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BUILDING- INSPECTOR RECORD <br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I ha.nr lmrn und6 pdulry of l€jury lhn I m .xmpl fmm lh. Contl.ior Licmr L,w aor lh. folhunB la). (S< 7011 5 <br />Bsird lttj Eof@$n ('od.) Any Cily or Cou y *hich rcqun6 a Fmn lo otrslrucl. .lls. i,lprov.. drtrolilh or .e.n &v <br />'lru.lu.. Furo ir! istlNc. !t Equtd rt ipplt&t fot N.h Fmil lo 6k. rigr.d lrdffil lh,lEornE i! ll.E d pullul <br />ro rh. p.ovnioB ofrlE Conrrtd 3 Lrc.ned t w (Ch.pia 9, Comdins wih Sethn 7000 of Divi,rion I ofllE ao.nd{ud <br />PFf.sio co&)o! $d lEorth. ir.tmpl lHrcm ud ll! b.sa lor ilE alLg.d aanFion. Any violrlion or sdion 701 l.J bv x, <br />lpt icd lor . Fhn rubj6l3 rh. .rtl(er io r olil p6.h, of mr mr. rho fiv. hui(h.d dolld (ttj(}) <br />-1,6 <br />o*G ofrh. Fop6ry. my anplor6 *nh *.s6 6 En $k mmFE.lbr nill&' lli*ut td dE rnlrci tul <br />idar&l o. ol[Ecd for rl. lsd.'704a, BuilB rd PbadioB Cod.: TIE cdmrdd'r Lilg ks &6 mt Tply lo e o*G of <br />rrE rmFr, *'lb hritld inqoc tlEq dd who &GshErt hirelao. h*lf or NU3h hit or tE o*n dqht6. <br />Fo\i!.d rhn ruch lqro\qlEBE d -rdrd.ddotu 6.5l. l(hoGE tlE hrildiB itrp.sE'd Brldxinoffi rs <br />of o,pldi(a rlE (XE tll,ilds wU h.* dE hda olFrrr8 dr lE d ilE dd dr hriB or in{ftr! E FoFry 6r dE FiFeol <br />l. s of,E olrh. Flrdry. @ d.n nrly.offin8 *nh lcqB.d onr&r6 lo @nfu rll FF tsa 7Or{ tl!n6 <br />ud hDkd Co&, Th. Co.ti*ro. r Lk@ t s &,a ml .p9ly b e ow olFoFn! f,h buik! or iopm\6 lhdon. <br />sd Llb oddr lor sh rDFr snh i (bmsro(r) li.rd! poBu ro rlE codndd't LitM t r) <br />I &n .rmpl udjs sd <br />&a8f,E8StCAU.eE$AUq! <br />DESJAAIIAB <br />I lE.t) !ftm undn Frulrt of tE ur) oE ofllE folloq !l3 &clJ lioB <br />I h!r.rnrillri d ! Cdrfdr. of Colmr to SGlf-lM. for *sk6t comFrelion. B pro\ iicd for b} Sdr io. r 7(r) or dE <br />Irhr ( od.. fn rlE Ffolrm. otrh. *oit 16 whth rh. Fmn ii iscd <br />-I hrvc rnd wlll m.inr.i, mrtdr comFlllir cu@., s rquir.d by Sdbn 1700 ollh. Irb.r cotL. lor lh. FfomE. of <br />rh. s..l aor $t&h thn Fnn i! &.d My hrla odFriion iNffi. ffi, !d Fla' numbd R <br />M;(sTSot)61 6 t2't?.t/ <br />I.dif, th.t in rh. p6lum!tu.of rh. worL ior whi(h rht p.mi! n issued. I shallnol oploy ey F$. in &y muncr <br />F 6 ro hdon tut dr rd rh. *orlds' conpsllnion la*s of Califomia ud ,sE thd if I should bccomc lubjd' <br />'o <br />th. <br />wod(EJ compcMrion pnrvirioN of Sdior 17(Dotlhc llhor Cod.,I sh.ll. aonhwilh comply wilh lh.* r,oriiioB <br />WARNTN(;] l'nilurc lo sur. *orld snp@rion cov4se is lnla{ful. dd shall 3ubjd m dployd to qidinal pdtrlri! mJ <br />cnil fin6 up lo on. tund..d rhotrsdl dollaR (lloo.mo), in ..ldilion ro lh. cosr of comP.Mrion. dmasct a p6vidd tu lh. <br />Sclioa 1076otlh.lrhr(bdc, inr66t ed tltomcy ! lc <br />lx,*.,r0.te.ts ,d <br />ul.LlIl:ll.lailr.Ett-1aaDtct"l&ulQl <br />197/6 q <br />/ct. tt. l?f1r,r c6 B't' I l crt <br />COISIEX TOXI.EID|ICIGIISI <br />I h@by .frm u.& Fdty or Fiu.y lhi ltst a . olrno.ib. lddtB +dy aor llE Ff(,trlre. of lh. rdt bt rtich ltit Fni a <br />Bu.d (sa !097.( tu (') <br />Lans'r AddB <br />- <br />afSrlciuLDEcIJBAno! <br />I hddy .trm unda ,6rhy of pqu,- oE ol rh. folb*i.r dalJdirB: <br />ftmkbn Pmi!-Arb.n6 Notf!.lbn F.darl R.Euldioa (InE &. Pd6) <br />-Rqdrcd <br />lnr6 otldri6.ri. <br />-l <br />csr,[ rhn rh. tn nl r.{!hio6 rEgldin8 sbdc ,om\ d d. ml tpplk bk b rh6 FoFl <br />I rdr6 rhd I h(. ral rtir lpgli.ron nd.rdc lhd th..h.\c bfolMi'! l <br />onjimn.6 Md srlrc lis E!|lDs ro hildins.od^cro[ ,rl lE lr' rdhri- <br />ii $rdr. Lstt ro @mply vnh rll Cny .{d ( oud, <br />rq.slr i6 of rhn Ciy !d Countylo dra lrpoi 0E <br />n,, /0' I ?' l9 <br />dFvc rMr$noj rrFtdry for .EFf,ion <br />/)/run I <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulation <br />Roof Sheathing <br />Shear Wall <br />Framinq <br />lnsulation/Enerqy <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 Report <br />Flood Zone Certif <br />FINAL <br />Certificate of Occupancy <br />Notes, Remarks, Etc I hdrt ) rmim un.l6 Frliy of r.rjury lhd I n lic6!d! odd Fovnion ofchlpla 9 (commocinr wilh sd6. 7m() of Divilo. l <br />ot rhc Buld ed Prcf<n'N ( o&. dld my Ii..E is h tull forcc En dl:.r <br />,** B <br />[------r------