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BUILDING- INSPECTOR RECORD
<br />SITE.WOHK DATE ID/SIG.COMMENTS OWNER BUILDEN DELCARATION
<br />I h.r.b, ,fl1.n hdcr F.nahy {,f pcrjury rhrr I am cxcn{'l lionr lhc Controcxtrr Li.cnsc Lrw hr lhe follo*in8 tca{,n (S( TOll 5-
<br />Busincss !M Pturcssion ci c)r Any Ciry or G,onr, which rcquiEs a rcnnir (, con(rud, ulrcr, iNpn,v.. dcnxni\h or rcpan ,ny ,
<br />srrudu,c. p.io. ro ils irsunrcc. aho rcgun.s lhc,pdrn.r rdlu.hlfrnln r. fiL i siSmd {ar.nrtrr rhat hcor shc h liccnsd putrur.ti
<br />ro rhc pmvisions ofrh. Co.kacrofs Li.ened Lnr (Chaprcr 9. Conmcmnr! wirh Sccrio. ?0O0 of Divisn,n I ofrh. Busincss rnd
<br />Pdc$ions Code) o! thd lE or shc is excnn lhcElrcfr and rhc ha\ii ror mlhscdcx.mphotr. A.y violationofscclhn?o3l5 by 8try
<br />aPplicu artr, pcmir subjcchlhc ryplicanr l.' rcivilpcnlrryoinor nFrclhln fivc hundreddolllrslSSllO).
<br />-1.
<br />!s owrcr of thc pmtEny. or my cnlploy.cs with wag.\ d r lrn \ob .onrFns.li(!r. will do rhc work and lhc stulurc is nol
<br />inrend.rr oroffcrcdforsle(Se70{,1.BusincssandPmlcsionsCo!c:lhcCo.trocroisLiccnscLrwdoesoorqrplybanosncrot
<br />rhc pmJrdy *ho bu ds or nlll'ms rhcrlin. lxl wh. dds n,.h *rI* hnn*lf ur h.rslf ot rhmu8h hi\ o. hc. own cmDloycc\,
<br />,rov cd rh su.h inlptuErEns m mr iN.ftldl .r orlcrcd lr slc li lkN.vs, rtr btrilnE or irpmv. En( t sU wirhin ',m ]ru
<br />of comphrbo. rhe Owm, Auiucr will havc rhe hurdcn ol tmvinS lh.l h. or shc dt nor huild o, nq'mrc lic pDpcny for dc t!.Fr ot
<br />l.rsowncrofrhclln)trdy.r'ncxclusnrly.onkrciin8sirhliccnsedcofta.r{,\k,conntudrhcpn+ct(Sc.7O1-{,Ru\urcss
<br />rnd thnilsi[ Cadc: rhe Contadoi s Liccn\c Lou, dncs .or ,pt'ly ro i. owtrcr or nori. ysho iuildsoi irnprcve\ rhcrcon.
<br />,ml trh..oikacrslu\u.hr FCr\ wirh r coirrrt,( \ r liccnscd lursunr t' rh. on Bctn \ l -i.cnsc lrw )
<br />Itr rcxr rfl und(r Srcri(tr1 .ll &l!C forlhi\rr{n,
<br />lhlt: Os rr
<br />1!ORt(Ut{,i', aONt PltNS,1',r( )N
<br />I2II(IA.8{II]T
<br />I ho.cl,!rlltrn,und.rl{nrlrvollxrturron.ollhclnlbsr! ..lJrrri{,n\:
<br />l luvc,nd sillmninrain r Ccninclrc olConsc loSclllnsurclorworkcrconrpcosllion.aspn,vidcdrorbySc.rio.l?ff)orrh.
