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<br />BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Rool Sheathinq *l>9/rl Itlt@ v7
<br />Shear Wall uil
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />N/aso n ry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL L q trlff 1Z bvY I f\ -/'
<br />Certificate ol occupEncy7
<br />Notes, Remarks, Etc
<br />OWNER BUILDER DELCARATION
<br />I hcrc$y ilii.n undcr Fnalry of pcrj!ry lhd I 0n cxcnu fmrn lhc Conlrucrm l-iccnsc Ln* ftt rh.lollowin! tc,sn (Scc70lls
<br />Busnrc$ lnd Prclcsion Codc): Atry Cily or Counlr {hi:h rcquircs a pcrnrir lo onsrdcr. ahs. nntro\q rl-mlhh or E .n lny
<br />srrucrurc. ri,trro irs is\!,mc,!h.rq iesrhclpplic, aq slch Itmir b lllc , signcd nde'mnl lh[ h. or nrc h ltcn{d !!ru!nr
<br />ro thc pmvnions oflh. Conlrocror's Liccnscd tiw (Choflcr 9. C.mmncir8 sirh se.rn,n 70fi) or Dirisi.n I ol rhc Busincss ond
<br />Prcfe$inF Code) or rhar lEorshc is.rcnlJ)r ih.Efio rnd (h. b*n forth.dlLScd.rcnuion AtryviolalionotSd.rinrT0ll5by,ny
<br />1!plic.nl lnrapcirnil s!bj(ls lhc apnlicanrro rcivilpctrallyolnol nunc lhln r_rvc h!8lrcd doll{* (5500).
<br />-1.!sowncroflhcproFrlr-ornrycmpk,yerwirhsrse\a\lhcirn,lccomp.ns,.otr.willd.lh.wo
<br />lnd lhc slru.lft i\ B
<br />idcflldl or olT.rcd for slc ( Se 7044. Bunncs Md Pmfcsrion C,xlc Th. Conrrcloi( Lie.e Ljw aocs nor lpply h an otN. of
<br />rhc lmpcny Nho hoildror iqr)res rh.d,.. lrxl *ho ddl such si,tk hnnsclfor hcrrclfor rhnugh hn or hcr o*n cnrtloy.us.
<br />prcvjdcd rhut such tnporcnrnrr urc nor inre cd o. orltd lo, srlc ll ho{tvci dr huiklilr8 .t inprovcmnl h $ld irhin onc ,tr
<br />orc{'nrLri'n. rh.owncr Bur*ld willh,vc rh.6{rdo or rorinB thit hc or dr dil mr hiH or i'qmt lnc pmFny ror rtE puqncof
<br />I.drowncrorrhctm0cn,.trmcxclusivclrcontmrirs$irhli.cn\.dcontr&bst,.otritucrrh.projd(sc.7Lv.1.Bu\i',s\
<br />md h)rl\sbn Codc ThcC(,nrra.kr's Li..n\. tjw do.s n r itplyx' ano!rcr ol tr.pc y*ho huikhor i'n ovcs rhcrcon.
<br />rtrd who contreds lbr such noJc.k *irns Conrmck(9lkcnsc pu^urtrrkirhcco tJcrois l-iccn{c b*)
<br />-l
<br />imcrcllrpr utrJ.r Scclio
<br />DaI€: Orn.r
<br />woqxrRs' aoMPFNs,lrlo^l
<br />Il[q.anAuoN
<br />I hcrchy nlfinnundq rcnallyotFcrilryonc ofrtE tolb*ing dEhrrrions:
<br />IhrvcaMqillnri anrCcrli,i. colCotrsctrlloSclfltrsurcitr+qkcs.o.rtnsdridr,rstx,vidcdtnrhySccrbnlTmofrhc
<br />ubor c(xl.. r.r rhe ,.rfonu..c or lh. $o for whi.h rh. pcrnril i\ issuc!
