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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loorA/enUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />ln s u latio n/Energ y
<br />Drylva ll
<br />D/|af;Ext./lnt. Lath E2 ..La <-t
<br />Brown Coat
<br />--T----r--
<br />Mason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />Ir
<br />FINAL l0 L1 \1 ,'(/4,,?\)
<br />Certificate of Occu pancy
<br />Notes, Remarks Etc
<br />OWNI]R BTJILDER DELCARATION
<br />I h6.b amrm lndd p6ah y .l tdjury thd I m dcmfl frcm lhc Co.rE 106 Licm. trtr lor rh. followi.* ..Mn i s('701 l 5
<br />lluri.6s ud liol*i.n (irdc)r An, (-i!r or (ou.ty $hi(h rcqutG a pd,nn Io conntud. rn6, inpro\., &rolith ur Er{n Mv
<br />ntuclu!. p.ir k' 'ir n$sr.. lls r.9un6 llE q,rlkd f.r s!.h Inmn ro filc r si8n.d $dffi' rhd h. or sh. i! licd{n p!,sif
<br />lo rh. In)rirtriN.ftlE (ink&fty'i l.'c.nsd lrw (ChrPld 9, Comncoci.s sil' S.cru 70n0 or Diviron I .f'hc llB'ndr and
<br />PmlshN (-od.)or rhd lEorsh. i!.lmfl 'h6.6.n d rh. ba3a aor
<br />'h. rlk*.d .r6n rioi Anyliol.thnofsdhn?0115h!rn]
<br />q4nk. for aFrn ruhrrltltt lp?l'crrl to !cnil,,.Mhyofmr norclhu fir. hun&cd doll6 (1500)
<br />l, o onE of llE FoFrr. m ny mph)6 snh *186 a lhn $L onpss i.n. sill {b dE sut id
<br />'lE
<br />rME i! d't
<br />inldrGl or olTd.d fd r]. (sc 7Or4, AsilB ud hrtdioE Cod.' In. Colrdorr l.(oE liu, d.6 mr +ily ro d .$G or
<br />llE,FrElr_ wL hoil&d a!.s6ilEotr ni qh6 rk6*hu! hi,elfor ha.laor ri,ougn hir d lE otrn dpkrrc.
<br />pr.riLd rhd $ch nFo\EEr! G d -nErLd or otu frr rl. lt hou6s.ltE hrifrnB or itr+.srEi ! rld }rfin (m 16
<br />ofsnpt b't tL (xE tlliuq *ill h.E llE hrddr ofF!\i'tg tlE lE slE tH d hild or llp.oE tlE FoF) ac tlE prlFE of
<br />l,6o*EotllE!.oFrr_,@scuncllconrIlrrrNnhlicqEal..dd6toc.tdruclrlEFDj.{{SE',0r,r,&6iK
<br />md Plrksn cod. Thr co rdoatr L(tu L* do6 tut lppry ro d orG of FoFdr_ trh6 boirdt 6r idpr.\6 ihamn.
<br />md rho srrBl! to rucfi FF(! rnh ! ConEo(J)li.ded p{EM
<br />'orlEConrdm
<br />3 Lt@ L,*)
<br />l nc\.rnr trnJa S(rk'n
<br />lrl)aK8as:(aufEdtal10r
<br />DEI]ASAIIA!
<br />I h6.br lmm undc Fux) of FJUry ocof rh. tulh*.i"s &(l!r!thE:
<br />I h,r. nd s 'll tumuin r (qr ifrl. or( olFr ro S.lf-lNuE fd $0116 omF6d io., 6 Fo! iH lor I'r Sdion 17(xr nr 'h.t,&)r ftd., n rh. p6ftrllr4. oltrE m* Ior sfiich lh. p6mn n isu.{
<br />I h!r. ndj eillm!in!.r uorl6 coDFcdio. iNur.m.. d r.qund b, sdionlT(loof th. kbo. ( od.. aor rh.Faolffi.of
<br />rh. *o for whi(h l,rB rqdil s isEi. My wort6 conlF6dhn Bum..Mir di policy nomb.r e
<br />I c.n'rvrha, 'n rhcFl rndn.corlh.rvorl for $hich rhis pcmi is 6ucd.I shnllnor drploy any pd$n i. .n, mann6
<br />s, nr k' iEtdtr. suhjdr lo rh. r'nrlF' dnnpo3llron la*s olcalifomia. rd asr rhar ir Lrculd tEcomc suh(r tJ rh.
<br />q.rtm (npd![on lR'vLidN dlSdioh 1700 ofrh. Lat{r Codq Isl-ell.fonhs(h comtly *irh rl$s novitr)nr
<br />WARNIN(] ljiilurr n, Fu. *orlsl conrpcnsnln'n .o!6.E. is unlawful. d snall subjd an md.y6 to ainrin Frh'6 nn(l
<br />.ivll nnd u n' onc hundr.d lho6lnd dolltrs ($100.000). in addnio. to lhc cost ofcompcnsation, dana{cs is pmv'd.J ntr lh.
<br />SRrnr tl)7(t.l rh.Irlin (inl.. tr c'dnnnarl|'nc\ rfccs
<br />DEC]IAAIIO!Ihod,lmmu s p6!hy of pdjory lhlt I m lic.tr!.d ondd F.!i!ion of Chapld 9lconmn inB $ nn Sd hn 7u )oil)nirii'n:r
<br />of lhclt6in6sd PmfdioN(td..dd nyli..B irr tull rorc ed.IIcr
<br />A |-^/e
<br />(AIiIAIJIfIANIENDIICICEICY
<br />I hdrb, .rm uftra Fn ltt 6f Fjurt rhr rha. ! ! o.dnErnn bdins astry aor th. Fforlj@. of rh. $ orl for $l h rh6 Fni a
<br />isual(s6 ll097.C,r (,
<br />AIIIJCAIIDECIJBAIIO!
<br />I hdt.trd u 16 Fn.ty of FJUr, oE otlh. folh$ins dc.Lrdiotr:
<br />l).ool'r$n Pmi'r-Arbdor Norifrd.. lddll ReoldioN tTnbr0. Pd6)
<br />R.qun.d lnls ol t{orifidxn
<br />I .sr '[ rhd rh. f6l(,1 rcruld n]N rc3rniry 6t6t8 rm\.1 e. e, 4!lk$1. to r his proi{
<br />I rdi6 rhd I h.\. r.id rhi! rmrk.rs. rd inc rhd th. ab.rc rrfonndion B cotrr.r I aarc ro .ompry * ih rll (-'ry &x, (iru.r)
<br />ordtre6 .nd srlrc tr$s rldins lo h'ld'ns cotrrrudir( ad hd.b, ruhriz .€FeIdrB ol rhs Cny .n<! Cou.D ro drd uF,. rll
<br />.h,\c m6ii(,..dFotd) tu icFdn,n
<br />,tpplicanl or \rdrl Sitn.lure
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