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BUILDING- INSPECTOB RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNEN BUILDER DELCAI'ATION
<br />I I'crch, ,i,irn tr c! pcnaliy {'r !.rjury (hai I un crcmpl h'm lnc Conh.br' Li.cnsc liw r',ir rhc lnllow a rclsxr (Se...r011.5
<br />Bu{tr.ss ,,rl Pdasson Culc): ,ttry Cry dr Cotrnry wlrieh icqun r a JEflr rr Lo.in.l, ,lrci mpn,v., Jcmdl*h (ir rnar any
<br />ntu.tuc, p.hr nr ill is!r.(. alv' rcqrir\ rh. ,pnli.a lnr slch lernir b llL a lisn.rl (arcm.r rhd hc or rhc t li.cn{J pusu0nr
<br />r' lhc frovirrns of $. cdnrrcr, r Lic.n\cJ La* (cha cr 9. collftrurnS wnh sccrnD 70oo of Diviii, I of rhc Bu\in.ss md
<br />l'nrc$ions Co!c)orlh.t l..orrlrc N cxcn rhcrcli.makl rhe h.sis tur lhc allc8cJ cxcmprion AnyvblalirDofsc.tionr0ll.5by.ny
<br />rtFlicnnr ti, r !.rmn suhj.c( thc amh.nnr t, r c,vil t iahyot nor .nx. rhrn hv. hlndicd doll,rs ($50o).
<br />l, !s owmr oillr pDpcny, or my cmploles *ilh va8cs.s lhct sh conrFns*ion. willdo tlE vuk {rl lh. dtulur is nol
<br />inrcrlr or oicrcd tu $lc (SN ?044. Busincs ind Pnicsions C(ilc: Thc G,ntracrois Lacnsc L{w les n.r rpply lo r. ovncr of
<br />rh. F,pcrly whd tdildr or iqx)rcr rh.hn. rnd wl$ J*s such w)* himsclf or hcrslf or ttm'u3h his or hcr wncml'byccs,
<br />F)viJcd rhar sr.h inl,ov.ft t,. n incndcJ $ oltadl lbr $L lf. k,ftvo. Ih. bxiuinA or iqrohmnr i eJU wnhin ',m ,u
<br />ol .otr{rl:lM. ltE Owner Blil]cr wil hnvc llE htrdcn oI ImvoS th.l hc or shc Jil h}l huio or imnmw thc In{sly lor lhc lloq$s or
<br />1. ,\ owftr of rhc l)roFiy, rn crclusiv.l, conracrrg w h liccnsJ &nrdtrs kr (mhd r,f ptu .rr lscc. 7(N4. Busncss
<br />dnd PnncssnCodc ThcContrdcnr'sL,rcns.LrvdGsnorrpplyloanowncrolprorcrty*hobnildso!inrpruvcslhcrcotr,
<br />and wh) .olrrarr n)r slrh pn+cls wnh . c(n r.clo(r lnctr$d punulnl ro rhc Contra.rd s Li...sc llq ).
<br />I amcxcmpr uLr Scdr.
<br />!!8trE8L.CO!IfjNSAIION
<br />DECIdSAIION
<br />, h.rcby rtrtrn lDJcr F.alry oa Frjor, ooe of rhc tnlo$itrs dcclr{b$:
<br />_l hrvc !d will roinrain a Cc,ri,lcatc oi Cotrr.nr b Scu-nrsurc i(tr w.rkc6 comltcnsrri,'n, r\ t ,'vid.d kr bl, S(rnn, .171x) oI rhc
<br />Lah* Ct c. nr rh. l}cnorhrncc ol rh. sork lnr which rhc Frfrir i! ir$u.J
<br />-l
<br />tuv. and willmanrdin sorkcrr ronlEtr\ari()n rnsurrn.c. r\ rcqun.J hy S.rrbn.1700olthc lf,borCir'lc. for rhc Frlortufrc ot
<br />'F"\,,,kfiruh',.Frhtrr,miri\i\ucJM){,tr\.'.',,,mnctr\",r,n'n.L'rtrc.dnic'di*lFntr\nurhc'r.f4c tAeJ >
<br />6z 3>2o7
<br />I ucnrly th.t h rhc pcrtbrmtuc ot rlrc work for whicl rha l.rDnr is,ssktl. I shall nol cmpby any t'cson in an, m.trR!
<br />$ !s ro hcc.m sul,jd io lhc $.rkc6 drmpcn$rn'n hvs olColilomia. oJ asE 6al if I shouU hccotu srbJ.d b rhe
<br />workds conpcnsarionF.vrsions ofSccrio.l70Oofrhc llh, clrc,I shrU. fonhwnh comdy with0n,s fd)vnins
<br />TVARNING: I;ailurc b scurc wo c,J co,ry'..sdnD {v.rasc L\ unhwtul, .trd shall sul,Jccl an cmrbycr n, sinmll rEmllis an!
<br />crvrl firs up l..nc hunlrcJ lhousu dollu^ (1100.000). nr i'1E .o( 01.omFfls3rion. damrscr as F'vid.n l,or rhc
<br />Scclnr 1076 ol lhc LalDrCoJc, inlcrc( a alnrlEy'V /L ts---
<br />r-rdeisey'fdr(fn ttror
<br />DE'J' R lION
<br />Lcid ur{lrt F,v,n .l ('hrprcr J'u.nmf, NrnF w h S.(rnn'0ur' r n.vrnn.r
<br />licctrsc is lu turcdrlclltct.
<br />I hcrchy aftirh undcr ncnally of pcrjury rh.r I a.'
<br />ol tlE Busincss an! Pmtcss nN O)dc. flrl my
<br />z--vse5
<br />2
<br />I hclchy ailtm un,lcr lcnillyolncrrurylhll lhcrc n a cotr
<br />rsrucJ (Scc. 1097. Crv C.).
<br />lcndingrg.n.y lnrrh.p.n.ru,r. ofrhc work ntrsh,.hrhi\ Frmir i\
<br />AIPLICANT DFC,LARNTION
<br />I ho:try sLm undcr Fnalty of,Errury orc ol lhc fo0t win! J(larations:
<br />Dennition Pcrmik-Asbcsrd Nolificlrion lcdcral Rcsularions (Title ,10, Pon6)
<br />_R.quir.d t ttcrof Noriicarion
<br />_I (d y rh,r rh. r.dcral rBxhlioB 6gdin! a$cslos ,.n,ral e no' rFolaabL ro ths pn,j.ct.
<br />J! dlrli rh.l I h,k rca,l rha alrli( on dn \ralc lhal tnc shvc inlomrhn n corer.l as@ tr.bdtly wnh rll City{nd C.xnry
<br />,nluEn(ci.nJ Srak Laws Elaring ro hui{in8cunnru ion. .d hcEby autho&c rcrcscntarivcs oi this Ciry and Counry lo cntcr ulon lh.
<br />nt$vc nrnloncd p$pcny Io, nr!..lidr lurrr)
<br />ADpli{nr o. Atcnr Siamru *l
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubllooriVenVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Reporl
<br />Enqineer Final Report
<br />Flood Zone Cenif
<br />//\
<br />FINAL 4 ^71-7).Llfl$r,
<br />Certif icate of Occupancy
<br />Notes Remarks, Elc
<br />Forms/Steel/Holdowns
<br />knJ.r(AJ.]rcs
<br />f-------T------
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