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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathin s
<br />Shear Wall
<br />Framing
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />ty Final Beport
<br />Engineer Final Report
<br />FINAL 1\5 \\r tAAAl9t
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc
<br />OWN!:R BUII-DNN DELCARATrcN
<br />I lrrchy il1lr undcr p.fuky ol Ftury rhjr Ln crcnllr riofl rhc (irntu.t8 t-i.cnsc tjw aor rhc tulloling rerson lss 70ll 5
<br />lrusinc$ rd Profcssion Codc)r Any Ciry or Counry which rcqutcs a pcrmir to con(rcr- llrcr. in,provc. dcnblirh or tuprn nn!
<br />{tucrure. fi{r h ik is$ancc. al$ requtc\ rhc trptlicanr i, such F.r i( h filc r si8ncd qarcmnr rh hcor shc h li.cnsd plrsuutrl
<br />lo rhc [ovnions ol lhc Conrrrcroi\ Licen*d Lie (Cnnpicr 9. Connncncins wirh Sr.ri,in ?(xn or Divhn,i ] orrhc Bu\inc$. d'
<br />Pn)f.s\n,.\Codd)orrhrr h.or\hc is.xcnft rh.r.lro md rhcbd\i\ lor lhc rlLScdc\cmprion. AnyviohriorofSedn,nT0:rl5byany
<br />!p!licanlInr ! Dcmnr subjcclsthc lpDliconr io acivilpc.rltyoinor morcrhan fivc hundrcddollrs (S5(D)
<br />I. $ .emr or rhc Imlrny. ofuny cnllorrcs willr $0gcs .\ lhcn wlc comn trs{rt'n. will d,, thc worl ud rh. ntururc n
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<br />irlcndd or oficrcd lor * c (Sa.7Or4. Busincsr and ltolt$ions c(ic: 1hc Coftrcnn \ t-i.cn\c tiw docs.or appl] ro an owrcrof
<br />rlr pnDcny rhd huilds or nnpolrs rh.dn. trtol wlb d*r {.h }.rk hins.llor h.s.lfor lhbu8h his or hcr own cmpl{,}cer
<br />|r)lidcd rhi soch i'ntnrmnh m nor inrcdlcd or oflcrcd lu sllc li h.w.!rr, rhc hoildir8 or mq,mvcmd k soH tr irhin orc )rff
<br />ot co lpkri,.. de owmr Builcr q,ill hare rh. budcn of rmvir8 rh.r tE or shc did ml l[ild or iq,rorc rhc pmpcny Ir rhc lxrrr,* or
<br />I. d .wmr ot rhc !n,p.ny, ,$ cxctusivcly .onhcnn8 wirh li.ctr*d .otrx.cto6 kr connrucr lh. projd (Sc. 70llt, Bu{h.(
<br />ntrd l')Dfcsir codcr Thc co r.clois Li.ctrsc Laq docs nor q,plyro inowncr.lpropcrrywho hoikl{.rin'!n*$ lhcrcofl.
<br />r J uho .onrrkh ftn such tnoj(rswi(hr(innrrrr{tr1\) li.ctr{d nrr{'r
<br />I rtrrcxcNtr undc. Sc.
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<br />I hcrcb!.fin utrdcrt n.lr' ol lErjury om ol thc 6ll.wir8 dccld diotrs
<br />-lh{vcudwillnui
<br />rinaCcnifralcolCotrr.lroSclf.lNurciorsorkcn conl',.n\cri(,n- ar t,n,vidc{lrorbyS.dionl?molrhc
<br />trbor Codc. foi lh. p.rfonrokr ofrM w.rk for which rhc rcnnn k issucd.
<br />_lhrlcrndsillnBt rin*o*. conr|f,ilrrion in\rrxNc. ss rrquind $yS.rrnnr 37(nofrhc ljh.rC.dc. forhctcrli'inrnccof
<br />lh. sqt forwhichrhh Fnnir is isu.il Mt sorkcr'compcnsa,ion in\urd.c .rri.r dxl Fri.! nuDbcr m
<br />c8rier:-
<br />PolicyNumber:-Eipir$
<br />I ccnifyrhrr$rhc |crlmmrncc frh{qolklirshi.hrhispcnnrtnt$d.Ishlllnorcntplotoi,tAoiindynritur
<br />$ h hconE suhrcd ro ric sorkcrs comr.n\aiion trws ol'Crlifornir rnd rgRc rharifl should bc.onr suhjtct to lhc
<br />*qkcrs compcn\rlbn povi\n,n\IfSc.rion:17(noirhc lrhtr Codc.lshall. ndhwirh.o'ntly siih rhoe ptuvisnN
<br />railur. t, {.u'. s6k.rs conlkniari(,n.ovcrrlc i\ unlnqtuL iM shrll subJccr (n cDDbrc
<br />k, oR hdtrdrcd rhou\rhd dollrrs ($lm.mO), i'r addti(itr k) rhc
<br />D&I'.AMIIQN
<br />I ncrchy 0rfirnundcr pcnahyo{!.rjury rhnr I ar licctrxn undcr provnn,n olChsprcr 9(c.rnf,n.in8 Birh Scclirn ?OO0) otl)ilhnu l
<br />oi thc Busircs.nd Pnicsions Cone. ud nry liccnsc is ir tull hrcc ordcilccr
<br />De:
<br />!ANI|IAIJEIIONIINDINC.d(iENCI
<br />I hcEhy atlirm lndcr p(nillyolpcrjury rhd rh.re n, con{tucrion hddi',9 rlcn.y nn rhc Frbnrrflcc olrhc $ork fin *hich lhh lf,rn,ir i!
<br />is{rd isc. 1097. Civ C.)
<br />ATTUCANLDIiILAAAIII}N
<br />I llrb! dmnn undcr t nlhy ol rerjry orc oI thc follouinB d(lar.rions:
<br />Dc mlniotr P$nrir$Aih.{os Nolificario. Fcdcrrl RcguhrionslTirlc 40. Pan6)
<br />-Rcquncd
<br />t.llcr of Norifi calirn
<br />I ccnifyrhJr rhc l.dcrrl rrgullri,)ns rcgrrding a\tf,no\ rrnntrr]rc ior rttlrablc k, rhl\ |n,,l..r
<br />l.idifyrhd I ha!. rcril rhii {tli.drion turl starcrhir rlx dx^r rli)nnd agre rocomllywirhrl Cnyr d CouN)
<br />ivcs or rhnCnyaDd Cotrnryh cir.r ur,, rh.o rncr\rnd srrrc I r$\rlrri,r! k,iunrg (otrnn:.rnn, r hfch\ rrr
<br />rtxrc nrnri,nrd nmai.nr lbr ii
<br />ADpliNnl or A€nl Sitnnlu(A'h-A,r}le--1e:/*
<br />Set Backs
<br />Flood Zone Certif .
<br />Lcndci" Addrcs
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