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BUILDING. INSPECTOR RECOHD
<br />SITE.WORK
<br />-DATE
<br />tD/stG.COMMENTS OWNi]R AUILDER DEI,CARATrcN
<br />t h.rcby rlfiirn undcr ncnalry (,f p.rtxry rhar I n crcmnl ltonr rhc G,nr ros Ltcnsc lnw tor rhc followm8.cN)n (SLt?l)ll5
<br />Dlsincss ud Pr,rc*ion codc)r Any Cily or Couni, whi.h roquics ! lcrmn xi co.ntu.r' rlicr. inr[ove. Acn$lhh .r rcmn anv
<br />dflcrurc. I,idtu ns ksuanc.- als' rcqut sthc,!fli.l.l ln. su.h I'c mil h filr r si8n.d sr cnEnl lhal hcor shc is liccnsd nursulnr -
<br />lo lhc lrolniqN .l rhc conlraclols Liccncd Llw (Ctuprcr 9. Conncrcln8 w h Stcrion 7(xn ol Divhion .] or rh' Brri"'!t x'd
<br />Ptr,frsiotr\ Cod.)orrhal lEorsh. iscrcmfr rkicfii,fl Md rh. b.sis lorrh.olL!.n.rcmprion AtryviolarionofS..rionT0ll.5hvrn,
<br />nprlmtrr for. pc,lnir suhj(ls rhc |tpli.anr ro rcivilllctr.llyofnor moto rhrn livc hundrcd dollxrs($5m).
<br />-1,
<br />as owncrofrh. |)nrFrly. or my cnrployts wirl sr!c\ as th.ir mlc c.n{'cn\rinrn. willdo rh. eork ad lhc dmnF k nor
<br />i' . I&i .r .f.red thr {lc I SN 7(t,t1. Busirr$ and Prclc$ions Codc Thc ConkMt s Liccnsc li* do.\ ior ll,nlv ro !n owmr ol
<br />rh.pmFny vho huildr or nmorcs llE@n. and who dms srch &* him\cllor hcr*lfor rhmu8h hn or her own cmflovccs.
<br />p.ovidcd rhul slch itryr.tmnk d. nor inlcdcn or ollcEd t, qL la howcvcr. rtr tuilding or i'ry,turcnrn( is $I1 s iihin 'if, Jt.tr
<br />ofc.rplcrirn, ttr Owncr Builicr *ill hxw rh. hod.n of pmvitrS thal hc or \hc did nor buiH or intmvc rhc PbFny for rhc luqnc ol
<br />l. rsosDcrorrlE roFny. rmcr.hrivclyconlliclins wirh licensL\lcorki.r)rroc.Nru.rrhc rnriccr (Scc 7ur4. Btr\i'x\\
<br />rnd lhnds\i, Codc:rhcC.nlft.lffsl,ircnscl-rwdoc\iortrprlyloatrosNrofFrPcn!whohuikkorinrli(,vc\rh.rcon-
<br />nd wh. ..nhdsiorsuchrn,jcd\snhrCo.lfu.n(r) li.ctr{d Plrnh r r'rhcCorrri ,\ l-i.ci{ bw)
<br />I ncxcnlP' undcrSalio
<br />raBtrl,&5laMPINl floN
<br />IIECLAEAIX]X
<br />I hcr.hy rllim undcr pcnahy or fiirjLry om olrh.follo*ios dcchlrrion\:
<br />I hair alrd will minllin a Cenificdr of Cohs.nr ro Scli lnsurc |or *orkdf mmPcn\ati.n. as Pmvidcd foi by S(l ion :17(rO of rhc
<br />Ldh)r C.dc. for rhc ncriormBncc . f i nc work for which rh. tEnil n issucd
<br />-l
<br />hrvcrnd willm n,hii workcrt con{cnsaltin innmrcc. as r.quircd tr_Scclionl70oorrht tnhorCod..lhrrh n rroanincc or
