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BUIL ING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns \,'1, ^l,o (i tl:Zt
<br />Erection Pads It vs '{i "[YY-
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Ene rgy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />,/'.24
<br />Certiticate of Occu pancy U\.l ut
<br />Notes, Remarks, Etc
<br />O\v NI]R BUIt,DER DEI-CAft A'I]ON
<br />I hcrchy rtlirm unl.r ncniry,n l}. jurv rhrr ! r ciemn! hn rhc Conkrtn- t-i.cn\. ljq for rhc li,llorirE rcrsn ( S.. 7(,.11 5
<br />ausincs d PRft$i{'. C*lt): An! Ciry or Cou ry shich rcqrn.s a pcnnir k, c.trsrud, rllcr. impnxr. dcnk,lsh ^, Rnrn ,
<br />'ysfl.turc. Uiintu ir( istr{tr.c..ko rcqu i.s thc lplli.Ml hr \u.h Nrnillo lilc! rilncd(nrcucnr rhi h.or shc n licct\.d Pusurtl
<br />n, rhc pi{,vi\iois ol rlf, G,nrrrcnr's l-iccnwl liq rchrpicr 9. Co m.n.i'r8 wirh Sccri 7fi,{) ol l)ivhion I ol rhc Busnrs\ rnd
<br />l'mrasidr! Codc) or rh{ hc.r\hc iscxcnDr rhcrcnoNnnd rhchasis f.r rhc rllc3ci cxcnprn'tr Anyviohln,nofSLtrn,n?0ll.5hyntry
<br />rpnlicanr lhr rpqnril s'bjccrslhc xptlicrnrroacivi!pcnrllyolnorBrcrhmfivrhtrtrdrcddollns{$5(x))
<br />l. as owocr o, rhc foFnr. or my .nrployccs *ith u4cs rs lhct $k conpcnelion. will do rhc worl :uxl rtr {u1uE i\ hi
<br />nrcndcn.rofltrcd,nreb(S.r.7(14.1.Bulimssandtrirtsion\Codc:-l'hcConhckr'rLi.cnscbwdocsn.raDDlyloatrowncrol
<br />rhc DmFcdy who l.dilds or inDrovcs rir.Nr. MJ *ho d@s su.h *ork hiDrcllor hcrclfor rhn,lah hh rr h.r osn.mployccs.
<br />trovidcd rh r \u.h inrpmvcmnh m bt inrcftnxi d oficrud (, slc lt horcis. rhc hoilding or impoKnEnt n $h wirhin on.
<br />'tdofonlPldi,n. rhc O*icr Brildc, willhnr rh. hrdeo.fpmring rhar h. or \h. dxl to, build.r inlr(or rh. Fmpcny f.r rhc Pqn{ ol .
