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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER AUtI,DE* DELCARAl'ION I td.h rrm !.{td Fn l) or ,.ooD rhd I m .rmF fnrm rh. (-o nclou l-tN l.{ fo. rh. lolhu 'ne ra<'n (s( 10! I 5 tlsin6r ard t,'ofstr,tr ( odc): Atry C y or Counl, $'hi.h r.{utr6 r rEr( l{, con tud. allo. impNrq ddolish or GIEi et {tucruc. Fnr h iG B3ud<. !h. ..qun6 rh. rppl(mr lor iurh Ff, ro 6k . !8..d nd6d 'hd h. or rlE b li(4s.d rueel b lh. FolisioB o f tlE ( onkrtor't l-'c*d lis (( lutid 0. Conmtrins snh sc.t$n 7000 ol Dirish. 1 ol rh. Burind td Pmf6rDns Cod.) or rh h..rih. t.r.mfl rhd.fr.m ed rhc hsi! f( rhc all4.d .x6Fl nn Any vd.lionofs..ln,tr 70.11.5 hyt/ spDli..d for . Fnnn .uhjd! rh. ,r,plicsnl ro ! ciril FEh e . f mt mor. rhan li!. hundr.d dolldt (l5cl) Lsown-ofih.rfrFnr.orny.mpnrr6sih*.G64rrh.t$l..omFtualn'n.$illdoth.eorlmdrtcal.ud&nn{ htarld or.lTd.d fo. $L (S€ 7(11.1. Bui.* ed It f*i.nr Cod. I h. Conlrlcro.s I k.G li$ &6 nor 'qlplt ro M orF , rh. I'ord) * h) hdd or nr{ro\6 rlE6h. ni $ lri &E uh Nlt him*lf or hq*lf or rhmugn hr tr hs .tr n dphr c. prorid.d lhat socn imFn\sErnr m ml n'rd&d or ordld tusL.l( hoNtw. rh. hrll'.r. or imFn\l11d i!$ldsnhinnnc !d of.on{'lir6( rrr()md sdldd $ill ha1.0El!^lar olFiri.g rhd h.or !tu did n hild or inprorc 0E,.!rEi)_ fbr lh. FiFrol l. s d*nq ofthc rrepdty, e.r.l6iv.lv.6ntr.cring srh l(dB.d o.tadoB ro codtud tlE F,,..l (Sc 7014. tt8o6 .,n Phisih crd. Th. C.ni*loi. Li(dk b* d.6 tun 4?lt ro & o$B oaFoFl! tr ho btn& or ioDrord rhnon. md $ho .odmds fn ruch Flj.crs u irh ! ComBlo(s) li.dB.d puF@r r. rfi . (b.rr{rois l.icos tr\ ) lm.roF und( s-ron D.t. ullBliliBu(auElsarpl DES.ATAI,PT I h6.hy .mrn uids t nsh, of Fr'ry on. oi ihe Llk)$ rng d&ld.rnrns Ih!1.rdrnlm' lin r C6rfkd. ol ( o.5r ro sclalN'. for q oikd- .omrsMhn. B Dr d.d tu t^ S.cihn um rrrh. l*or ( ode tor rh. Ffm@c. ol rh. trod lor lticfi lh. pqdil ii i$u.d I lI.!..nd q ill minr.r sorl6 conFsrrr iM*., s r.qoE.d lry Sdr. l7l{ olllE l,txtr cor!. tu rh( tEaolr1lm. ot rh. $.'I for *hrh rhi! Fmil k a$.d My eortd comFMio. iNurffic.sF,rd polry rumta e(. l.nrryrhr! inrh.rEfomN(nf rh.$olr for *hf,hrhi: Fmn 'r asu.d.l shlll mr mrlo) inrFei in lny mrn6 r Nlob..on llbjdt h lhc sod6' conD.oslion l0$ of ( olifornia. mdalrlh,r if| rhould h.(om. suhj{' 'orh.$o.t6' comrq$rion prorti.B olsdFn r 7Oo o, rh. ljtnr ( qj.- I null fodh( irh omnlv \ irh tlFr pr.r;bB WARNING rr'lur. 16 sw $0116 mm,Esi.. $rd4. k !nl$tu|. ar! {ull tubicl oph}F h diniMl Ftrtii nna civil nn6 up h on€ ntrndr.d lhoue.d dolls (tl(n,(xxrl. in.ddiliotr lo rh.coi olcomp.MlnJn, damd*n as P idcd i,rh. JqLIFi 11076 orrh. ljtr. ( odq i.r6.n .d rrrorEljr fc Drl.:__ pplisnll tlclNslD..(alrtacfaa DECI.A8AIIAT I h6-r.s dIm undd pdlhy of Fjury lhd I m li.ocl und6 rr.ynion of Ct.fl6 9 (commocinr $ h s(r$n 70ml .l Di\ isFn ! oa rh. aGins ed Prcf<ioa (.d.. ai nyli.@ bin tullfon.,n.rer (aljiral]cr]orLEtDttc_ag!:!(I I hscby amm unds p.lallyof Flury thal lhEc 6 ! mnslru(nrn lcndrn* t*d.y nr rh. FrfolrMcc of lhc sorl for $hrh rh'i Ix ii n issu.! Isd 109r, cir ('l 6r&rc xt-DEcl.dnaua! l.ry'J.rmund6 Flhy of Frrry orc of 'h. follo*in8 d.cl{ F.3 I).n.1'ri.. P6n s-Asb.srJs N.rficd o. lr.{drl Rcxuldio$t lirl.,10, Pd6) R.quir.d l.dr6 olN(ciltrdi)n I cmrry!ll!l rhc r.ddilrclullrtr)ns E!rd'n! ash.sros rono\alr. nor.ppli.ihl. ro rhi. prold l.drl)rhnln6cr.!drhirltrriftrroan3!n.rharlh.!h\.inf.tunn6rof,d I i*.8'.rmr,l! trithrllC r.ndc.unrt o'{jina.ci rnd Sror.liws Glarns ro b{ildiry c.drucro( arl hd.by.urlx)liz. ElrMrdir6 ofthir ( ity Md (i,uiryt drfr uF n rh. $or. nario*d prr'Darv ntr i6!<nnr flEFB \pplicntrl or 'lx.nl Sipi,rrurr Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenUlnsulation Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif /l FINAL -/bL/h t/ru/r/ Certificate of Occu n Notes, Remarks, Etc I I I I I