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BUILDING- INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />7))Su bf loor/Vent/lnsu lation
<br />Roof Sheathinq ?.ze.tc z -{
<br />Shear Wall
<br />Framinq
<br />lnsu lation/Enerqy
<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 />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL dttlrE 24/
<br />Certif icate ol Occupancy / I t tl
<br />Notes, Remarks, Etc.
<br />OWNER BUII,DER DEI-CARAIION
<br />I h.rcby afi n undcr D.n.lry ot Frjury rhar I m .xc rrr fo'n rhc controdos Lkcnt lj* tr rh. f.lbwirg rc!{nr ( S( 7frl l 5
<br />susinc$ aDd Profc$iotr Cod.): Any cily or County whicn rcqun$ ! pclnrir ro con{ru.r. nlrcr, imptuvc. d.'noli$ or rcn.it .nv
<br />incrurc. trhrt(' iis ksuMcc..ko rcqutes rhc lpnlicmr iorstrch pcrni h filu r si8rcd n.lcmnl rh,r h.or sh. is li.cn*d nuNrnr
<br />ro rhe pmvisions of rh. contrcrofs Liccnscrl t ' (Chaflcr 9- ConnrEtuing wih Scclion ?0(]() oiDirnion I ofrhc ausirtcs and
<br />Piofcs\ionr Codc) orrhat trorshc i\ cicmpr lh.rcfronrnd rhcb.sir tu rhc allcscd cxcarPrion AnyliohtionolScclionTO:ll5byrny
<br />.pplica rbran rnrir suhJccrs rh. anplictnt lo acivillxnahyolnot morclhln livc hundrcd dollm ($500).
<br />I. rs owmr ofrh. lmtcny. or ryelnplnrt.\ *irh wagc\ n\ rh.t v,l...mp(Narion. willtlo rh. s.rk md rlf, (trrw i\ nDr
<br />i,rcndcrl o. oilrcd io! {h (s*'- 7o4.r.8usiR\s and Pnrts\io s C.dc lh. Coik,c!tr s Liccnsc Law does nor lPnly n, mowacr or
<br />rhc F)p.n, sh. builds or irnprorcs lhcrcon. ud wtu) d{Es such s(trk hints.lloi hcrellor lhtough hh ff hcr own cmlt,yccs.
<br />pnvnhd rhir srch imf'rovcnEfh ffc mr inrc'xldl orofltrcd nrek ll, hoqclu. rtE huillin8 ot in{oxft.r i\ sld eirhinonc )!
<br />ol&mpLrior, rh Owftr AdUq willhovc lh. hDrdcn ol'p.oving rhlr hc or \hc dil tror build or imprck rhc pmFny i, rh- luilnt ot
<br />I. n\.wncr.frhct.opcny. !mc\cluriv.lycotuxcri'1g sirh licri\cd.otrtr.rtrs l,).ondtoci Ihc tror.r lScc 70'14 rlu\n.s
<br />rftl ADfc\k'nCodc lhcContn.t sLiccnrct-w(hcrnorrmlybino*ndr.fnrolrnywhobuildsorimPn,rc\rhcrc.i.
<br />who .. ri.s lor $chn'+cr\$iihr Co tu.k}(t h.cnrcd ttrfiuanr r.rh. CotrtJ(tr s Liccnsc Ltrw)
<br />I rmcrcnl|n u er Sccri,,
<br />Dat€: O*ner:
<br />wonxrCs cortrmns,rriortr
<br />DS]I,TIBAIIO!
<br />I krc6y lftirn undcr p.nalryorpt4ry orc orrnc rolbsn's d(lonlions:
<br />Ihavcdrdwillnnilltrir.CcnificolcolC.nscnrr)S.lflnsurcr{nworlcr'compcnslrion.r\I,r,vid.dforbySccrionl?(t)ofrhc
<br />bhitr C.dc. forrhc lcrrornnnccof lhc *orl lor *hichrh. nlrn1ir i\ h\ucd
<br />I hlvcnhd trill nrinlaitr workcri c.n!f,n\rri.n insur,rc. rs r.qu tcd by S.cln,n .1700 of (hc Labor Codc. lbr rhc ,.fimnf,c ol
<br />rhc s.r* fo. which r his ,,nmil is issucd Mywotkd\ cooDtnsdn,n in{tMcccaricr a.d rricy.umh.r trc:
<br />-l.cnify
<br />lhnt in Ihc pcrtbrroncc orrh. $oik rd whrh rhis P.nnit is ksucd. I $rll mr cnrpk,y rny lcnotr in an, tunncr
<br />s ro bcorc sur,j.{r h rh. qolkcs conDcns t'n h*\ofcalironis. did,!m lllnt ifI should hccorc \uhjccl hrhc
<br />wo c^ conrpcisdi(n ptuvisions ofSccrio0 or'rhc lrtxr cdql \l[ll. n{rh$irh..n ysiihrho{nn,v*ons
<br />idr .ovcriEc is utrlaslul. and shall nrhr..;r in cmlL}tr lo aininal Jrnrlti:\ nnd
<br />Nrri(nr. drtrugr\ r\ tovidcd tut r1r
<br />!]1,!LUUI!1)I
<br />Ihcrhrrfln ro dcr ncmlryorp.rj!ryrhrr I x li..n<tundrr l)nri\i.trofChrflcr9lconnmnci'i3 \irhS..rion7(xx)) rr l)ivni( r
<br />z?7%
<br />(:()NSl RL Cl-t(,N I -t NDt N(; ,\( i IiNCI
<br />undcr pcn lry oir.riury rhd rhcr. ii d.o.\rrucriotr lcnd irs oFcncy for rhc ncrloiinaDcc ollhc work f(tr whid rhis lll-rnril is
<br />i\\ud lsc. :r(19?, Civ C )
<br />-l
<br />ccni,ythar rhc tedcrulrcgrhrnnsrStrdirgrsbr(osrcnNv.ldrc rol rPtrlicxhlc ro rhis ltroiLtr
<br />_l .cdity rh r I hrv. r.ad nhnc inin'mrnnr G.onccl l aPrelocornlysirhall( ir
<br />onIfrD.c\ xtr.lSr11.I r\\ r.ldi',N
<br />ibolt rtrrnrcd[ot:n,lor
<br />Apt,li.anl or Aa$t Sixnrl r
<br />ISITE-WORK DATE
<br />Erection Pads
<br />('d/,*)
<br />iDfutE,r
<br />ol rh. th'\i!,cs dd ProL$krN(-odc, ad my liccnsc i\ i'r lnllftx( md.lTccl
<br />AXPIIIANLDEII^AtrAIIA!
<br />I lirrby fiim u.d.r p.nrhy of pcrjury onc of rhc followint dNlarartrnsl
<br />Dcmliri.n Pcrnrirs Astr{os Norincation rtdct0l Rc8ulal io.s (Tnt ,()- Pd6)
<br />_Rcquncd bn.r of Norilic.tion
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