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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG COMMENTS OWNAR BUILDER DIILCAR TION
<br />I hcrcby rlt.r utuirr pcnrlry (,r Icrjlr, 'ha'
<br />I m excmnt ,nn rnc Conrlrtor' Liccn* tiw for thc follosine rcason (Sec.?011.5
<br />Busincss orl Porc$ion cnlc)r Any Cny .r Coxnry shich rcquircs a pcn.ir ro on\lrucr, alrs. imporc- dem.li\h or rcnl 'ny\rtocruE. rrbrro ils isu8m.. rho rcquics rhcapplicmr ror \nchFrmir !n fil.r n8n.d {arcftor rh, he orrh. i\ li.rn(d ruAaanr
<br />to lhc povnions of rh. ct,nh.tn i l-ienr.d liw (Chaprc! 9. Connncrcins rirh Sccrh 7uJ0 oi Division -l oI thc Bu\incs !trd
<br />Pnnt$ionsCodc)orrhartrorshci\crcnr,)lrhcrcfromadrhch3rnli)rrh.rlhg.dcrrntrio. Anyviolari.nofSdionT{Jll.5hyany
<br />aPPli.ur for a pcmil s!hj.{ls rhc appliclnlro icivilpcaillyofnor nhrc th nvc hnndrcd dolltrs (Ssul)
<br />l. as owtr$ urrh. pmtrdy, o' myc pk,rrc\ *irh N!sc\ u\ lhcn n'b conrpln\ali.n. $illdo lhc sork iod dE nB-,.rE i\ n.r
<br />i cfldcd orollcicdtu\nlc(SL\71}t4.Dtrsi,rcssa.dPrcr.$i{,n\Co.lclhcCorrrxctr'\l.iccn{lrwdocsnorapllyt,rnosncroi
<br />rhcrmp.ny *ho lrikls or i,ryntrr\ thcr.rm. rd*lDd.ssuchM)Rhl \clforhcrcllorrhNuglrhisorhcrostrcnrd yccs.
<br />pnvidcdlhrr such mF)vcnNnrs rc nn i ctrdcdorofcrcd for \rlr ll hoscvor dr hrikli"! ornnpn,vcmnr is v,kl Rirhin oi.,rttr
<br />olotrrLrbn. rh.O*ncr Boikhrsillhavc rhchurdcnofprolinarh hcorshcdd nor huilLl or improvc rhc pmFny for rhc purrxxc oi
<br />_1.ffowncrofrhcrrotcdt.!ncxclusiecly.o.rcringqirhliccn*d.onrrckBh.on\rflcrrl-.!n,jd(Scc70,,,1.Ausnu,,
<br />, rh,fclin C.dcr-l hc Conrrocttr r Liccn\c Law docs tror rpflyk, rtrown$ ofprnlf, ywho builds or ima('vcs rhcrcon,
<br />r.d who.onra.rsf.ru.hpDjcdssnh,co.rr.r(rlian{dplhumllorhcConklcroisl-ic.nsctrw)
<br />-lsmcxcnrfl
<br />utrdrsc.rn
<br />D.rc l)en.r
<br />uoaxEBS:l:0Mt[N,r/U!]N
<br />DIiCLA.S6IION
<br />I hcrcby.!ttm utrdcr rLnrlly of !.rjury om orrhc r.Uowin! declaration\:
<br />-l
<br />havc inl will Dinrnirr(tdificrrcofconscmr.Sclfln\urcforworlcr\'co'np.nsarn,n.!sprovidrdf hySsri.n.lT0Oolrhc
<br />LJh{.G1.. r,, rhc nfl r' tun('{ rh trr{[ r,{ {htr h rhr nonl N F.ucJ.A
<br />[f,." -o *',,*,,.* *..rch' !.nrcntui,nn ,n\dtu n.c. ]\ rcq,rd by sccr on r7., or rhc Lahor cod.. k ihc pcr,irm .cor
<br />Fc troR'nrh'.nrhr.!.na r.tr.unlMys^'1.'!..nlli.n{riin'nau'r'rr,'n*' dF,[.)ndmh.,rctfi, t+*hfirfit{ La'- 12.
<br />l.cnitr rhar in lhc l].rrornEE-'. orrhc Norl lirr *hich rhn pcrnit is irsu.d. I shdll nor enrloy any rc6on in rny nrnncr
<br />io .sto b..om.ublccr b rh. wolkc* conqE.sar io. las r ofcalilornia. atol aBdd rhar'fI sh.xld h.oft bi.rturtr
<br />*crkcr' comn ns ion pn)vkinis ol Scri ST0Oofrhcht.C,xlc.I{hsll.f.nhwirh.onrpltwirhrh.stmvhionr.
<br />WARNING: Failu,c x, sclE uorkcn conrcnsalion covcmec i\ utrhwtul. ond rhill suhjd in cmplorrr lo oininll pcullics and
<br />cilil finc\ up lonm hundEd lh.usutrl dollas (SItxJ.o&), ir rddiri.n h rhc.o{ oi.omp.n\ ion, d,.trBcs as pra! cd lorthc
<br />Sc.rn,n :1076 ofihc l.16.r C.Jc n .rc( md x|onf,v s l'.(
<br />,/4/4
<br />DECIII.BAIION
<br />I hcrcby alrnn undcr lcnJry .l !.rrury lh.l I rm lir.rL{ onder l,(,vnion of Ch.p($ 9 (.om r..i.g wnh SLlrion lo(x)) ol Divisid 1
<br />of rhc Bu\iksnnd ltofr{ionrCo ., Md my liccnsc is in fulltorcc md cticcr
<br />g ()
<br />fu)-f/ 3
<br />{:ONEISI]CUONIDNTINC.&GEtsCI
<br />I h.reby !film undcr Fnahyoi,Erjurylfial rhcrc is 0 conshcthn lcndirB 08crcy for rhc pcrt'ormancc oflhc work fnr *hich ihn lErmir n
<br />hsucd ISs. ll(l97, Civ. C.)
<br />AEUIANIDECLAXAUS]T
<br />I trrby nfllm undcr Fnnky orp.qury onc orrh. f(rbwing delrrrion\
<br />Dcmolirbn Pcirnih Ashcios Noriticrri. Fcd.rl Rcguhri{nr!1'l'irlc 40_ l,rn6l
<br />lccniiyrhdrhclcdcr.lrcguldi()tr\rsrdrAdshc{o\ronnrr rrc noi qrtl .rhlc ri r,h nnic.r
<br />-lccnily
<br />lhal I hrtc Eld this rydi$lior and natc thd dc ah'v. nrfoflrkrion isc.rct. I &rre toomrly $nh all Cnr.nd Counry
<br />ordinMccs lnd Sratc Loqs rclarins ro huildins construcrion. tud h.rcby aurhorir rcprcsntlrivcs ofrhn C ymdCounryro cnrcruFnrlE
<br />lhotc mnrlncd nh!.n, n nsFllln rul?{(
<br />^ppri.sr
<br />orAs.nr srpnsrur 1l . I
<br />Pem,tumme,pr,.,,: lin 6*kt,.
<br />ilu/nt
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framrnq
<br />lnsulation/Ener sv
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL Alzfllt ,,(,u/E(/9)
<br />Certificate ol Occu -Ipancy
<br />Notes, Remarks, Elc
<br />trndd'r Add'cs. _
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