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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS O\'INER BT'TT,DER DEI,CARATION
<br />I hchby atnn, undcr r.nahy ol pdjury rhar I am cr.npr rmm rhc ConradoN ,-iccnsc L!* ibr rhc followins ea{,n (slt 70:ll5
<br />Businc\s and Ptur.ssi,rn codc): Any Cny or Counly \hich rcquncs a Frmir ro c.n\rdcr. rllcr. irprov.. &frnnh or rc$t any
<br />struclurc. I'rtr lo ils issuarcc. ulso rcqutcsrhc arplica for such ncrnrir b,ilN d siBftd {arcm rh{r tE or shc is li.e.r.d pu u]ir
<br />lo rhc povisions olth. aonkr.in\ Liccnsd Law (Cn!plc, 9. Coflnnencins *irh sc.rion 7(D0 or Divhn,n I of lhe lrusinc$ lnd
<br />Pmfcsi.ns Code) o! thal h€ or shc iscrcmfl rh.rclrom and rhc hlsn ltr rhc allcB.d cxcrption. Anyviol.iionofSErionT0:ll.5byrny
<br />rptlicdnrror!ri.lmisuhjft(rh.,ppli.an'roa.ivilpcnalry.rnornnmrhanfivchundrcddollais(3500).
<br />I.il owtrcrolrhc|not^-ny.ormycnrlnrycc(wilhwrscsasrh.i,$lc.omFi\Jrnn,.*illdorh.work drhe(b-lurcisnor
<br />intcndlyl or oficrcd li,r elc ( S\.- 7(L14, R!\inc\s and Pmfcssn,os Codc: rhc ConktG s Li.cnic l-r* de\ nor xpply r. .n own$ .f
<br />rhctn)l1ny sb hulds or nnr,vc\ rh.Fn r wh. .nEs srh so' k hnnsrll o' hrr\c lf or rhrcUh hi\ or hcr os n enllkDccs.
<br />F)vidcd rhrritrch inrF)v. rnh ircmt nrcMcdffotlcrcd Lr$lc lt ho$cvcl rh. huildin8 or i'npmlstunr is suld wirhirnnc rr
<br />otconrrlcrion. lhc Owner BuiucNillhaee rh. hu'd.n ofpoving rhar hc or \hc did trorbuild or improR $c pn,Fny tir rh. Nlrscof
<br />l. own.rofril!r,peny,am.x.lusivcl,.onr,.ring*nhlic.trsd.otacMcloonnruclllEn!+.r(Sc.7t).14.Sunmsr
<br />n PnrasiinCodc ThcCotrlrrctols Licctr\c La$ docs nor applyro rno*ncrofl(,pc ywho$uilds.rimrrovcsrhcrcon,
<br />an.l sho conk k Lr su.h tioj.{B silh , conrdo(t licctr*d pursmr lo lnc Conlracl{, s t,icetr* Lrw)
<br />I rn,cr.n,|, un,l.r Scc.o
<br />D.t€:_ Osn.r
<br />woRt<Fxs' coMmr\{ar()ii
<br />DECIJAAION
<br />I hcrcb, afrrn und.r ncnolry of Frjury onc ofrhc followins dcchralnns:
<br />-lhavcaduill
<br />uinr n,Ccninc cofCon*nitJsclalnsur.roruorkcs conrDc.sarion. $ pmvidcd lor by s.crion.rTtrooilhc
<br />L{bor Codc. lor lhc l)crformncc otrhc iork tur whtt lnc lr.nnir is i\\u.rl
<br />x hrlcrtrdNillnMnn in w.rkcis-.oNtxtrs.rion iDsrflf,...s rcqDncd hySccriu.lT(x)ol rhc l-*orc(dc. lnrlh.rrdli)Ir.!n.coI
<br />*ork fff *hich Ihi\ pcinir is h\ud Myw.rkc coNt trsarnr irsurrtrlT cnri.r lnd policy t rh.r r.
<br />t0-bt-18
<br />-l
<br />ccni,irhar in rhe lj.rloirDrcc of rhc trork lo' *hih rhi\ p.rnir i\ ir\trcd.l shrll norcn{'l.y 0nypcivn, itr,nr xnnrr
<br />s At,lffom slb]ccl ro rhc *orkc^ coqxn\ario.lrws orcaliarn'r, lnd a8rce rhrl ill stx,uld h..onr subic.t h ttE
<br />workc conrpcnqlion provilions ofS.crion:1700.1rh. Lahtr C.dc.l sh.ll.lifhqilh omPly wirh rhot pmvhiotrs.
<br />WARNING: Frilurc b *xr. wurkcs .onlENrrion covcriA. is unl.*1ul- !!d \hrll suhjN nn cNPloltr r. oiniNlFnrlri\ ind
<br />.iril finc\ up b ohc hundrcd rhousatrd dollars ($l0o-0(x)). in addili)n b rhc co{ ol.onfcnsnrion. doflugcs as pnvidcd ntr rhc
<br />s(ri.n 3076 of rlr hhor Codc. irrcrcsr d! omr'\lic\
<br />(*"1
<br />Uq:lnD-QJ-lf,ilLTlJX
<br />IJT]I]LABAIIIJ!
<br />I hcmby rlnrnu s t'cmltyofDcrturyIhir I om liccnKlundc, pmrision of Chrfl$ 9 (.o.mrr irrB wilh S..l i,,n 71XX)).1Diviiotr:l
<br />ol rhc Bu\incs mil Pn,f.s{n,n\ Codc, trrylicctr{ ir ir lull li,ra!Mclltcr
<br />g88 t
<br />laNllll]rlltllllJjllzlNc]XifllI
<br />I hcEby amrm undcr rEmhy 6l pc.jury rhd rh.rc is 6 on{rudion rrndinS agercy for rhc perronu.ce or rh. eort lor which tht lErni ir
<br />hsucd(Scc 3P9?. Civ. C ).
<br />AITLUINLDICIABAIIA!
<br />! lEEhy flllmr undcr pcnxltyofpcrjurt o.d oflhc following.ic.Lrdrtr*
<br />Dcmlirion Permih Ashcstos Norifi.arn,n FcJcrrl Rcaulit,ns (Tirlc.10, PM6)
<br />Rc,luir.d Irricr ol Norifi cdi,rr
<br />I ccnrfyrh.l rlr lcdcra I rc8u lll ions rcErding,\heslos rcm)vrlr. nur dpPli.$lc ro lhn lolet
<br />-l
<br />ccnilyrhar I hitr rc rhhapplicari.idd {nrcrlrrrhcdbvc inr.nn0riotr tc.rrccr l08rerocomdywirhnllciryrtrdCounry
<br />o iRnmcs !nn Sllrc lr*\ rcldifE ro huil{!i',8 con{tucrir)n. rnd h.rcbv xrr r.pr.\cnhrivc\ ol rhn Ciryrtul Counry ni cnrs u|xn,rhc
<br />rltrc tr,(nrntri(d t,r,tUry nlr ir!t)r(rn{
<br />f ppliunr nr
<br />^8dr
<br />si,rnsrtrr.
<br />. l'.m,ileo nnnr lpri r:
<br />-X-,. 1:b. 18
<br />Set Backs
<br />Forms/Sleel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulatron/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />b/%//L >)6Y
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc.
<br />\
<br />Subf loor/VenVl nsulation
<br />FINAL
<br />a -\x {*1a -wtrg
<br />kEci\ AdJr.$
<br />-
<br />tPoo
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