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BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDI'i DUTAf,ATION I lE.ty rlIm u.da Fdry olp<.jurt rhd I m dmF fNm lhc co.ltr.ls l*.M l!$ tor lh. hllo*iog l@n (Sa 7011.5 aNin6s rrd tlofdion Cod.): Any Cny or Couly which rcquu6 ! Fmn b on!ru(l, .116. imphve dseliih or r.r.n &v nrudu.- Furo i! 6rft( lko r.qUG tlt,?ltd for mhFn lo lik.tls,td trqFi rfi,lEot iE it li.aldl Fl,rd ro rh. FlrbhE ot tlr Corl[cls! Lisiti L,w (Ch.Fd c. coMins wilh S61iot 7m] of rriuitbn I ol [a BdnB .nd P}ol6bN Cod.) n ihn lE or nt n dmp rMrom Dd rh. b6it for th. ilLs.d .xoPlion Anv vhlnion oaselirn 701 I J bv u, rtplic&r f.r r Fnn $Lirlr rlE rrplid b ! ciril p.Ety olmr @E rh.n fiE hun&.d &l![ (ltm) -l, c o$ffi of th. FtrFly, or m,6pl6y6 snh s.e6 6 rh.n $t.uFlnmE eil.h llE *dt !d EsnEE ml inrarLd orofracd td $1. {56 7041, asind &d ProldioBC.d.r Th. (oir.rd t lrcM t r.lGrcl,pplvrouo*E.t rh. l,$q!l $ho b!'t& or iry$â‚¬ rlEEa d s'lF dG uh s* hihr.lf o. h.Elf o, lhrcugh his or hs om @plor!6. IroriLd rhd su.h in4otElEu & ol dqtt l d 06..1t r !.L lf. lnr6t. rlE tlildilB d rssdcr a $ld wihn m ]d ofmnphna E olda B{iUE will hlE dE hrd6 ofp.lvi.s dii h. or shc dn ml build or inrFot 6. FoFrv tor tlt FtrlDe oa t. B osc oa rh. Flrdrt, e 6.lsidy onr-l ittg r nh licdB.d ..ffim lo mi.rucl llE F.i.< (56. ?Ol'1. ltlllB !d hs63.o (.o&: Th. Conl,.clof. Li.@ I.* dG mr .Pplr ro e ownd ofproFry *ho hrilds o. iopotq lh66n and sho od.xti fs uh Foi*lrrnn. C.drro(s) lKaEal puR@l roln Conlftldt Lhfu t s) .u &PC forrhtsrdon l) e (hn.r $ oR(rlis cotllrrisal lot DrgdaAllo! I h6.tr ,lltm undd n6rl) ol IEtu^ om.rrh. follo{dr! d..l{.r[n5 -I h.E lrt *ill Mim.in ! Cdifrd. ofc.ist tu S.lf-lNur. for *ukdr' onlFnslon, 6 rtotd.d fo, by sclion 3 7@ oall,c l*or Co<L, for ih. Ffoffi. of llE $ d tor snkh rrE Fmn ir isu.d -l hn..nd rill roinrlin wo.I.n' .omFMrion iMEe s r.qun d b) sdhn l?(, otlL llbor coa.. for tlE Ffl)lrle. of rh. *ork for which rht pdir B i$u.d My Bortdt ompcnrrio. iNue. cEir sd polty nunba a.: -l.diryihi infi.Ftolrrm.oltlt *orl for shah lhir Fm! n 6xE{ I shtll mr dnploy uy F&. ir ot nmF $ 6 lo t &ru rubdr ro rh. h.l@' comFNd ion hw! o r Cllifomia md .Br thn if I 3hould bdom slbjdl lo ltE $nrt6 otrrFlnion FortbB of Sdi.n l?00 ol llE Ltbor Cod., l Jd!. fdhwnh @n'ply wnh lh.e FlrBiod WARNINC: F ile ro se sorl6 mnpnsaio. ovo.cc i u.l5stul. ud ilull tubJd 3 arrlovg lo oimin l Fdi! rd cnil fi6 up to oE hurH rhourd dolls (tloO,OOO), r lddrion b !h. o{ of comFErion. d!tus6 ! Pmvidal r'r ilE S.clsn 1076 ofrh.l,hor (odc i 6.n ad &dr.y'r ad LlcEME-calurclaa DECIJ8AIITA I h.EbyEmrm unl6 pddly o r pdju.y rhn I m lic65.d uds F.vi!io. of(-lEplq 9 Go@.inr $irh Salbn TUJO) 'r Diriri" l or rlr B$i'B.d Pml6iod Co&, ard s, li..e ir in tull fod eri.fid CONiIA!](I T!J,!!ITI!CICItCI I hs.lry rfim uftl6 F.,ht of prjutt rhr lha. 6 r .nldtucrnn lardin! .sdy fo, th. pafolll:m. of rh. slrt tur *hi.h rhn pqn it is!.d Isd.lr09?, civ c.) ATIUTAII.DTCLAAAIIO! I n6dD .f6tr undd Fnlhy or Fiu.y oN of lhc rolk,wi.! d*l(.r io.s D.mlnrn l'o ri-A3b6ror Ndificd oD l.ds.l R.*uhrE (lnl.40, Pd6) _Rcquir.d lnra oatdfEds. -l cd,ay lhar rh. Ld6.l rcsuhlioN rcaitdr4 sh.{os movd trc ool lrplr.bl. lo rhit ptojrl -l cd iry lh'l I hav. raa lhis .pplic.lirn !i srrc lh,r th. .hv. inrom.lion i! cotr.<1. I alrc ro conDlv wnh d Cit, md Coutv .dinft6 srd $n. t56 i.lrE8 h tuikiry conrrdio.. id h6.tt dlr'ir EF6qrdfr6 of thi! Cnv Dd Cd@tv io atc uPon ltE !bov. mdtioEd propcty ror iEp.dion Frpos. Apllicrn( or ,\Edrl Siltrilurt Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUl nsulation Roof Sheathinq Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL /-c- /7 2 c fs,ut 'Lo> 6t) Certificate of Occupancy Notes, Remarks, Etc lipid: - I (.e NumtE