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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG COMMENTS OWNf,R BUILDER DEL(ARATION
<br />I hftby affm unda Firlry of pdjury thd I m .r6npl nDm lhc (om.icror' l-ic.nr. L!* for lhr lolbwbg rcen {St.7011.5
<br />Bdins dd PmlBbn CoL) Any Cny or Count shrh rcqur6 . Fm! to .oldrucl, .lls. inp.o*- damli.h.r r+u Dy
<br />srM@ Ftr to rti aBls.. rrro GFG rh..rpltd for sn Fsd lo 6L.,s'td 3li.,En $d lE o. Jr ir lict!.d pu,$ar
<br />to $. Fllirioc of d. Conl8ld ! Lie.e{ L.w (ch.prd 9, ComftinS *hh Sdion ?000 of Dvnioo I 6f rh. Bsi,B ed
<br />Pru lsions Cod.) or rh, tE or ,hc ir crmfl rh6.hon Md rh. b6b tu th. .lh.d dmFDn. Aoy vrltriod of Scdion 70:r I .5 by dy
<br />.pphcslfor!Fri$bj<krh..pplicslio.civilpdttofmlmclhenEhuidr.ddolh!(1500).
<br />-1.!owofllEFDpdly.dEyalptor6rahe.s66tn$LmmFEdp4}illdodE*dl!ddE.MGtmlinradcd q or6.d for eL 156.70l,4. asilB od PDEsbN Co& Th. Co ndol.l.i.tctlw&6norTdylodow6of
<br />lhc FFty vho hilk or inFor6 ttEotr r'd wbo (h6 sfi s.t hiell o. h@lf or tmuah fiir or hd os .0d0)6.
<br />p.oviL<l rt r s.h i'nFEGr. c d -Grd.d 6r ofiftd 6r rl.. r[ lF@. tlE hrildlB or itFEd ir $ld *ihh * ]{
<br />of orpldbE dE 6E AddE *iI h6t llE hr(h of Ft"g dd lr r JE dil ml hrild s ,r+oE ilt FoFry fd th F,F. of
<br />-1.
<br />s ollm oarh. FFly, m acluiEly corlEcliry wnh [cos.d co.rlri.lo^ ro minrud th. pmidl (56 ?044. &dt6
<br />r,'d hokmco&: Tn codr.dd',Li.cet w&6mr4?1,rooowEofFoFryshah ikL or iEFoB lhdotr
<br />.d $bo onrxrr 6rst FDlnrvirt. Corrrfio(rl ltd3.d p{6ar rorn. (.orrr..rr't LitB t&l
<br />_l dh.r.mfl trfrlf Sdtn'
<br />D.r. OrE_
<br />sat8rsr:calirElsartq!
<br />DESIAEAIIO!
<br />I hr.by amm und6 poeny oI pgjury on. ofrh. followiiS dcliEliou
<br />-l
<br />h.!. rn e ill Mirbh. CGrifrdc of Co&n lo s.ltu@ ld wlfl mFqrnrG a Foqhl for by kion lr0o oltlE
<br />L.t(r Code lor 0E Ff6|1lltrc oarlE Hrt tG "|li* llE Fhn i! ieFd
<br />,ll.v..ndrillmli ain oorlc.i comp.N ion iNr@. N r.qut.d by S6lion :1700 of ttE Llbor Cod.. lor lh. pdfod&c. of
<br />*hf,h this Fnr 6 ie.d Mr *sr6'(oDDddion iru[x.(zJc lrd r{lk} nunbd e
<br />*uwA-/ttszal t1 T
<br />-l
<br />cdrft rh.i
<br />'n
<br />th. Ffolrl4. of rh. ro fo. *hth lhi! Fnn a au.d. I thll mr dDlo) er F$n it o, nEE
<br />D s lo b..!m. sbic.l lo llt *$rt6 .ooFGrion li*r oac.lifomia &d er rhd Il I ilould tra'ft 3ubal lo tlE
<br />*orkd' comrEulion pNvilioro oas.dion I700 of lhc lihor Code l3h!ll, lonhvth comply wilh th.s PrcvilioN.
<br />cov6!s. n unh*aul. Md tull 3ubjEl u oplo)f ra 6imin l Frllil ud
<br />00o). i4 rddhior b rlE .or of @dF@rior dlr.ed B Foril.d for llE
<br />AJvrrzul_, Lla_q,DZ_C
<br />uq}_:Ill(l)!tBt(llx
<br />!fIJ'AAIII!
<br />I h6rty .,fm !"& p6.xy o r Fjlry thr I D ljc'!.d un& FeGFo or O!.prd 9 (offiiry s'nh SetDh 70m) ol Divshn l
<br />of th. Buing dd Pofdiod Codc, !r!d m, licru n in tull forc. .rd cftdl
<br />I
<br />r)$k L
<br />lotl ZL ILI
<br />rlt 1
<br />(olllaaquali.L}nDlliIilcElQ
<br />I n@o'_ a,Im unda Fnsrly or p.rjury tht fid. i a coldrucliro brli.s is@y for rlE psfollrlN. of lh. *!& fr. snkh rhi! Pdnil i
<br />itru.d (Sd. :10e7, Civ C ).
<br />Arfu(AllDEg/aar.lo!
<br />I hod-v dftt u'd., FuXy ol Fjutt om of rh. folhu in8 &tL,rla
<br />Damlnion P6nil''A.h6ror Norifi.dion FGr6rl R.8!14.N (TnE.rtl, PI16)
<br />-R.qund
<br />l.aro olNolili.!rio"
<br />I cdit rhr lL Lds.l r.suLlio6 as.d'ns abcr6 r@vtl ac mr {,9la!6t ro rhii p$Fl
<br />-l
<br />.dit tha! I havc r.sd rh6 .pplicdion an !lar. lhrl rh. .tovc inaom.lFn B .ord1 I tgre lo cofrply *ilh i( Cny &i ('o!nr,
<br />onlin6nc6 md Slrr. Liss rchlrn! to ios .onntudion. ,rt hdby .ulh.rn. rcFen iv6ollhir(ilysdCounlylo6rdu,rn E
<br />,lxrc mori,tud Il(,pd) f(r
<br />tl,plici r or 186r \ittrrrr('o1,.,---LP>/ueL'dvu Ll7.Zq.VL
<br />,,,. z/>-/r 7
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation ,-\
<br />Roof Sheathing 1-24-1",P,t-!i(I Yz,AtyLeF{
<br />Shear Wall
<br />Framing
<br />lns u lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL tTutn'/o-
<br />Certificate of Occupancy
<br />Note marks, Elc.
<br />h lt ll4
<br />*s'n-
<br />La
<br />Q1-,',Ud,Z? u^?.'L
<br />I
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