<br />t,f rha
<br />^ord
<br />y workcr' <nnpcn\lrn)n i'$uBlrc.atricr rd FIi.y nu,nhcr dc:
<br />{ lt{t(w 0 ttl
<br />I cenify rhrr i.lhc p.rfoflMncc {,trhc work fir whi.h rhn Fnnir h h\!cd- I rhrll n.r cnrk,y 0ny pcsotr in rny nunrcr
<br />h ns lo bcsnE subj$l lo rhc uorkds .onqrnsalion hBs ol Cllifo,oir. and .{rcc rh.l if l \lx,drd t .om sut Fcl lo rtr
<br />workcr' sml'ctrsal ion pmlhioni or s.cr ion 3?fi) ol rhc tifnr Codc. I \n,ll r.nhqilh comply wirh rh.s Pmvnioni
<br />WARNINC: Failuc b sui. workcs conrpc.salion cortosc ir unkstul, lnd \hall lubF.r ro cnlloltr ro ai.ri,rl !c.dri6 d
<br />.ivil finc\ !r ro oE hundrcd lhousand dollar ($Ifi),lxn). in ddilnr h lh. c.{ or.onD..sation. d!rogcs n! ptovid'a ro' rhc
<br />sccr n.\0n'.i r)c 10r.,grd.. !r,rc.rotrd ri.R) .'.^ ,Z ,2
<br />,.,",.112?/ tb irppun*X /2,422-z' LlcrNsdf('oN] RACftli
<br />IUCI,ANAIION
<br />I hcEby ofltmundcr pcnnliy or p.rjury rhar I rD liensd untlcr [.vieiotr ofCh.Prc.9 (coh]t'*i.8 with Sdion ?fix)) oIDivision.l
<br />or rhc Busnrsand Pmlcssion Codc. ld my!{cnsc n in iulliorcc 8nd t[c.r
<br />ct0 0
<br />7 27 /te
<br />coNs'l Rl l(:T l{ tN I FNDINC A(i ENCY
<br />I h.rch, ar'lt'n u.drr !.trdryotpclu.yrhrr rh.to is r.nenrlio.lcDdins4ctrcyroirhcFrlanrrrccorrhcsorkrirrwhichthtP.rmir(
<br />n{kilrs.. 1097 cn c )
<br />l. ri\ Nr c
<br />APPLICANI IIFCI }RATITIN
<br />I hRrhy lnim !ndcr pcnshyofp.rjrryonc oflhe fnllowin8 d(lararionsl
<br />Dcmhion Pcrmns.Ast sros Noiifr.,rion Fcdcral Rc8ulntions (Titlc.l0. Pd6l
<br />Rcquncd kltcr ol Ndifi calion
<br />-l
<br />ceniayrhar rhc iedc.nl ngulal ions rcsrdins ashcdos rcm.v,l ffc ml atPlicahle ro rhh proj.ti.
<br />-l
<br />c.niryih t hovc r.d lhh lppltarion ,Jki {.ie rhar lh. atnvc informrn,i n .orsr I .sra io omlly wnh all Cilv ond Couniv
<br />irdinaNa ed Slar.kwsEklins roh!ildingc.nrd.lion. a h.rcbyaurhori& r.pnsnlarilcs oflhh Cir, trd Counly r. cnrs dnon rh.
<br />.bovc mnhnmd nn,pci) ri n.ltdnrTry*:2> ? 4t-Z/tZ
<br />npo,*,",",nu,,sr**rn)X'- {2fua?i D.,.' U////u
<br />".-u***,,",',[ A-Lio - /V+qYe'1
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil
<br />/ . /,t/t a t, /z-
<br />FINAL r///5//7 /I.(fi,t///(:p\5
<br />Certificate ol Occupancy ' I I
<br />Notes, Remarks, Etc
<br />Subf loor/VenVl nsulation
<br />T-Bar
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