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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Forms/Steel/Holdowns <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUlnsulation <br />Roof Sheathing <br />Shear Wall <br />Framing <br />lnsulation/Energy <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 />Flood Zone Certif <br />I <br />FINAL ,////q .ffin/ <br />Certificate of Occupancy <br />Notes, Remarks, Etc. <br />owNltrl 8ul l,l)llR DELcaRATloN <br />I hdcby afirnr und.r p€.ahy ot pdjury tlfl I e .remfl noh Ihe Conrtdore' Lic.ns. Ilw aor th. lollowinr t@n (s..70r1.s <br />Businss and Ptuf*on Cod.): Any City or Counly \vhich requi!6 a 16 1 to m.sttuct. all6, imProv.. d\,nolish ur rcp€n u), <br />srrucru.. rio! ro ns isue.c, also relun6 thc applicanl ror such Fmir ro nl. a sisn.d stdmdl lhal h. or sh. b licmed pursu r <br />ro rhe prcvisions olrhe Conr.dors Li@nsd bq (Chapls 9. Conmd.rs wnh Serion 7000 of D'vis$. :t ofthe IrGioG od <br />Prol*io6 Cod.) oi thar h. orshc is crmpl lh@Eom dd lh.lr.is aor tbc all.B.d erflpln n Anyviolarionofs..lionT0ll t 6v ad, <br />applicant aor. pdmit subj€clslhc spplica roacivilp.n,hyoanormorelhanfivchundrdldollds($500) <br />-1. <br />d oMd of rhc proFny. or ny mploy6 with wass s lh€ir el. onPdMtion. uill do the rvorl a.d th. nnrlm b ml <br />idoddl or oft6.d lor slc (36.70?14, B*ine od ProfsioB Cod.: I hc co.ri.crors Li.m ljw d.6 nol ,prly lo tn ow.s of <br />th.Dtupdry whot ilG or iflprov6lh@'1, ed who do6 such Mil hinsclr or hd.lror rhmuSh his or hd oq .nplov6. <br />providcd lhal such ispno6ds e mr inldxkd or oifdql for sk Il hosd6, $. hildins or imp(v.i6l t $ld wnhin one y@ <br />ofcoi{,kio& lh. ol,td Erildq will have thc hrdo ofproving dEt h. or shc did rcl hrild ot inFo!. ln. PDpsry for lh. Papoe of <br />I. s owner oflh. Fopdy. er .r.lusir.l, co.rad in-q silh liccn$J .onl.acto6 ro onsIrud rhe Foial (S€c 7(x4. lr6ms <br />Md Pofsioncod.: TIEConlractois Licmsc l,aw do6 nal applylo otr.q of propdly who b ilds or improlcs lhs@d. <br />and who codrrts ror such rrojRb with r c'ootraclorls) licds€J puuut.r lo th.(onltlclois l-icdsc trs) <br />lm.r.mnr undd sdrnn .A & P.C. tor lhBr@on <br />Drte: On.d: <br />laarualcoltEiNsA.Ilg!DtrClllSIlqI <br />I hseby amm undd p.nalry oi pgjury onc olthc tolloq ios d(LrarioN: <br />-l <br />hav. md will ,mim.in a C.nificare or Cocdl !o s.lalGui. lor workda conDensriofl, s f,ovidcd for by Sc.lion I700 oarne <br />lrbor Codc, for rh. poaollmc. of the *o* for f,hich lhc psen is s!.d <br />_l hav. and will nan ain wortc6' @npc.sarion i6udce, 6 rcqtrned by Sd ioo 3700 olrhc tjbor Cod., fo, lhc pdaomece oa <br />\\x?[rux My workgs conpderion insurancc cujd and poli.y numbd d.: <br />ci <br />6zr"iNt.l oot=\t-l-r q <br />-l <br />ccniry rhar in rhc pcfonnecc oarh. rvork for which lhis perDil i Gsudl. I shall nol snploy any p@n i. anv dns <br />$ sro bdone subrd to rhcsoIk6 coipcMion la$s otc.lifomia. and asr€ lhat ifl should b..omc subj€cl rolh. <br />$olkds comp€nstion prcvisio& of Sa:1ion 1700ofrh. tnbor Cod€. l sttrll, Ionhl h .onrtly wiii lhos proris{ns <br />WARNINC: Failurc ro Kr. worlds compmalion cor@s€ is u.laRfol. and shall subjdl d dPlors ro oiminal FahE ed <br />cnil lin6 xp <br />'o <br />on. nun&€d lhouMd <br />llr7n.frh.l trlsr Odc i' e'd <br />u-Lq4K- rlcExs[LcaxrMcloa <br />ITEo,ASAIO! <br />I hd.by afiim unde Foahy of Fjuryrh l m lica!.d onde provision ofChapidI (.omnEnci4 *ilh Sstio.7000).rDivisi.n I <br />ol $c Busin* &d Poa6io6 Code. !d my licee is in full torcc a.d .ficr. <br />,"," r1-(or Vorlhu'>,596+en JTAIiIBI!IIQIIJ,]jMr!(]!;I:!) <br />I hdcb, amm und6 Fn,lry oa psjury lhal lh@ ir a .oGro.liod krdi.8 agfty lor lh€ ,oloi:@c. of thc wort for whth thi. Frmn is <br />Gsucd (Sa 3097.Civ. C ). <br />AIII,ICANI.DICIASAIIOX <br />I holby.n'd undd pd.ny oa pdjury on. of lhe following d(ldar ions: <br />Dnoliion Pmire&bcros Nolificalion Fcddal R.sulalions (Tnh {0, Pd6) <br />-Rquircd <br />t.cnd of NolifiBlion <br />-l <br />cdiry lhat thc f€dral rcrula(io6 regedrS sbBlos rdnoual &c not aprli.abl. b rhis prcjc.l <br />,lfcdify rhsr I ha"€ rad rhis appli.,lio6 ed skr.lhol lhc ahov. inlomalio. n .otrer. I sgre to co,.ply uirh all city and counlv <br />d hdeby aurhonz rcpr*nlarivs ofrhis cnyed courr lo 6t6 up.n the <br />''. l !Q-rG <br />I <br />a4a?9€ <br />-t I <br />L.ndd'! Adds: <br />- <br />Erection Pads <br />T-Bar