (SN 7()4.1. Btrsines r.d ProLssnnr C(xft Thc Conkd{r\ l-iccnr I i* dms rcr aplly b & o*ncr ol
<br />ihc pmpcdy uho trilds.r i'qrr.vn rhcr$n. rd wio d€s su.h s.rk hmiclfor hc6rllor rhiouFh his n h( osn.'npk,yrt\,
<br />troridcd rhirruch impmv.mnrslrc tr.rinrdxlcd or.ffcE{ f(r r't ll hrnocr,rhchuiklingor i'n0rolrnrnr ii stlwirhinaE )qt.f..mplcii,r. rhc O$ncr Bniklct rillh.r rltr hnl.n ofFoving rhll tu.r \hc did n.r huild or nnpoc rhc fmpcdy li'r ric puqixc ol
<br />rl.rs.wftrorrh.pn,I].ny.rrncr.lusivclyconrractin8wirhli.cnscd.onr&r$h.oni.rrh.pi{)r..rISd.?(I!1.Busnr\\
<br />and lr.lcsionCodc:rhcConlrrcktrsLic.n\.1-a*do.\nor,pplybuoBncrofpnlcny*h{,huildrorinD!.rcrthcrc.n.
<br />rnd sh. R,nh.r s for slch pn*cr\ wirn a Conr.donn li.ctrscd rur$,nrrorh.conri.L, ( l-iccnsc bw)
<br />-l
<br />am.rcmpr undd Sdrioi .8.&P.C lorrhisrcason
<br />Dat€: ()vn.r:
<br />UOBtrE&1SJUIINIAIIAN
<br />DEIIAXAfI!]!
<br />I hcrchy innr utrdcr NnrllyofN{ury.nc olrhc l{nlowi',g de.'hrdiotr!
<br />I have and willrMi aha (tnirf,rrc ofcon\.nr ro Scll l.surc l *ork.6 c.mpctr\rrion.rs fnvidcd ior by Scd i(r 3?u) or rhc
<br />litxn Codc. iorrhc FrrronMmcorrhc wor* roi whichrlrc pcrnrn n issucd.
<br />I hav. and *ill nainrrii $o.k.rr comocnslrion in$roNc. r\ rcqtrtcrl by S(r io. :l7lx) of rh. litxtr Codc. lor rh. ptrlnnu.cc of
<br />i,rc qork Li which rhislcmn i\ is.c{l lily sorkcG .ompcNdtun nrurnhr(dicr mdFrli.y numb.rd.:
<br />I..nirr llrr in lhc I).rlormarcc olthc wolk r., whi.h Ihi\ pcnnn i\ i\\u.d. I shall not cmploy sny,)c6on in any mrtrmr
<br />e os 1o h.r. f sxhj.cr b rh. *.*cr\' mnll].nsllion laws of calrfornir, aln] ,8N rhar if I shJrlil h.tum suhj.d nr rL
<br />w.rkcr' sml.isdion povhi.ns of S.cr i{nr :l?(Xr of rhc LatFr Cndc, I rh0ll. fonh*irh coDDly wirh tlx,{ pmvnn)h.
<br />WARNIN(: lrrihr. kr {.ur. workcrs .'trnN $rtru ro\rrr|r hjc.l rn cn o)_cr h (ri'ni'[L [(nn]ras and
<br />cNil lnr\ ut, tri rm l,trnlrci rhinifd ol c.nrFtrsrli,,n- dannsc\ s tnovi(lc lnr lhc
<br />sucrnnr ll)76 oirhc l,ih.rCodc. dcrcst
<br />I,)r!ttltjM
<br />I hcrh!rfinhu .r r.nrlrl ofpcrjury rl r ljenscduftlcrff)vi\n rofChrrro9(onnnri.ingqirhSc.rion70(XD.f Divtion.l
<br />of rhc Busi'h:srd Pmicssi{nr\ cod.. ri nry li.c0sc is fullf(trc.Yn*'
<br />IANiIBIJEI()NIINDINGI(iINCI
<br />I hcrehyomrmun,,cr ,itr yorpcrjMyrharrhdrei\rcon(rucrinnlcMfuiscEylorrhcpcrloflnrnccofrhcwolktorqhichlhhpcanirh
<br />isnrcd (Sc. :l(D7. Cir C )
<br />APIIISANIDEII,AMIIO!
<br />l,rsct y rltim undcr pcn.lry of prjury onc.rrhc rollo{ins dcchrltiotrs:
<br />Dcrmliriotr Pcrmirs. shc{o\ Norifi.srion Fcdcral Rcsulaliotrs (Tirtc,l0. Pfi6)
<br />_Rcqutcd hn.r.f No(iar ion
<br />l.cnllyrhrrrhckalcBlrcgulxri,if c! (lirSrdrsosrc nrrlnr.nornptlc$lchrlnfoi.ct
<br />-l,
<br />cn'b rl-{ I h,v. nJd rtr,rrd'crr^ r JU rJF,hr'l-c ly$irhillCnyind(ounrv
<br />o i'ran.c\ rnd Sr .l.ru(icL
<br />$oir nrDrnrrd nn)p.n) fr
<br />\u,licrni rr,\xrnl Si!nxhr.
<br />y nCounryn'cnrn urx rlr
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />I 'zgltB //<4',6a"- (o*, ( O"'' Iry )
<br />Shear Wall -TO f.p( r"c so,,.i hqat
<br />Framin s tltll . o(.
<br />lnsulation/Ene
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Pool Fence
<br />T-Bar
<br />Handica Re
<br />De puty Final Beport
<br />Engineer Final Report
<br />FINAL I mrflh-
<br />Certilicate of Occupa ,t- (-
<br />Notes Remarks, Elc.
<br />COMMENTS
<br />Roof Sheathino
<br />lt/asonry
<br />Flood Zone Certil.
<br />/n) -
<br />Licensc Clo$
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