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SITE.WORK DATE tD/stG.COMMENTS OWNER BUILDER DAITARATION
<br />I hmt'y lrm undd Frlry ot Fjury rhd I d d.dpt &on $. a'oln,..lm l,ic.nE t * lor th. folbwhs rc&. (sd 701 I 5
<br />BGin* .rd PrcldFn Cod.) Ary Cny or CIMy which (quiG . Fni lo aldnrl. !Xs, anp.oe.. iktrblbh or rc.n ey
<br />tu, Fs 'o
<br />i$ isue. .Eo r.{uiB rh.lrliur for rut Fai ro 68. r$ncd naanon thr lr or $c a lic6.d Ffld
<br />lo tl! tft\i.bd oltlE Co.rrldi Li(nd trw (Ct F6 9, Conmdirg wilh Sdtion 7000 ofDvilio.I oflhc BBiB &d
<br />Ptuf6bN Co&) orind Edd. ir.rdF $ad!nDd th. b.sir for llr.lhcd ddF.. A.yvioh{ ofsarion 701L5 b, &y
<br />.!plic.d fo. . Fnh rubjEll rh. rpplk&r lo ! ovil pouly of mr mr tha liv. hui&.d &ll,r (tr00).
<br />-1,
<br />B o*E ofrh. FDrEry. d Dy .nplorc wnh f,.96 s th.n nk ompqiiiol! ril do tlE rqt in 6. sdc a d
<br />idqrlai (ofia.dfdit (Sc.roll. &Eir dd PrcfsBCo<k In codr.<ld t l-toE lt$ &.! ml tpPly lo d 0{6 ol
<br />lt. rmFry lho tlil! or Eqo€ $a@ nd $lto &s sh 6rt hinB.ll6r tr*lf or tlIush hit m hs o*r dlPloyc
<br />Fo\-Li rhd rEh imF!\qEi!Etd irad.do.ofiqld 6r $t lL rb6d, tlE hrillit d trrE s€Ei i' sld wilin m )d
<br />ofoiglablr 0E (xE Bcil& wil hft $. hnldr ofF!\itB rlr lE r tE dd tnl hlld 6 h+.nr. lh. FoFiy 6r tlt F4e ol
<br />-1.
<br />s o$nd oloE Frpdy, m dclciv.ly olfuins vnh lkcB.d co,itu lod
<br />'o
<br />r.dtud rlr FD.jd (56. ,Ol.l. BdtrB
<br />rd ProEsih ('o& Th. Cont..ror ! Li..s Lrw do6 mr rppl, ro s owE of FlpGly sho b{ild! or @por6 lh66(
<br />iid tr lD conlntt aor 3!ct FDirl3 pilh s Codr..Ion3) lk.B.d FEu&l lo lhc co.lr.<loit Li.R L,*}
<br />_l dn.r.mfl u.d6 sdri)adl!,-,,,!, rL-3-\S ".*,,V c4.u.l,r4 c.riBl 8lxtj.ll]llra.lalliJ.N. UI(IJBAIIA!
<br />I ho.b\ rrjirm utrd6 tEnll\ orp6juq onc olrh.loll.sir! n(Ltrarkff
<br />I hR. srl *ill mintlin ! Cqiitf,dc olcongl to S.lal6u. for wortsr' onD.norim, d r,!ri&d lor by sdtion :rrGJ of lh.
<br />Irbor (bd., for rn Ffollrle. otlh. wort for e,iah th. p6Eir a iBudj
<br />I h.!c md sill n.hllh *o o' codFcdio. iBu@.., s ratut.d t'y Sdion u& of trE ldor Cod.. for th. p<follir4. of
<br />rh. *ql fo. *'hth rhi Fdn is ied. My lgto snFdion iMe.6ir rrl Flt) nuhh6 i.:
<br />-l
<br />.criry thr in th. Ffolitr. of E wort anrtlihfiE Fnn 6 u.d.I th.,lkn arph, r, Fen in&yM
<br />$ s to b<oE $bcl ro rh. *qi6' @6p6rb. lN! of c.lifomia rd .{E ltd rf I nruB bao6 $tis ro rlE
<br />*!d6'$tuFErionFovaio6otsdbnlTmorth.tr!o.(od4lndlfon,$rhodPly{inlnEFDvilitE
<br />WARNI G: Falu. ro K@ wt6' @hFEaior ov6ts. i! oLstuL !n ddl 3ubl.d u ophF ro 66ii.l Friir tId
<br />cnil fi.6 !p t! om hundrcd lhrerd rtollG (5100,000). i. rllnE, ro lh. cor ot (omFNlioa d!.!s6 a Folit d for lh.
<br />saro. 1076 ofrh. tihor Code inta n !d rtohry !
<br />l2-3 -t$
<br />DEOJAAITOB
<br />I h.,.t y allm und6 Fndry of pojury rhd I m [caB.d und6 FovLion oachrrld 9 (.osmtri.s $nh Sclion ?@0) ofDi!i.io. ]
<br />of rh.Dsin*md PmfsioB Cod.. dd oy lic@ i. i6 axll forc..d.fi(l
<br />ca!: aucrl,)lLEtltdc-acl!(I
<br />I h6!ty ill@ un<16 Fn,hy of Frur.v fii llEc i3. oldrudn. bdlu ts*y lor rh. Ffm. of th. *vt 6r etth rhk Fni i]
<br />uld (S€. lo9r, Civ C )
<br />ATI1.I(AdLDICIIIAIIIT!
<br />I hd6y .IEn uid.r Fuh, of tEjlry oE of rlE rolbu'iry dElarl i,N
<br />Dgmhrn PoTnr-Arb6rot Norificaio. F.d6.l R.Buld ioN l l nt 40, P!16 )
<br />-l.qurol
<br />l.xs orNori6<aio.
<br />I rdify rh.l rhc f.ndrl rc{uhioN Esddi.s 6h6los rdo\ .l e. Nl !ppli(.61. t. lhn Fojar
<br />I Grify Od I h.v. rdd thn dpplicltior ud stllc lhal ltu 6torc rnfomdion ir.ond l.3ralo comply wnh.llCilyand Counly
<br />drdinm.6 d sril. lr*. El.liiS io t{ildins coN!ru.liotr .d hs.ny lutlFdz. rctrsrdir6 o f thir ( ily sd Cou.ly lo and up.. th.
<br />r1r\. nrtrri,nrd | ,trnv ntr
<br />'nspdr
<br /> t,pli(rnl nr A*01 siEnrluro Co,^"ilr.-vp lttr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />/;.\
<br />FINAL 7-lz11 vJl{ldt
<br />Certificate of Occupancy u/
<br />Notes, Remarks, Etc
<br />BUILDING. INSPECTOR RECORD
<br />C-q^goo* -
<br />Brown Coat
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