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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER AUiLDER DELCARATION
<br />I h.rcb, trlfirm under P.nalry ollEriury lhlt Ln.xcnu lm'n rhc Conrluct,* Li.ctrs Liw lbr lh. rollowirg rclson rs" 7o1r 5
<br />Itu\inc$ !.d Porcssion Codcl: Any Ciry or coudy qhich rcauires , pcnnir ro cotrnrucr, alrcr' improvc. dcmolth or EPan V'v
<br />dd.rur.. Drior ro irs issun(. trlso rcquircs rhc 0pllicanr nn skh Frn ro filc! sisncd {,r.trrnr rhd heor rhc i\ liccnsed I)Urs.nr
<br />k, rhc pDvi\ions oi rhc Conlracrois Li.cn*d Lrw (Chapicr 9. Coo'ncnci.8 wirh S.crnrn 7(xD or Division I orlhr Btrsin'ss 3nd
<br />PrctcsnnF Codc) or lhll ne or sh. is cxcmfl tlEriron dd ih. bdsis lor rhc illcscd cx.'ryrion Any viollrionorsccthnT0ll5 hv rnv
<br />rprliclnr tor a pc,nir \ubj(Bihc rmlicsnl ro !.itilpcn,lrtol.nr morcltan liv. hundrcddollar (5500)
<br />l.rsown.r.rrhcnl.|Eny..rnlycnlPloyLrsNirIBlscsrsrhcire,tu.onl|)ctrsrriotr.*illdorhc*orkandrhc{turu.nior
<br />i .,kll{.r.fibrcditrsrlc(Sr_70,!l.Busin$\{ndhofe\\i,nr\CodclhcContudtrsLi..nsclisdocsn.rdPplyrontrotmrof
<br />rlttmFny *ho buildr or nlll()Es rh.ron. xl*tn)ddssu.hw(r*[iDsclforhdr{llorrhroughhisorhcrowncnrlqrc\.
<br />|rrvdcd rhrr such inlP(rMtnN r nu| i' c'rl.l .r ontrd hr qb. li hos.\.. rtt huiiinA or nqrovcm.r is v,hl wirhn orc rr
<br />ur..lll|)hrinr. lh. Owmr Brildcr *ill h.vc rlt hrtlcn oi Pn)viry rhd h. .r slr di.l nor hui or nnprclc rhe pmP.ny lnr rhc,rurrxxc ol
<br />l. Bo*ncrofrhc Pmpcdy. tmcrclusilclycontacrins qirh lrc.scl cotrkr.ror\ !) .on(rucr llE pojc.r (s( 7044- Brincs
<br />r lhni:si Codc:IhcConlrlck{rLi.cns.Ldwilocsnolnntilyh iustrcrolptoPcnysh(,buildsori,npn}rsrh.rc n.
<br />rrd who conltacrs nn \u.h ptujc.h wilh ! Gnr rrt,n, li.cn€d Pur\umr b rhc c'rtr'lor's Liccn{ tjq )
<br />I hc,csyrrfir rnd.r Fn.hyoipcrjury onc orrhc tt,lbunrr d(laralii,,\
<br />-l
<br />htrld mdwill minloin aCenificarcorconscnr ro Sclll.surc l'or workc^ compcnsulion.as Fnrvidcd r'ot bvSdion lTlx) orrhc
<br />Llbor Codc. for rh. pdrotnEncc of lhc wotk for whkh thc !.m h nsucd
<br />-thalc{ndNillmrirrainsolkc*.ompcnsolbiNurlo.c,asrcquitcdbysalionl7m.rrh.tihorCodehrrhcFr'onnanccorrhc work tdr whici lhis pcrn r ir ilrudl. Mtworkcrs oml,.nsulio. irrsur,trcc .oricr {nd Flicynumbcr m:
<br />lbLict N0 rhdr:-lixPncs:
<br />-
<br />I ccnifr rtu in rhc |. fttrtufl.olrhcwork i(r *hich rhi\ ltrnrir n isucd.I \hrllnor corlhv..v Pc^.n in.nynunncr
<br />$ s ro bc.om ruhtd ro rhc {ortcn co'np.is,r i.n lass ol Cllilomia. r.d aenc rhdt ia I should ti.onr hFl lorlt
<br />workcr'con{i.nsarn tmvisiols oi Sccrio lTm of lhc ljhr Code l shJl. lanhrirh totrDly s iih rlDrc P$vis ions.
<br />WARNIN(;] failurc l,) \crurc r.'kcN c.mncnrrtn, colcn3o is urhtr rn cInlLiy!r r, !ri' i".'l trhl]i\ n'Ll
<br />tr\Jriiin d r!!\ J! nr^,LlrJ , { rhu.ivil 6ncs up to onc hrndrcd rhouslnd dolh6 (Sl
<br />Scdi :107(, ol rh. tnhorCodc. inrcresr and rr
<br />D^,", 3'L.o-tg
<br />I hcruhy rlftrundcr pcmlry.rn$luiy rh lnnl.cn\cd nmvsion ol Chllrcr9(conmEtrcing with S..rur 7000) o
<br />.r rhc lJr\i'ro\\rtrd n,'lc$i,n,\ ('(nlc. nnd rr li.crsc i\ | h'Lllnrccn (lcrla.r
<br />coNsrRtl(l't()N Lt\nlN(:
<br />^(:FNcYI hcrlhy Dfin'n undcrymltyof rcriu.yihar rhcrc ir r cotr(rlcrior hnJing +c..y lor lhc pcrrd rn.c ollhc work rd shich rhh pc.mir is
<br />nsucd (s( :l(197. ci! c ).
<br />trndra! I.m'-
<br />tJndci\ AJdrc$:-
<br />A.EEUCANLDIOAAAIIQTi
<br />I [rct y uiirm undcr p.nrlry.lpcrjury onc orrh. l.llowirE dcclararnrn\:
<br />Dcnrliriur l,crn,ir\ Arh.{os Norincation FcdcrrlR.gul.tioN (lirlc 40, PanO
<br />Rcquted l,(cr or Nonicalion
<br />-l
<br />cdiryrhar lhc lcdcralEsr]ldions rcSnrdir8 nsbc(o\ rcnov,lrc noi {llicablc ro rhn prcj.tl
<br />I rcn'l! rhrr I h r. r.. rhn rll l.nrr xl sir. rhrr11[rhr.
<br />,tr1j rrn!.\ rf,LSrr.l N\,r
<br />rh,k r.nlnnr !n)Nrlt titr iD
<br />,\pplicnnl or Ax.nl Si(nnl
<br />t corurt I .pra lo $ff ly *irh 0ll Cir, dnd Counry
<br />.rcnrc'cnrarvc. olrht C y and Counry h cnrcr ullon 4E
<br />""," 6'1.0 -11
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf Ioor/Vent/l nsulation
<br />Rool Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputv Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />FINAL 4ll1h4. 1 ilA$^e.^i'V,)
<br />Certilicate of Occupancy rl ,/l-
<br />Notes, Remarks, Etc
<br />"*" %'zfr.ilq#
<br />Pool Fence
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