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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATI()N
<br />I h.rchy amrm undcr,.nrhy {,f p.rjury rhar I !n crcmfl rtum ihc Cunk o^ Lic.n€ rj] lbr lhc foln,,ine rc!\,n ise70-rl5
<br />Ilu\incs nd Pn,l.\sbn C{ric): Any Cil, nr Counry whi.h rcqunc\ a Frmil t(' c-n{ruci. ,lrcr- imnn,vc. dcmlnh .r RIlJtr ;nl,
<br />nruclurc. priorlo its issunncc. aho rcquircs rhcapplicanr nn slch Nnnir t, filca riSnctl {ni.'re ( rhar h.or shc h licctr*d Pu6uonr
<br />ro rhc F)vicions of rtr Conk0dols Liccnai ljw (Chatrcr 9. Comnrcrcing wirt Sccri.n 7fiX) of Divi\ion :l ofrhc Busitrcss rnd
<br />Itoit$ions Codc)orthar hcorshc hdrcnpr rhcrcliommd rhc bffix tqrhc rll.Scd.rc plion Anyviol(ionolScdbnT0ll5brrny
<br />lItlica tu a ncrmn suhjcch rh. aptlicntrr ro r .ivil lcn.hy or &, moe th3n fi( hundrcd dollas ( t50o)
<br />-l.
<br />rs owncr ollhc prcpcny.,n mycmpbrrcs *irh wlgc\ us lirci $L compcdldn,n. willd. rhc sork.nd llE (B1urc is nor
<br />i cndcd .r oflcrcd i{n slc ( S( 70{4, Businc\\ md Pr.fc$n,ns Codc Thc G,ntr.hls Ltctrs ljw docs n l anDly ro an osn.r of
<br />rh.pn'Irny wh' hoildl or in{$rcs rh.mn.,nd who d6 su.h work him{llor hcselfot rhmu8h hn or hs osn.n'plotc.r.
<br />providcd rh.r ruch nprovc.rflh orc ml inlcdcd or ollcrcd ld $t. Ii howcvci rhc trikting or irnprow@nr h $U within .rc teu
<br />or.nnd.rion. rh. Oen Brild.r willhrrc rhr bunt i ofl)nrin8 rhd tr or \h. did ftn hriu or mro\r thc pmpcny ior rhc I,UqD*oI
<br />_1. a\ o*ncr ol rhc proI.ny, I'n cr.lusircly c.dr!.i ine wn h l'..rs.d ..ffrdois lo coNIrucl lhc pmicr (Sa 7{X4, 8u\i'klt
<br />ld Plo,c$rm Codc:'l h. C.ntraclols Liccnsc L.w docs noi lpplyb 0n oqocr oipropcn, who build\ or i4pbvcs rh.rco[
<br />atui sh. con'recrsri'rsuchpmjech wirh r Conrracro(n li.cnsci pu^nanr b
<br />'h.
<br />c.turtyt Li.cn* tjw).
<br />I u,.r.f,fr trmLrr Sr(rion l] & I( lnrrl'r '.I\!l
<br />lhl. ()sncr
<br />Iraa(!8,slautrNtAflaN
<br />DECI.ANAIION
<br />I hcrchyrllttrrunlcrNNlryolp.rjoryomolrh.latk,win!d.cl ainnB
<br />-l
<br />htrvc rlsillnDinruin oCcaincircoaCon*nr ro Sclt ltr$rc tirr nukc.s con.nsarion. $ pblidcnlorbySccrionl70t)otlhc
<br />trtr, Codc. rd rhc p.rroflmrcc olrhc work rbr rhich rhc Fnnii k nsucd
<br />llt Bork ntr which lhisFrmir i\ i*kd Mys.r*.r comrcn{ri(,r iisurntr.c {rtrr aM Inicy nunrbq &
<br />I.cdirylhd nr$c pc.roirnrrccollhc sork for whi.h'hh |Eflnil i\ i\sucd.l shalln.r c.rthyrnt l.non in rnyarmncr
<br />s s to bccomc subicl ro lhe qodss onrpc.slrtD lnwi of Caliturnia, .id .grc hd iiI slFuld h.EonE suhjsl b rh.
<br />workcn' comncns0r ion pntnn,n{ ol S<t ion l?(D ol ihc I nf.r Gxlc. I shall. lorh*irh comply p ilh lhos povnioni
<br />WARNINGT F.ilurc k, surc sorkcr'conpcnsirion.ovcn8c is utrlowfdl. and \hau \ubJccr !n c.rtlo)tr lo mminllI4n!lrE\ lnd
<br />.ivil llncs u,) rJ.rc htrndrcd rlrcusnnd doll s (Slur-0OOr. in oddilin io rh. con or.onP.nsnriotr. daM8cs 0s [ovidcd rbr rhc
<br />sccitun.1076 ofrhd bhr Codc. n crc{ snd rrronry s fccs
<br />?,o g", ) r.26/zt I tl ^epr@nt, fu.le 4
<br />Llt:Ell,l[Ill;0Nrldcroa
<br />DECI,ASAIION
<br />I hcrcbynlft'nundcr pcnllryolpojurr rhur I an li.cn{d und$ tn,vkirtr olChoflcr 9 (comnrcrcin8 sirh secrion 70(n) oroivision l
<br />.l rhc Bnsincs dnd Pml'csions Codc, lrd my licensc n in tullr'oreudcrc.r
<br />g ?o t'ttl
<br />r)ir o al z:.lra E./e* 9r.ls t {">
<br />caNgralcuqtrIDdDllclcrNlr
<br />I hcrchy lllirm undcr Fnalry 6r pcijury rhar rhcrc h a.onsrfl.ri,n LrdinS e8crcy for lhc pcrfo.mrcc o{lhe sork fttr Phhh lht lEnrit is
<br />ksucd isa. 1097. ci!. c ).
<br />ATPIICANLDII;I,ABAII!]!
<br />I ilnhy rffinundcr pcnrlryof F-rjlryonc ollhc louosins dcclomrn,is:
<br />Dc oliriDn P$mn{.Ash. os Norifi.ation ftdc.nl RcAuLt ions (Titlc 40- PanO
<br />Rcquncd kn.r.f Noiff, {ion
<br />I (aily lh{l rE ledcrrlrcsuhinri\ rcgrdin! a\li(.\ rnn,vrlar. ror rftltrrhlc ro Ihi\ pn,Irr
<br />-lccnilyrhlr
<br />I tuvc rcsd rhis anplic,ri(,. ,Jxl {arc rhd rh.,h.v. nrrormlion is $rcd las[rr..onltlywirh,llCityandCounry
<br />odina.c$ a Srarc ti*s El"ring b huildi.g consrudion.,.d h.rcbr.ulholizc rcprcscnrarivcs ofrnis Ciry Md coxm! to cntc. uponlhc
<br />.hvc trEDrioncd pmptny for inspecriotr l)urlhsc!.
<br />Appllcsnl or,\*cnl SlgnnltrE
<br />49o L44
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation
<br />Roof Sheathino
<br />Framinq (./g -/8./)c-t {r,€s
<br />lnsulation/Enerqy
<br />Drywall I ZD,fo{ot -9
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />r1
<br />FINAL 1-q"v r.v#61
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />Shear Wall
<br />krJcr'\ Ailitrlr:
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<br />o{.Slzaltd
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