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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DOLCARA'IION
<br />I he.6y altrm nhdo !6alry ot pdiury fial I sn er.npt f!o'n th€ Coht.ctoB' Lic.ns. tj* lor tfu aollowin3 rea$n (Sr ?0111 5
<br />Busincss and PrcfNion Cod€) Any Cny oi Counry which rcquircs a dnir lo constocl. alls. improvc. de'nolish or rqE e,
<br />srtuciure. prior ro iis isum.., also r.rtuns th. +pli.rd aor su.h p€mril lo file. sisned slalool rhd hc or sle i, licmed pumdri
<br />to the Drcvtions ollhc Conlri.roas Liccdscd Lar,(Chafls 9, Cohfre..inr *th Sslio. 7000 ol Divhion :t ofthc B6ine*r od
<br />Prorcssio.s Code) or Ihal hc oi shc is .r.mfl rhc.6on dd th. brsis lor lhe alLt€d ermplion Any violatio.ofsdlion 7011.5 hyany
<br />,ppli.ad ror a penn sobjets ihc applicant ro a.ivilp.nalryofnot norelhd five hundr.d dollds(1500)
<br />-1.6
<br />oMd olrnc pNpcnt. o ry employG snn $ag6 s lh.n eE conrpdstion. \ill do d. sorr md rh. s'odE is not
<br />i Rltrl orofi@d aor el.(Se 7044. Ausin6 ed Prci6sions Cod€r'Ihe contadois Li..ns. tjlr dos nor .ppl' lo ai oNld ol
<br />the pnpfiy uno boilds o. imF6!6 th66n, rnd w6. do6 su.h \rcr( hnns.lf or h6ell or nmtrsh his or hcr own .hplot.6.
<br />povidcd rnar slch nnprolmots d€ ml irtdd.d or ol[s€d 6rslc.l[ kJr'66. dE hildins ot impiovffir is eld sihin.n€ Fr
<br />of.o,nlldion. lh. owns B{ril.kr will ha\. th€ hndd oa Fovins thd h. or she did nol build or inpnn. lnc lrtrF!} tu lh€ pr[pos ol
<br />I. s o{nd olrh. IroFny. m exclNivelycontmctins with licc6.d coitEclou ro coinru.lrh. pmj6t (S(. ?0.1.4. A6ne
<br />and t\:(rftssir Codc: l hc conlr.ctoa s Licos. Law do$ .or apply to M .wntr oaprop€ny sho builds o! improvB thd.on,
<br />and sto comm$ for ch poj{ts wirh a ConlGto(r licG.d pu6udd rorhc C'o.lrc.rolr Li.@ t w)
<br />I am cxeDrpl trndcr Sshon
<br />Dsrer Ownei:
<br />WORKERS COIIIPENS,\rIoN
<br />DS(.LA8A!I)!
<br />I hncby amrm und6 pcnaltyofpgjuryonc ollhc tollowins dslaralbd:
<br />I h.vc d $ill nrainrain a Cenificarc ol CoMl io SelllNurc ror sorlda conrpensari.n, 6 pmvid.dlo!bysxlidn11700ofrh.
<br />tnhtr code, lor lh. p6fommc. ollhe "o* lor rvhich ihc psnrit is issuld.
<br />IhaesnJ('llmr rd,.'!../?*"',.',"",,,'".a dui.Jb\s(rionlrooclrh.l-abo,('ode.ro'rh.@i.mMtcot
<br />,h. u.!r ,,, uFrfthF r/A ,.K,Jr*,irEl "-+try*.** -rpJrc) nJ,ibq dc.
<br />cmd l4)-_x_, u -;J..ffiot\t-,-:c(
<br />-lcenilyrhal
<br />in rh. tofoi,nance olnr. work aor which lhis !.rmil is issued.lshallnol nphy.n! pn$n h 3., manmr
<br />e 6 to bccom. subjdi lo lhc s!rt6' cohp.nsioo laNt ol caliaomi.. .nd .Br
<br />'hd
<br />il I should 6*0r€ subjer (i th.
<br />vo.I6' compqsrion povisions or s<rion 1700 oarhr Labor code, I shall. lonhwith cohply \vith lho* pn,virtum
<br />wARNlNc: Fnilurc ro *cu. wortcB conpsation ovsasc t unla$tu|, ed sh,ll srbiet e cnploys Io onninal p@[i6 and
<br />rcJ ihousnd dollaF (1100-m0 p€Dsrrion. do.]lg€s trs pftr .d for rhc
<br />inrd6r rnd dk tr.!'s liL:
<br />\
<br />ol rl[ Busir6s.nd Pml6siors Codc. Md lnylicelse is in rull rorce ed ella.r 72ro?
<br />( {)\\ rxL ( u()\ l r \rr\r; v;r.\( \
<br />I hseby amrh undr lcnan, of p€iury that rhdc is a coNrudion lddin-! as6cy tor rhe pdromdc. of$.qorl fo, whichlhis r<hil 6
<br />issu.d (sr 1097.Ci!. C ).
<br />AIII.TSXLDICI.ABAUA!
<br />I hotly altm und6 p..alry .apsjury onc of rh€ aolloNin! d.cltur' ions
<br />I)€'nohrion I'.nnrrs Asberos Norifi.arion Fcddal R.soldions Onb 40, Pano)
<br />R€qutrcd l-.1rcr olNorifi.dion
<br />-l
<br />cd ify rhtrr thc Ldsal r.sularioE resrdins 6Lsror Emoval d. nor applic.blc to rhis projEI
<br />I cdil!rld I havr'.ndrhis ( Jri^n dd i..rhd rh.rh. c rntorrr.liol i, core(r I i!,e h.
<br />ordrd.6 md srare L,Ns rchring
<br />alirvc nEnrioncd propely lor irspdion
<br />Appli.rnt or .{gdl Sigtrsture
<br />aurlnrize rcprBfllatir6 or I
<br />,.nn, \ !irh aLlJ ir\.nd (i,umv
<br />r,,..i,, -a cl"r"'. .u( ,p"" 'r.".(/t/z
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathing tl I tq4t!1 TrtlrtlW tll --Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL rl )o/ {{ -iry t'xt*otxf l,\ )
<br />Certificate of Occupancy Urg
<br />Notes, Remarks, Etc
<br />DIOJAAIION
<br />I holby ailirn undq Fralry o f pdjury r har I @ li.dsdl undd pro\ ision oachapld 9 (conndcins rvirh s..lion 7000) of Divisio. l
<br />L.nd.''1 AJLIr$. _
<br />Set Backs
<br />Subfloor/VenVl nsulation
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