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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS OWNER AUILDDR DELCARATION
<br />I h.lchy atfirm dndcr l..rlry ol trrjury lhnt I am cxcmpr rinm rhc ConradoN Liccnsc tjw ior ihc follos'ins rca$n (s..7011 5
<br />Busnrss and Pror.rsi.n Codc): Afy Cir, or Cour, *hich r.quirc\ n Fnnil io construct. .lls. im *c. &rmlish nr Ertrir my
<br />slodurc.,tior ro ils issuancc. a\. rcqun.srlt amli.r r ror su.h pcnni o ile l si3md srrrcmnl rh,r b.or shc is liccnscd Nruld
<br />ro rhc ptuvisions orrh. Conttrdols Liccn\cd Llw (Chufrcr 9. ComnEncins wirh sc.rion 7fi)0 ol Dilision:l oa rh. Busirrcss rnd
<br />Pmn$ions Codc) or lhar hcorshc iscxco,fl rhcruti(nnand rhc hasn lorrhcrllcgcJcrcmplion AnyviolsrionolSc.ridnT0ll.5by.ny
<br />lmlicanr turarcrmir \lhjccrsrhc rml'cdnr b r .ivil p.nnlry or troLRtrc lh{n iivc hund,ed dollm (S5m).
<br />l. ns owRr or rhc r$Irny. or my cmplo)ccs wilh w!sc\ !s rhct $1. co rNnsar ion. s ill do itE $ork ud rhc nmrm s mr
<br />nc cd.roficrcdforsL(Ss7044,BusircsrndP,'.Ls\ioisc.d.ThcConrochi\t,icetrEtj*docsnotrptlyloanoNncrof
<br />rhc pR,IFny wh) hikls.i itr{trorcs rlTmn. a.d Nho docs sEh *o!t himsclror h.r*lfor rhn,ueh hn orh$ o$n enrpbyccs,
<br />lrovidcd rhat such imlrorrrcna aE nol inlc .d o, olibrn for st li. h,*dcr, rh. bui i.8 .r i'iprcremnt h stl wirhir orE )tr
<br />of compLri)n. rh. Osncr BuiklLJ wi)l hurr thc budctr of pmving rh.r hc or shc dil ftn huiu o' itrrmlt rh. Popcny lor rhc PITnE ol
<br />-l.
<br />rso*ncrolrhcnmpcnt, amcxchrivclyconricrins rilh licensdcoir!,ct,Et,.onslruclrhc projccl(SN.' 7l|r]l, Busnc$
<br />ml Pml6sbn Codc: rhcCo racrofil,iccn\.I-rsdocsioitrptlyk,an.qncrolpii,pctlywnohuild\.tnnrrolcsrhcrcon.
<br />,!d $ho conr,ac( for such pn,FcR with r Conh.lor( t lic.n€d prsuunl l(' rtu Conkrt \Li.cns.tiw).
<br />I Jnercmnr undcr Sc.rio n ,ll & P( li,rlhi\ rcxvtr,
<br />lvaaa!8slaufENlarloN
<br />DECLA&IIII)N
<br />I hcr.by.llirnrundcr l{nalry ot p.rjrryoncofrhc tulk,wiig c.hrdriorr
<br />l hn\cadwillroi 3inaCenificarcolCoisnrios.lllnsurcntrworkcs coorll{nslrion. as providcdforbrsc.riotrllmofrhc
<br />bhi, Codc. r.rrhc Frrorm,nccollhc work forwhich thc pcrmil is hsucd
<br />IhilcoDd*ilimrinlainworkcr\'compcnsnrn,ninsurtrcc.nsrcquncdhyScdi,)n3?(nolrlrI;lhorCbdc.rotlh-PconNncol
<br />thc *ork io $hichlhisp.rrir i\ n\xcd Myworkcis .onl).nsdn inntrnncc cadcr lnd policy tumb.r d.
<br />R,licy Nun,bci-Errnci:
<br />CANEIIIJCIION.LINIINCAGEIIT
<br />I hcrhy !I6rn undc! Fnahy of Pcrjory lhdr rhcrcisa.onndcrkn hndiryaacncy rdrhc!. ormnccoflhcso fot whkh rhis Fmir Lr
<br />i\sucd(S.c. 1097. Civ. C.)
<br />AITIIIANLO&ELINAID!
<br />I hcrby afim undcr p.trrllyoipcrJuryonc ol rhd rolk,qing dc.l-ariotrt
<br />Dcmolirion Pcrn,ih A\rE{os Notiication rrdcralRc8ullrions (Tirlc 40, Pd6r
<br />R.quircd t.xcr of Noil'rcorion
<br />-l
<br />ccnifyrhar rhc acdcr,l rcgu ld idN rcgddnrS lsbc(osrcmvalm nor,prlicibrc ro tht lmirr.
<br />lceniftrhdlhr\.r.idrhisrntli,:rri.niBlslxrcrhrrll,crh)!c,dn)nnrtr!ti!..rrccr I rCrLr t, mn'lly $ [h xl Cilyr]rdCo!nry
<br />odinrnc.\Jid Srnrc trqsrcl rn!ro huildin!cotr aulktrizc rcprc\cnl,livcsorrhkCiryindCoutrryk,cnlcrulxlnrhc
<br />$.v. nEniiomd proFny lnr
<br />^,, 6 - t/-/g
<br />Aopli.{nl {r Aa€nl sixn,l!ft
<br />f.milee mm€(pnnl):
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFEFI Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino
<br />Shear Wall ,{
<br />Framing tr-v.4'1[)
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />A
<br />FINAL 2-n-r,kJl-{,l{l
<br />Certilicate of Occupancy
<br />Nqtes/ Remarks, Etc.
<br />. L6F .L r:(u'4 VLcss'' n,n TalWl lPv
<br />L -n-t\
<br />l.dnifyrhrr idrhc pcrlbrumc ollhc worlt forshkh rhis tcrnrir il issucd.l shlllnol cnDloy uy pc^on inany mmner
<br />$ !r lo bcconr sul,jecr ro rhc sorkcA ..nD.trsar'on laws oic.lilornia. .n{l larcc
<br />'har
<br />itI \hould k{ont subF;r to lhe
<br />wortcF compctrsrion povtion( orscdion:17{x)ofrhc lrh.r Codc.lsttrll- fonhwnh.onq,ly wirh rh.s prolisions
<br />WARNING: FiluR ro NUrc trorkcr compcnsrion covcm-qc i\ unlawtul, ud \hdl subl.ct an c rployc! to dminrl l*ndhics md
<br />civil fin.\ ur b on. hxndrcd lhousond dollnn lslo0-Ou,). in lddnion b ihc.on olcoflqEnsllion, danEscs as Iiovidcd f.r rhc
<br />Sccrion 11076ofrh. titff Codc. inrcrc atrdarlorrcv sfes
<br />;",, i--il-ii :;^:^", x#-
<br />LI!.INSEO_COrrA6!ruf,
<br />DICIAMIIgN
<br />Ihcrchy.firorunderpcnalryot!.rjuryrharladli..n*Jund.rPn,vhionofChnprsg(c.nftmingwirhSccrhnT{m)olDivi\ion.)
<br />oi rhc Bu\incs and Prorc$iors Codc. md aryliccn$ h in rull ror.c &xl cilccl
<br />lxnd.r'r NMc
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