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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWN!]R BUII.D&R DET,CARATION
<br />I hcrchy rftlrm uNtcr tlcMlty of pc4ury rhar I am cxcf,Fr fmrn rhc contmdon t,i.cnse L0* thr lhe lhlbwing rc!\on (sm70.115
<br />B!\incs and Plofcssion C.dc) Any Ciry or Colnly $hich lcqutcs ! ricmir ro condtu.r. drcr. iolrovc. &mlish or Eprn rtry
<br />eru.rurc, prtrb ih i\surnc.. alh dquir.l rhc,ftli.anr Iq such Birnir ro lllc r siSncd Mlcmm lhll lror shc is liccnrd pu.\Enl
<br />r. rhc !r'!nn,ns o, thc Conrr&tr\ Lice sed hw (Choprer 9. Co'nmcncing wirh sccrion ?fiD or Divirbn 3 oflhc Busincss otrd
<br />Ptur.*6n\C{dc).rrhlrh.orrh.is.x.mtrrhfi.fronnndrh.hdskntrrh.alkecdcxcmpti.n.AnyvioldionofSccrion?0.ll5bruy
<br />0pnli.rtrrfor rFrnrn subi..Nrhc afplimntloacivilNnalryoi.rfrorclhntrlivchutrdEddnllars(S5m)
<br />-
<br />l. a\ owncr ol'rhc Is,I,cny. or art cnuloye\ s irh wrscs $ lhct $lc conDcnrrri,,n. *ill d, rhc sd'k and rh. nmrurc is nol
<br />inrcidcJ orolTcrcd n {lt (Sa 7044. au\imssand Pmf.\sion\Cod.: Ttu G rrntr'\ l-i.cnsc ti* do$ n.r ltply b atr owmr of
<br />rhc nmpcny whrbuild\or inryovcs rlE@n. ntrd $io n€sn(hso* himsclr'orh.r.llorihnruehhi\ orhcrownc rlotcc\.
<br />povidc(l rh0r sk h imporctrrnr .E rn inrctrdcd or oitrcd f,, srL ll hoscun rhc t^rildirS or nnpnumnr is sold Nirhi" unc Jcr
<br />of.onlphrbn. rhc O{nq Builder will hrv. rtf, bxrdcnorpmling rhar hc o' \hc dil frn buiLl or inlmtrr ihc pn)t'cn, for rhc purlr)r ol
<br />l.asoscrofrhrfrn'p.dy.rmcxclu\ivclyc.k.rinBpirhIiccn*dc.rricl,)ntocon(rudllEpojccl(S.c704.1,Btr\in.\\
<br />and Pmfsshn C{nlc:'l hc Conkmkn r l-iccisc l.a*d@s nol lpllyxr rno$n.r ofpropt }shohuikhornvrovcsrhcrc.n.and Nho.onkactslorsu.hrrojccrswith0Conlmcr.(s)licctr*dNrunnrrorhcC.nlnclolsl-iccnsljw)
<br />l.ncx.n!, undcr S(rion .8 & PC lorrhis rc.{[
<br />rvl)ntrE&5tloufENtalla!
<br />DECIAMIIAN
<br />I lNrchyrtllrmu crnrtrrlryol0cruryorc.llrclnilo*insdc.hnlnN
<br />I hrlc rM will nmi.rain !CcniarcarcoiConknr loSclf.lnsurcfd wor[c6 comncnso!ioo.as proidcd io, by SNrion ]7m .f $c
<br />Latxtr C.d.. Lrrhc pddbmnncc ofrhc wo* Ior which rhc l.nhir h i\sucd
<br />-l harc and pillnrairr.iD Norkcr' conrr.trs0rion nNur.kc..l rcquncd hySccri.n lTlX)olrhc ljborCodc, for rhc pcrlornBmcof
<br />trh(h rha Dfin r t n\uel M\ "orlcr r0. Sa,aa rVafidtu/'nnttr,or n irNrrncccdtricr undlt,lt] nu rhcr c:
<br />lns (" L"c
<br />trti tq -ocl nt-or-7aFl
<br />I ccnily rhri i'r thc ponnnmn.c.frltc sork li)r *hirh rhi\ tciinir i\,!sucd. Id lltror cmDloylny Dcrs,r n, rny nrtrncr
<br />v, ns lo hc(nrE \uhjccr ro rhc sorkc6'.onrr.r\[ion hws ol Cal]lnn,ix. rnd ag(r rhrr if I \h,uld b..o'fr suhrccr !i rhc
<br />Norkcr\ conrpctrvri,nr pro!i\i,'n\ ofSNrnn,l?(X)olrhc lf,hr Codc.l\hrll. n)nhNirh c.nr[y wirh rhoe !rovirion\
<br />WARNINC: Fdurc lo scurc worken compcnsation covcmse is utrlawful. ,nd ihlll suhjc.r .trlr.y.r !).rinrinal I{nrlrEs lnd
<br />civil 6tr.r up ru onc hundr.d thous0nd dolh6 lsloo.fiio). h .ddirion to rnc cosr ofco
<br />Sr.rirr:lll7(orrhc trlrr Ci c.ir cr$rnfttrtrortrcy \ ltcs
<br />,lt)8'2otz
<br />I hcrht affirm undcr p.mlry ol p.rjury rhar I 0m licch*d und.r tmli\ion oiChaDtcr I (commrcins wirh S(rk,n 7m0) olDivision l
<br />ol
<br />'hc
<br />Buriness und Pmfcs\ions Codc, ard ny ltcn\c is in flll aorcc utd.ff&r
<br />' " -"-A t2Q
<br />O"r", , b'l<4)8 c.'r*"* !=
<br />issucd 1Sc. :1097. Civ. C.)
<br />I.ri'll rhrr1tu ltdcrJl ,.3!hrnnn rugrrJr! r\la\r\r.trirrlrr. orit)t)lntrhl. !' rh \ U(!r.l
<br />lc.nifyrhd lhrvcr. rhis.nplicrinnlxlsiorclh thc $ovc inl'onn ion hcotrccr lrSmhcdnrplywirhrllCilyandC.unly
<br />ordiMNcsnnd sr,rc Ltrwi rcl,rinrlobuildin[cotrsltu rn)n. k] hcrc lurhorizc rltrc{nr,rivcr ofrhi Cny.nd Counry lo cnrer upor lhc
<br />rhrc Dkn1i,) rtl 0'o|cn! ttr i'*t..ri(,1
<br />,r,,,,*, - n*-, t,".r*" }(
<br />"-,r**-",rrr,, ><LlC?
<br />''gh
<br />orqi CL SFrllqc-
<br />I),'lr,(!-lt'ZDE
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />t'loof Sheathing
<br />Shear Wall
<br />Frami ng
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Beport
<br />Flood Zone Certif .
<br />I
<br />FINAL z,/4/t {4WL U]
<br />Certificate of Occupancy '7 7-71
<br />Notes, Remarks, Etc
<br />--+
<br />Set Backs
<br />UFER Ground
<br />AfILISANLDECIABA:IIO!
<br />I i.n{'y nrfim undcr pctr0lly ofpcrjurynn. ol rhc n'lhwin[ dcclorlrn]ns:
<br />Dcnmlirion P$mir+AslEslos Nolincarion rrdcnl ltc3ullrions 0 nb &. P!n6)
<br />-Rcqun.n
<br />kttc! ol Ndili.ation
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