<br />Llnor Codc, rbr lhc pcrrbrntrncc 01thc $ork in lhicl thc pcnnir is nsucd
<br />I h.vc ,M will 'Dn 8nr sor*.n comJrinsdion insunn.c, a\ ftqrncd by S..r i.n 1700 of th. Ilbor Codc. fo. thc lcrformrc ot
<br />tltr work rbr which
<br />'hk
<br />pcmjr is i$ucd. My wortcu .oq,.6sario. insurano cmicr . policy numbcr rcl
<br />C.. Icr:
<br />I ccnifi rhrr io lhc rcr,onnrncc olrhc work li)r \hi.h rhr\ lcr.rir n n{icn. I shall ml cmploy rny pcron in rtry
<br />'nrnncry) d\hhLconr subJ.crh rh. sork$\' conl,cn\ ri(,n hs\ of CJlilnrnir. r lsrc rhnr if l r&,!kl hc.oN subl..r orlr
<br />qoikcr{conlpcisri(rIr'vi\n,n\ofS(rn,n.l7tX)otrhcI]htrCodr.lshrll.n)nh*irhconrtlyairhrho{tn)visi($\
<br />WAINING lr.ilurc b surc Norlcrs .onfctr\it1.tr .ovcngc i\ unlnsln]. rtrd \hnll subiccl rtr rnrDhrycr b di iMl |{nllli.s !n,l
<br />civil lircs ut lo otrc hundrcd rhousrnd dollln ($l0O.U]0). in ro Ihc cn$ ofcom0.nsrion. drmaFcs rs providcd li,r lhe
<br />Sccrion :11)?6 olthc tjhor C{tc. irlcrcsl akl nrioaEyt
<br />IIECLAEAIION
<br />I hcr.hy afln undc.lcorlrJ,oipcrjlryrh,rIuliccnsdumlcrnovnn,nol'Chilrcr9lcomri.ingwirhSc.rion7m0)ofDivsrnl
<br />or rhc Busircs rnd Pmlcs\n,ns Coth. Brtd nry licensc t in rull lirre lrd cffccr
<br />I hcEhy ailirnr u.dcr Fnrkyoipcrjuryrhor rhoc is o snnrdion hnd,ng agcncy lor rhc nffloilrBnce ollhe wori ror *hich rhis lermir is
<br />hsucd (Sec 3Yr7.Civ. C )
<br />AIELTSNLDEQAAAUAN
<br />I ltr$rrlllnnundcr,,.nulry ol pcrjur y onc ollnc lollowinB dccl!turi{nr:
<br />Dcnnlirion Pcrnrils-Ashcsros Nolifi.arion I.cdeml Rc[Uhri(trN alirlc 40. P!n6r
<br />-Rcquncd
<br />Idlcr of Norifi carion
<br />I Ndily rhd rh. fcdmal rcguldi,rns rgrdnrg a\h.no\ rcm,val m ior rmli.$lc ro rht p$jc.r.
<br />-lccnili
<br />rhar I tuvc.cod rht ryrlicdion Nrd srardMr thc $ovc informorion h conccr.I lsre lo complysirh ill Ciryand C.umy
<br />r'iinrmc\ rn'l Sr,rc bw\rcldins ro buildins! nlrrucr ion. ffil hcrchy autholtc rcI]'cpnrlrivcs ol rhir Cir y and Counry ro cnl.r uFn rh.
<br />rh.\c mnrnncd noncny rn nsrcc,ionn Jrc/'i^)^),),"^rii "-..#'@*, 7// y', I
<br />pemrire Mnc,prrn,,: 3/?a-ar" ///u rc,'o
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall
<br />framing t/z6lt*J)'J/W
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />lllasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En ine er Final Report
<br />Flood Zone Certif.
<br />/r\
<br />FINAL I -ls -tg pil-\u
<br />Certilicate ol Occu pancy sv
<br />N otes, Remarks, Etc.
<br />2,-n ,7"", {
<br />4t1i r {"
<br />Lcndcr'. AddE$:
<br />-
<br />Forms/Steel/Holdowns
<br />Sublloor/VenVl nsulation
<br />Brown Coat
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