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BUILDING. INSPECTOR RECORD
<br />SITE-WOBK DATE ID/SIG.COMMENTS OWNER AUIDER DELCARA ION
<br />I hcrchy rffiirn undcr Fn.lly ol ncrjury Ihal I am cienrpl lmm rhc Conlruck,s Lkcnsc tis ttr rhc rollosinB rcn$n lscc.?01115
<br />Businc$ und Prolc$ion Codc) An, Ciry or Counrt which r.qunG I f,.mi b con(flct. itcr. nnprovc. dcnn,lish or reprn dny
<br />srucruft, pri{,k, ik issuakr, al$ icqu,rcs thc appli..nt for su.hFnnir io filcu siSncd (arcmnr rhar h.orshc s Iiccnscd Pulsnnl
<br />ro rne ll'ovisions ol rhc Cohktrdorq l-i.. {d hw lchaprci 9, co nmrcir8 wnh Scclion 7O(x) o, Divnion -r or th. surincs 8nd
<br />Pbrcsnn*c(dc) orrhar hcorsh. iscxcmpt rhcrclrom d rhch0sk rhrthc rllegcd cxcnrpiion Anyvn.rn,nolsNrionT0ll Sbyury
<br />,ppli.rtrr r'or. lcmt suhj(klhc aprlicrtrr to acivilpenalryofnol nutrc rhan fild hrndr.ddolldsl5500)
<br />I. as owftr uf rh. phlEdt. or trry cnpk)rccs wirh w!8cr {s rhcir q,lc conrpcnsllion. will lo rht *ork .M rtr $u1uE i nol
<br />inleRlcd oroicrcdntret(SE.'7044.Busi'rcssmdProlcsrnr\C.d.'Ihccontrud.r'sl-iccnscliwdocsno!aprlybrnnwmrof
<br />rh. pn,lcny who blild! or im0mrcs rhcmD. ard *k d€s skh *on hinsclr .r hisclf or lhntrgh hi\ or h.' oen .hnloyccs.
<br />pn lidcd ih sxch i,npoRnrots m mr i cndcd or orLred ior $h lt hrw.\ti. rhc buildinB or inuorcfltnl is sll wirhin nnc Fr
<br />olconDlction- rtf, O*ncr AuiBer willhiwrhc hurdcnolp vingrhnrh.orshcdil mt huitl or imtmrc lhc pmpsry fo h. tx{rs of
<br />-l.
<br />rsoemr.llhc ptr,pcny. rnrcrclusivcly.onrJ.ri'rg sirh li(n{J..trt..ron ro consrrucr rtEIrDjccr(S( 7o,rl. Brnrcs\
<br />rd A.r6rbiCodc:rhcAnnriclofsl-i.ctrscLtr$docstrorrDtlyro!oowncrolprupcdywhr)huildsorimt,rcvcsrhcrcon.
<br />and who onrEchfor\!chDmjcctwirhrConrri.hnr)lic.n\cdtursurnit,rhcContocrr\l.i.cn{li,r
<br />-l
<br />m cxcmlt lndcr Sccrion-. B & P C, ror rhis rcason
<br />D e ()*n..
<br />wl|RxFrRs' c()1!tPENSAT|()N
<br />DlictlSalro!
<br />I hcrchyrlfthun&r |[ rlry.rFrjuryoDcoirh. lolkJwine ilcchrnrions:
<br />-l
<br />hr\c ani!ill roinrain r Ccnilicrrc of Con{nr h Scll l,nrrc lor w.rkcriconrcn\rrii{. \ ln,ridcd nn hyScciionllT(Xrolrhc
<br />hborCodc- l'orihc pcriaflnuccof ric work Iorwhth rhc !.rn1ir is is\xcd
<br />I hrr rid will dainraid wurk(r .onUEns.r ior irsuriE_c. as rcqutcd hrSccrnr lT(x).frh.Lrbor(odc. forrhc pcilirrnDnce oI
<br />Itu worklnrphichlhh pcinrir is nsucrl MyBortc^ comFnsrn,n i.\rrak..ricr tut golicynuniEr !rc:
<br />.i!il finci up to onc hundrcd rhousrtrd
<br />srrnr 1076ol rh.lrhTdrl. i, .rrd:
<br />rx)rxn) r I .inlr.n !, rh..t onD.nsdjon. dflmxcs rs rrovidcd f.r rh.
<br />I hcrcny ofinm undcr pcntrlry of p.rjnry rhrr I m lki{'d undcr l)nrvknr olChDlct 9 (comtrEncinB wirh sftrbn 7(x)0, olDivisio..]
<br />ol lhc Busincsrand Pmfcsions Codc. a.d my licen{ i\ in fulln{a.MclTLtl
<br />06- ie,\E
<br />I hcr.hyrllnnir .rNnrll!.1 t)r'iu\ rhxr btrdirs arcncy l,trrhcpcrlarnur).c ol rhcNork lor ahich rhi\ pcnnir i\
<br />ks'dl rS.. lrrS, aiv C I
<br />trtrd.fs Nimc:
<br />A.ttLll'1lt{LDE.eLn&trIAN
<br />I lan hy rlltm ufddr |[trrlry ol Nrjrry otrc.1rh. lnlk,*ir8 d.chrrrur
<br />lXrnlirior Pcnnirs Arhcslos N.lific!lion I:cdcrrl Rcgulrri,r\ 1Tilc,l0. Prrr6)
<br />Rcquncd l-cns.i Norifi c.rion
<br />)rc i,lnrn r,r, n (r'..r l ilr.. r)..n )lr_ \rlrh xll (iryrnd (irtrrv
<br />;lhcr.byaurhori2. rcrc*.rarivcs oflhis Cily and Coury b Mr.r uBitr thc
<br />5e-Rct., Jo
<br />06^ t€-18
<br />Set Backs
<br />Forms/Steel/Holdowns i
<br />Erection Pads 1,14 L\{D
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing 'z r?-t)
<br />lnsu lation/Enerqy I
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL ttr lltt \.rorlf r.r,r,":n f,?.>)
<br />Certilicate ol Occu anc
<br />Notes, Remarks, Etc
<br />T-Bar
<br />Flood Zone Certif .
<br />Policy Numbcr:-Exrircs:
<br />-lccnilyrtu
<br />inrhcp.nnrn Rc ofrhcwork (tr whi.h rhi\Frnrn k Gsucd.Ishlllnor cmlk,yrn,p.N,n inan, manncr
<br />$ N h hc<,rc suhjcd to rhc woltcn conDcnsd ion hws of Calirorni( xnd lgN rhr il I should bccoaB subi.r k, rh.
<br />sorkc 'comtcosariontDrnionsotSccrio..lT0Oofrh.l,rhrCrxlc.lshnll,fodhBnhconrply*irhlho$F,vi\ions
<br />WARNIN(;: Fdilurc kr sccurc workcm compcnsorbn covcra8c l\ utrls{iul, nnd \hrll subF.lr { cmPlor€r k, d,ninrl Fmlrics rnd
<br />o".".o6-t8-\F
<br />Lcnd.r. Addrcs':
<br />-
<br />I rh. lr{lcn'l rrsuIrnn] (grd,tr! rshc{o\rc tr)vrldc tror,'Dnr.xnlc h rhl\ f',)ir(r
<br />I
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