<br />-lhdvc nn willNirl3in wor(rrr.onr|[turi,n, i'r\urrnrc. rs rr{trndd htSc.rt lT(Xrolrhc l-rh.rCodc.lnrrh.Iirnxrnn..or
<br />lhc uork hrwhi.hrhn pcrni is i\susl My*.rk.s ro ,Fnsnri{)n nsrrri.a cfiicr n Fnicy Nrhcr rc
<br />Policy Nun$cr:-Ertnc
<br />I .. iry rhrr h 'lr prrronniNc ol rhc $olk tor whrh this l)cnDn h n\ucd- I filll
<br />io tr ro hccomc subjcd lo'hc rod.cs conrpcnsrrion law\ of Cllifimia. rid J8fturhar
<br />wo cn'cotrrpctrsurionnrovisn,DsolScrionS?OOofrhcljtxrCodc.lshnll.Ji,nhwirh
<br />WARNIN(; I ldr x' a.u,- w.'k.'', .unur \Jttr,n (.\.8t.
<br />'. u1lJslu. JnJ .hr
<br />!trjl l a x! r.',n. hund'nl rh,{$no d"llj, altt).(rr,,. ,,dJ ittn ,n rhr i^r .
<br />su dr:11,76 otrhc Ldbor Corlc. mrcrd flnrrrcfrEv's kcr.
<br />"^,",8-n- LV \V-"", tz.*tN-zz
<br />/ \ ug;rJ.SElLll I&llr!)8/ \ Df(I. 8AU!A
<br />I Trch) J,i'rn Ln,lcr p.1dlr) ',i r.UUJ rir Ln,li,\lundd p'.r'nrr ' t'hJrr.'c
<br />nf rh. Bu.rrcs d Pilc*rn\Cnnc. Jnd tr\ li(cn{ i. in'ull lnrc ahl c'liI
<br />n.rcmplo, nn, p.rY,n nt rtry mrtrn.r
<br />ir I should bccom subjccr x, lhc
<br />onply *ilh thoc r)visions
<br />ll \lhjecr an c'ntlortr tu riminrl lEnrhts rnd
<br />rr.oi1pctr\ari(,n. d,nuBcs as ,'lovirlcd lor rhe
<br />(.onnrcmi.E wirh Ssrk'n 7(XD) oIDi!ni.n l
<br />vq
<br />,"",1-q -/ i
<br />I ncrcl,y llliTUricr pcnrllyol Frjury I
<br />issucd (Scc.3097. Civ. C.).
<br />i(tr' llrnliDsrscr.r_ tt rhc Dcrntro n.. ol rhcNork lar \hi.h rh'\ IuD,r \
<br />AIPI.II;ANLI'ECIAAAIION
<br />lhedy!fiinnu.dcr Nn!lry oipcrrury one ofrhc follo*in! 'lcclrnrior\lD,nrlirtu Pcflnils Ashcsros Norirlc(n,n LdorxlRc3ll rions (lirlI,l1). Prd6)
<br />-Rcquncd
<br />kltcr of Nolitralbn
<br />1,.nrr,f n" "o*, **",.n. (eord,ns
<br />'qb.{.q *rmv.lJ,c no, imlicahle n rhn |F,rc.,
<br />(.-\t//"r" *.,*anprrruonffd $o,crh rhc abovc iniormarin n ..dd.r. I 0gle r. .ompry wirh arr ciry onrr c:olnry
<br />irdmaft(0iAhk ljws rclrrtrrs ro huildinscondrudnn. and hcreb,ourhd.izE,c!!.!cnl,liv.sofrhkCn, dCounlylocrrc,llonlh.,h". ^-,J",N,."*d, t- i"
<br />^***,1**i".r"- lZ /Y ^,,6 -? -li."-u*--",,n,/e.W H'
<br />ID/SIG.
<br />T-Bar
<br />Flood Zone Ceftil.
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<br />1o o ZTc(F
<br />I
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