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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.OWNER BUILDAR DELCARAIION
<br />I hcrchy lmrn undcr Fnalr, of pcljury rhlr I d crcmpr fDh rhc Conta.tn Li.cns h* lor lhc lollowiry Erv,n (S( 70l l 5
<br />Busincss nnd PioLssion C.dc) Any Ciry oi Counrt uhi.h r.qxircs r pcnnn nr conslruct. alls. ihproh. d.nnnrh ot rcpln .ny
<br />(rudurc.Fiortons issuatrcc, als rcquncs Ih€ upplicad rbr su([ pclmir h fiI. r siSmd {arctunr th,t h.ot shc t liccnsed puEuonr
<br />to thc povtiotrs ofrr Conrrudors Liccn*d tj* (Chrprcr 9. ConmcrcinA sirh Sccrion 70Oo or Divhn,n 3 oflhc Busincss and
<br />Prnt$ionsCodclorthal hcorshc t cxcmpl rherctodlnd rhc l,u\is Lrrh. rlr.sL{cxc,ryrion AnyviolrlnlnolSccri'!TOllthy,ny
<br />a,lpli.,fl ro..p.ftn sobjNNrh. rypli.ant ro..irilpcnakyornor nucrh firchu rcd dollar (5500)
<br />*1. rs owrcrol rhc prcpcny. (n y cnll]loytcs qirh wrgc{ as rlf, ir slc ompris tnr. *1ll do th. w.r* drl rhc slulm is mr
<br />inrcqkd or olLlcd ft, slc (Ss ?(!.4, Brsimr\ anJ Pldtsion\ c{xi. Thc Cront..kr's l-i.cn$ Lnw d.e\ nor anply ro an owrcrof
<br />rhetopcny wh. huilds o. i.np..rcs rhcNn. id * ho oc\slchsrtiimrcllo.h.r{llorrhrcughhisorh.io*nrnDloyc.\.
<br />ntuvidcii rhi su.h imlrek Enh e noi imcnded or .ffcnl fr, $L ll howcr.r. rhc tlildir8 or in{mvcnrnr is $ld sirhin , c ,a
<br />ofconrrkrion. rhcOwncr BoiLdd will hdv. rh hurdci.ff,vi'r! rhrr lf or shc did nol huih or inryo* rhc pnpsly lff rhc l)lrysof
<br />I. a\owic!ofrhclrotcny, i rcr.lu\iv.ly.onrra.ri'r! uirh 1i..tr*d.ortr.rosro co,r\lruct rhc lrrolcr (Scc 7044, Bd\in.*
<br />Md hrli\sbtr Codc ThcCotrr&tor( Licctrsc Lia docs nor stplyro anownerolf()pcnylho huildior inrtovcs rhcton,
<br />rnd qho conrracis for su.h pr+.Guirhs Conrncrorl9 liccn{d prnrrDr hrhcc.nL,.tr/ s Li.cnsc bw).
<br />I rr.1rf,tr utrJ.r S.cro
<br />DEie: Own€.]
<br />t!OITKT'RS' C(}MPENSATION
<br />DECI.A.BAIIO!
<br />I hcrcby rflrmundcr pcnrlryorlfluryonc ofrhc iollo*irE dcclnrarions:
<br />I lrvc mJ q ill tuidrin r C.nilr.arc .rcutr*nr tu Sclf.l trruic lir sor*.rs c.nlEn\lrion. $ pi.r idcd ,i,r hy S..r ion l?m of rhc
<br />Ijh, Codt. ror rhr icrfomncc ofrh. woA fn which rh. Frnrir i\ ilsucd
<br />,kcr' coflrpcnsation in\unwc- rs roquired I'ySc.rnrn l7(Xlofrhc tibor Codc. forrhc Nllormtrccoi,W i'xur .i cn"irr rnd rilicy u bcr c
<br />.r)-- ,/1
<br />-lccnilylharinlhenrrorroncco{rhc$orkntrshthrhi\pen
<br />r is t\ucd.I$rll nor .nrdoy !try t'crcn in rny munncr
<br />$ rs() hc.o r sub)c.r ro rhc sorkr^ sm,rnsarion liws ofc.lifornd and ogrcc rtar ill should beco& rubJccr ro rh.
<br />woik.rJ ..nrcns,rion porisbtrs of sNhn 3700 nl thc titnr C.dc. I shall. tnfl hwir h confly wirh rhos F,vhions
<br />WAI{NINC r.rilurc n, {rrc worlr^ .on,Nnsnrirn, (ovflrg!
<br />.i!il lnr\ np k).nc hutrd'c rhotrsr d tl,,llnrs (11(Xr.0lx)).
<br />cmpbrcr t, cri'ni'ul li'uhic\ nd
<br />ion- drnHEc\ rs tn)v cd fur rhc
<br />D:k:1
<br />I hercty rflnmundcrycnalryoiFrjury rhlr I am
<br />of lh. Businc$ d Profcsions Codc. u nyI
<br />orChaprcr 9 (.onnNNnrS wnh Sccti,r'70(,o) orDivisi.n l
<br />4
<br />I hcroby aifirm undq pcnulty otF.jury lhar lhc,e is uconsrrucri{,n l€ndins rgctuy rur rh. pcrrornmc ollhe woll for *hich rhi\ p.rdir is
<br />issucd (Sc -109?, Civ. C ).
<br />ATf,.ICANLD&CIAaA.IION
<br />I h.rty aiinn undcr Fcnalty oineriury.trc or rlE tollowiop dcchrari{,n\:
<br />Dcmoliln,n PcrmirlAsb.{os Notili.ation Fcdcral RcBul0rions (lillc 10. Pfi6)
<br />Rcqui6d lrltcr of Norii.rliotr
<br />l.cnrfyrhar I havc rcrd rhis.pplicrrionrd ion is comcr I agrc b.ofrplyairh rllCiryrnd Counry
<br />odirrnccs,nd srarc hws rcld ina Io huilding iurh.ri?r rclrroenrxrivcs .f rht Ciry and Couniy ro cnrer upon rh(
<br />ih)vc rc rnn(l Pn,pcnylnr i'r
<br />Set Backs
<br />Erection Pads
<br />UFEB Ground
<br />SLAB Floor
<br />Roof Sheathinq 'o/r/ /tr r.'tz/l/ r.A 1o---
<br />Shear Wall
<br />Framing
<br />lnsu lation/Energy
<br />Drywall
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL t,olrrLk -,tlli',,v*/ 6-'\----
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Forms/Steel/Holdowns
<br />Subf loor/Vent/lnsulation
<br />Ext./lnt. Lath
<br />Flood Zone Ceftif .
<br />b.d.r'(Nu r
<br />trnd.i\ Addr.$
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<br />-l
<br />.cnify that rhe tcderul rc8uhtn,nr Es dinB asbc{os rc'mvrl m nor rpplic$t b rhis pn,j.!r
<br />ry ??24J
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