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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNIiR BT II,DF,R DEI-CARATIoN I h@t'y lmd utuj6 psBhy ol pnju.y On I m q€nFr lNn rhc coirdcron l.i..B tl( Lr rh. rolb\i.r,a$o (S<70115 Busin6s .dl ltof6ion (ird.) Aly Cily or ('ounty shich r.rt ir6 a tdnil to cotrrrucl. !1t6. improlt, &rnolLh oir.p6( int nodue rrr lo ill duuc. .&) rcqurB rh. lprltdr lor ruch F n ro lik ! i's*d 'l.r.fur rhd h. or ]h. ir lic.ffid puednl lo lh. Fnvbbc ol E(ontdoir Lk.N<d lrs (Cl'rFd e, (nmftinf qhh S(ri)n 7ux) olDtrLion I of th. aaine..d Pmt6ios ( od.) or rhll lE m iE 6 qmpr rlElnom sd rlE t6u for rlE dh.d.rnFion Any \rltlio.olsalin 70ll 5l^ lnr dppl'c, for ! Fmn subjds rh. r,1)lrmr ro !.irilpdalryofnorioErhd fiv. hundrcn d.llB ( lJtx)) L s o!ffi ollh. Fotslt. or my mphlc wilh was6 s rh.i $L conFNliion. sill & lh. trqt ltd llt sMrm k mr idon d or o,I6.d tq sk (sa 70,11. BGic. &d ProtBsB ( .dc Trt Conrdor'3 Lke Ir* &'6 mt Drl' l. u .trE .l rh. FoF! { l$ hril6 o. ,r{tsrs rlE@n. !n r h &B sh uln hiNlf or h6*ll or rtmugh hs or h( o*n mnlotc. Fold.d rhi tu.h inFr\lffi! e mi i dil.n m oturd fd sk If. htraa. rlr triHnE or itrs.trrld ii $ld snh'n ok ra olcotrrpklhn. rh€ ()$E Blills sill hdt rh. hdtdt of pr.\ilrl lhd li or slr dii Br hi'U 6 nlprn* $. Fnport f llE F,Fosof l. 6 ouE olrh. F.Frv. @ crctundy co6.rrins *nh lica<d.odocr@ io.odtu.l rlE lmjd (sft ?(x1. tlllrB rid hrlsd (ixtc: TtuC.nrtuoa3Lk.M trq &Emr q{'h 16 xo{nd.lFoFny$h. blildr or inpro\6lh.on. ud trho o,iEG for rlch rmj.(tuni i ( olllncro(i) li.and psudr io rh.( odrdDir lie hs) I dn.\cn, trnd6 S(rnn'.ll N lr llr rhs,rx!r' ,)rr.: Ornd \1oRxEILS ( OitPEiSATlOr OISJf,AIIA! I h6c6! ofinn ndd D6nh f ol n6tuo on. ol rh. nnlo\ in! d(lrd nns Iha\cDd*illnuintlin!('drifrllcof(ongrroS.ll-lB!r.nrqorlB comFMrn, a F.rxLdaorbysc!n'nI700oflh. l,&r Co&, for 'h. Faollffic ol llE *!lt f.. $ hi.h llE Fmn ! is!.d. I h.r. iftj tr lll nlinllrn I or{d! ..npceiion rNurancc. tri r.rtur.d by Srr ion iTUO ol rht l$ot ('od., lor th. Ffomdcc oa lh. work nrshi(hlhis Fmit; is.d Mruork6 compo$lhn 6ur .cc r..,tlFlic) nuf,lE r.: I ccnify lhil in lh. prfonrun.c or lhc *ot fo, shrch thi pon B tstu.d,I lhdll nor dnllor.'.ny pdsn inontm rd er alot&n !!bjd b rh. *olt6'comFMrtun hssol( rlifomia, and,!N lh.l ial should b.(omc subjEl lolh. Mrl6 c.mFM' h. provriirN oa Sdmn 17(xr ol rh. lrhr ( od.. I sh.ll. fonhs nh conply sith rr$s rrerisF $ARNIN(; lr.itur. lo su. norls' NmFGlrio. o16..r. 6 unleqtuL .nd +!ll 3ubj.( u dphld ro $imiml FEhi6 anti .r 'l fiE up h oru hun&.d tlrus.d {hllB ( l l (]O.O00). h dtt irn lo th< corr or .ohp.rM'o.. d.,re6 a n o!d.d for 'h.S.<rFn 1076 ol th. ljtFr ( o<h, 'nrq.n ud dro,Ey 3 fc. Appllonlr__ UCIISEDIqBISAIIAB DECIjAAIIO! I ffi! .mm unLr Frht .f Fjur) rhi I e lr.ru.n un&r Im\ aki. of (-hqiq 9 (onffirs n''i h k nn 7o0O) oI Dn ishn .r or rh. Busnd Dd Prcl<nd(od.-rd nylt.e nin tull foc &n.lI<r CAXSIAI(.1IQNIIIDIIC-&C!!(I I hs<r!.llinn und6lEnahy oftfjuB rhd rh6. B,conslruclx,n Lndins a! ) nr rh. t'dfolm. of rh. \o fo, \h(h rhit rErn( ir tsu.ri(Sfr r(r9r, ( i\ (-) AIIUCANLP}IIJf,AIIO! I hodr'.rm ui&. p.n h) of Fjur! oE ot lh. folhsr8 &clrdFnl D.mfi6n P(mii3-Art.kr Noriicdion F.&r.l R.guldionr ( I tG a0. Pd6) R.qur.d l.lrd of Nolrfi c.li.n I cdif,_ lhi rh. f.ds.l r.xul,rFB Eardm* 8tElo. rm\ !r r. tui qrlt$k n, rhis Foi.d I cdiay r hd I h.r. r6d rhB .pnlicdion erl sr.rc rtd fi. at \G rnnrmdrcn 6cotrd Ir[rr ro mndy +irh.ll ( ir] 0nd ( our! oldinan.6 .nd srar. l,ws rcLnnr ro buildins co#rucriotr md hs.hy aulholizc rqrs 'ln 6 of rht (\ry and Counr t b nrs upon rh. .lFv. hotnrn.d propGly f.r inrr..tun !n4hs ,\ppli.rnl .r ,\3ml \tmlur. Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subf loor/VenVl nsulation Z\ Roof Sheathing 1''lt 4./y.K0a PILN LWT Shear Wall ,/ Framin s ln s u la tio n/Energ y Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handica p Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL Tht llgT\[ Certificate of Occu pancy Notes, Remarks Etc L4-o8."J vZ 7V I I I J