<br />L rsowncrofrlr pNtcdy. rcr.hFivcly.onk..rinEwirhli(nrd.ontadonroconslruclrhelmjccr(Ss 7Or4, Bt\i"c$
<br />and l,,trlc\siotrCodc:lhcCo.r!,croisl-iccn\cl.!wdocsnoilprlybrnowncrorpn,pntwhobuild\ori povcs rhcrcor
<br />,nd who cd[oclsr iu.htmjcd,aithrCo rrro(,li.ctr{d |[rur rorhcConrllcrols Liccns lrw)
<br />I lcrcnrtn undcr Sc.r
<br />,",.L7//,-t// {a
<br />t)t.l t.l\R lIoN
<br />t hcrchyrri,frunrl.r |ttrrtlyor |ruluryon.olrtrcr(,][,*i,i3 (t.ch,rrirnN
<br />I hrlc ilwill hidnir r(tnr1Lrrc ofCon{nr k) Scll.ltr\urc for sor*.r'.rnVrnsiri,nr. rs proridrdi(nbyS.cri.nlT({rofrhc
<br />l-nh,C.Jc. for rhc pc.lo.nrmcofrhc $u[ r{n whi.h rhcpcnnir i\ i$uc
<br />IhavcanJ*illmainrainwork.rJ.o r!..srrn,n rnsuaNc. r\ rcquiadhySariotrl7L[)olrhctalrrCodc.forrhc,rcrnm'rn..nr
<br />rh. sork ror whicl rhis ,.r.rir ir rsucd. My worknC .nnD.nernm nrsnr..c canicr ani tolicy nun$cr rc:
<br />cMicr
<br />-
<br />Ic.nilirhdinih.pcrf(mun.cofrhc*orkforwhkhrhi\$rnrnnnrucd.Ishlltrolcnrnloyrnypc^onirry rnkr
<br />$ asro hc.om suhj.{r to thc q'orkcn compcnsrlion h,( oI Colilorni.. rnd ryrc.rhar irl \h,uld b..o t bl.d to rhc
<br />v.rkns conFnsariontmvisionsoiScdionlTmolrhc Codc. I \hill- fonh+irh.on,nly *irh rhor t'ovi\i(rr\
<br />)
<br />$ARNIN{i li' lLn. r, ...r:. r.'t.'\r.,rd s trnhslul. xtrtl \hr I \llrccr nn c rtno$r k, (rirfi'rl |{Mlri(s xrl
<br />.iril ftNs up r. onc hundrcd rhousand dollaF ,- in lddnion ro rht con or c.'nD.nsarion. doma$ !s Eovidcd t, rhe
<br />sccri{)n.10?60frlI I rhrcftic. dcrc! rfJ
<br />",,",'71/21t8'
<br />I hcaby alfiirn undo prMllyofpcrjur,lhll I anr liccnsd undcr pmvisn'n ol Chapr.r 9 G\nn t cing wirh scdion TuDl ofDivnn,n:1
<br />of rh. Buiik\r and PmLssbn\ Cod., 0nd my lacnsc r n tull fore akl cff(l
<br />CANSIBUCIIIIIiIEII}INC.ATiIIII
<br />I hcEby otnrmlnds FnrhyofFrjory rhar rhc( i\ tr co.sfl.rion hndinp r8ctrcy ior lhc Frr'onrBnce oilhc wo.k fd which rhis Frrn n
<br />hsued (S(. 3097. Civ. C )
<br />I.EIIIIANLIE1;I,IIAIION
<br />I hcrcby rfiinn undcr pcnallyol'pcriury o.c orrhc iollr*ing dcchdn,trs
<br />o.rmhiotr P.nnils.Ashc(os Norificlriotr ljedcrll Rc8ulirion( ( lirlc40. Pfi6)
<br />Rcquncd htrd of Notifi cnrion
<br />I ccnilyrhrrrh.lidcrrlnguIrn,.\ ruBIding a\tf,{r\rcntr,\rlrrc trfr,']Ini.iU. r. rhi! Dtrrlccr
<br />-l
<br />ccniryrhlr I hdvc rcadrhn smliclrionud sr3rc rhlrrh. lhovc irlonn ion i\comrr I JFccr.cotrflywirhallCirynnl Counry
<br />ordinircc\ ud sttrrc haseLl n,6uiklinscondn'cri,,n. ud ltrrc$yaurhornirqr.\c rdnc\ofrhnCiyandCounryroctrrcruF)nrhc
<br />ih^r nrinor[d ftulEnt ior
<br />Aorrli..nr or l\a.nr si,tno ?
<br />'D!f.B-W,.t7-7rE@ldwi.i
<br />-<;-
<br />,'l
<br />Subf loor/VenVlnsulation
<br />Pool Fence
<br />Flood Zone Certil.
<br />FINAL
<br />tu6
<br />@ ,'Z-tue
<br />Liccn* Clas:-Liccnr Ntrntrr:
<br />-
<br />Date Clonlrtrlor
<br />Gndcis AddE$:
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