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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OIVNIiR BUILDER DI'LCARA ION
<br />I hslby afiinn u.dq !.ialry ol perjury
<br />'hfl I m ercnfl &on rhe ContacroE' Li.mc tjs lor lhc tollo$iu r.en (s(70115
<br />ausinBs dd Ptulcssion cod.)r An, Cny or connly $hi.h r.qft6 a l.mir to con(dd. .llr, inprov€. d.molish or rcpat any
<br />sttu.tuq prntr ro ns isumcs, also reqoirB rhc arplica.t lor su.h Fdmi ro 61. a sisned slalmqr thar hc or she is licceJ pusuam
<br />lo lhe p,olisions ofthc Conrs.ror's l-ic.n.dl Ii* (Chdpl€r 9, Conmdcing wirh S..rion 7000 of Division I otlhc Busin€s and
<br />PmfNions Code)or rhd h. or sh. is.rcDU lhd.fro,n ed rhc bsis for rn. allcs.d erarption. Any riolalion oas€clnn 70.r I 5 by any
<br />applicanlloropqnitsubjdslhcapplicanlloacivilpcoallyofnotmorclhalivehutulr.ddollds($500).
<br />l. s owns oi the p' op.ny. or my cmrlo)6 rvilh rvas6 as thcn eb comp.flsatn'n. rv,ll do lh. \vorl dd lh. stnrdu. G nol
<br />inrdl}, or onecd lor slc (sd ?0l,1, ausind and Prof6sioc C.dc Th. contaclois Licm. ti* do6 nol arply to u o$r.r or
<br />lhc pmnsly who builds or imrmr6rh6sn, md who do6 slcn m* himsclfor h6.lror thnush hir or hd o\t onplot.e.
<br />providen thar such imlrcrmrs de ml i.rad.n or ofi6d ror slc l[ ho*6,6. rne bildin3 o. impro\ orc Ls sld *irhin on. !s
<br />ofomplclior rhc orvnd aui&r qill n.1. lh. &rdo olprolinB rha h. o! sh. did .ot hild or inplov. $c popqly ror thc purlrr or
<br />l, 6orv.ooflhc propsly. an€xclsircly contraclina virh licmsed conrEclo6ro conslod rh. ptuj&r (s...70,14, B6ine$
<br />an! It$iission codc: Th. conracro.s l-ic.ns€ Law do6 nor rpply ro d ownd o f propcny *ho buills or inporG rhd6n.
<br />and rvho Lonrrr(s lor suclr ptujeB virh a Co.tradork) licc,6.d pu6u&r lo rhcConlr.crofs Licmc l-.w).
<br />la exempl und€.SL{rnrn
<br />TOBXEtsS:COIIT&NSAIIA!plcldSauaN
<br />I h€r€by amm undq p<nahyolFjuryoocolthe lollorvins d(l{atio6:
<br />lhaLeod willnrinr.in a Cslificate ofCorear to SclllBure lor workgi coopserio.,6 povid.d for b! s{rio,r l7L{ ollhc
<br />L.bor Code lor rh€ pqfom6c. ofth€ Nort lor which rhc pmnil is isued
<br />I halc and s ill m.inlai6 soil6' co'np€nsalion iNornnc4 s r.qon.d by Sdion l?00 ol lhc libor Codc. aor lh. Fdaomdc. of
<br />rly. \'nl ior {htrhrlspmir i!i:{c.l MJ ror16 r. rprMrionrBiaNecanin udpoli!)7^" E:re,1a*r OeltarY''
<br />\,,,.,,.,,,* (' e?at > tszllLl,,p,e\t /s/i
<br />I ccnilylhar in lhe p€rfonnance orthc Nork fo! phrch thh p€mit t l ndr mplo! any lcrson in anymanner
<br />e 6 ro laoh. subjer lo $c {0*6'comFMrion L*s oacali iil shotrld tEcoflrc subj(t kr rhc
<br />s! m c.nrpcnsirrcnpfuvisionsoiSr.rtnr :l?00oarhc Lalttr
<br />\},rxNlN(;, riaihrc 6 KLre \rorlcB conr.rrdi.n ro\crrrc
<br />n 1076 oarh.l:bo.Code imdBr ed rtrdlrB's IG
<br />DEQAAAIIO!
<br />I h6.b, amm undd F.nalrt of p.rjury lh.l I m lirdsed und6 Fovision of (.omnrs'ci.s s1lh Se.|on ?000) of Dilision l
<br />o, rhe tlN,n.\s and lrol$n.ns(inlc. tu rr- lircdsc is i'r tull li,'rctutrl- <-93 q?k:
<br />')mtJi <&)
<br />S)adgasgltst!!!lell9Elf!DDc1(4l(!
<br />I hdcby affinn undd p.nahy o f tajury thal lh6e is . coNruclion ldding ,86cy for lhc pgfomucc of th. work lor \'hich ihis p€flnit is
<br />issu€d (Sc.30!7, Civ C.i.
<br />AITLJCANLOECT AAUO!
<br />lhex6, aliinn lhdd po.hy olpqjrry onc oflhc follownrs d(ldalionsl
<br />D.N)hion Pmirs Asb6ros Norincarion l.der.l
<br />Re!uncd Ltrd of Norifi calion
<br />I cslif! rh.r rhe l€ddal!4ulllions
<br />lcdriryrhar I hnve rad lhis a l33relo comply*irh all ciryand counry
<br />ordinan.s &d Srar. La\* r.larih8 6 oflhis Ciry dd Coum, ro drc upor he
<br />rlx\c tr,.[r(md p'r|rnr ln,
<br />/,lpptictnt or,lgcnr sigrutuc,
<br />\.rn,irce n Dc(prnrr):lt ,,,," Lbltt
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u lation/Energ y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL L- f -/5 t ala Ja /? (crY)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Set Backs
<br />Flood Zone Certif.
<br />cNil fin6 trp Io otr€ hun&€{l lhoGand doll6 ($100.000),
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