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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OTVNER BTJILDER DEI"CARA'I'ION
<br />I luchy rlfirm uNlcr pefulrr r,r Pcrlury lh.l I am excmpl tiom rh. (iNradom t,iccnse Llw r.r rhc iolbwinr r.rv'! 's" 7o1l 1
<br />arsinc* a*l PnrLssion Codc): Any Ciiy or Coutrry which tcquircs r F ni n, .onsflct. olrcr- imPovc. d.mlish or NFt m,
<br />srru.rurc. prior b n\ nrutkc,,l\o rcquncslhc omliconl fot such rflnir ro lilc i \istud {aromnl rhal fuor shc is li.cn{d p!6uanr
<br />b rhc pruvisio.\ olrhc Conrra.ntr\ t-icctrscd tiw (chr s 9. Gnn"r.ncing wilh Sccrion 7Ux) orDivision I oirhc Brsnrc* lnd
<br />Pnrtsions Codc) or rhat hc or rhc hcxcn$r lhcrctiona lhchNkforrhcallcgcdcrcmpltD AnyviolarionolS(iion7{}ll5hynny
<br />atpliclnr ror ! pcmir subjsts lhc opplicrnlro !ciril0cnslryorhr nn..lh$ aivc hrndrud dollarr($500)
<br />I. ,s owrer oi lhc DmDcny. or my cnrlolt.s with w03.s m lhct $h coml)..sd io,r. will do lhc wo* ,nd Ih. drucle is nol
<br />inrcnncd or ollcrcd r{r slc (Se 7l)44. Busincs und PNrc\\ions Codc: Thc Coorrrcx, r l-iccns. tiw docs ool qrplv k,.tr.qncrof
<br />rh. Dmocny who lNilds o, inrrmB rrmn..nd wh. dos su.h *o* hinF.lror hcsclfor rhooah hk or h.i owncmplovccs.
<br />pmv id.d rhlr nrch inproHDnh m fr, inrcfrk{ or oficrd lor sh ll ioNcm. rlE hoikiing or in{'olflrnr is nrld wkhin nn.
<br />'ttr.tc.mpLrbtr rhc Owrcr BuikLr willh:k rlt hu&6oft$Urr8 rhol fu.t slrc dil , huiu or iryro$ rhc pmtd, for th PlrF)s of
<br />L nsow,f,r.lrhc trcpcny. om c ic lusir.ly .onr acrne uirh I i.c trscd .onkacr os r) cotrsdct thc pmj.tr (scc 7(l4]l.8trsin.s
<br />and }lofcshn Codc: Thc Conrr,.k s Liccnsc kw docs noraPPllh.nowncrofPnpenywho buildsor inrl,rorcs rh.rdJn,
<br />and sho tunr.ads fdi sucn trejcch wilh o Conracronn li..nsd punuinl h lnc ft.rrrors Li.cnse La*).
<br />I rf,drrD,tn rftl.r S..rn,
<br />.U!.8liliBS:.(OnilMrllIQ.N
<br />DI'!:II-S]IIIOI
<br />I h.thy,fiflnu.dcr pcnalryorp.rjury oi..rrhc lollosirS dslaraliotr\
<br />Ih.vcondwillmainrainrcdnifi.rtc.fConsntloS.ltrlnsurcf{tr*orkcK.onDcnsorion.a\ pn'lidcd lor bvSc.rion.lT(x).frhc
<br />lrbor Codc. for rhc pcriornr ncc of I hc work n" sni.n rhc t^_nnil k hsucd
<br />I harc lnd till mlinrain worr.s comf.trsolion insurar-'c. as rrqutrL\d by Sclion :l7m of rhc l-nbor Codc. lor rhc lnli)nnrne ol
<br />con{$\artfl irsurmce cr(icr rd Fli.y nunlhcr ec:
<br />1,05
<br />l.cnilylhar ir rlErierlornunccofrhc s.rt hr whichlhi( Pcrml n isskd.l shill trot cnrPbylnyP^on ir onvnunntr
<br />so $ lo bcco'rc suh]cd b rhc rorkcis ompctrBrion ln*\ ot Calir.mia. rd.Brcc rhar iil rhould tr.o.rc subrccr rorhc
<br />wo crs conv,..sflrii,npovisiotrsolSccrio.lTmoflhcljrr,rGdc.Is ll. lnnhrirh conrply wnh $orc frovisnrn\
<br />$ARNING: F.ilurc h ccurc Nork.r comp.n\dnnr .ovud8c i\ trfhtr l. a nrll suhjcd !tr cntPht$ k, diniflrl p(nrhi.s rftl
<br />,h r,r' .t'\omFF\orr,,n J res r nr,ri.kJ 1 rh,'
<br />I
<br />DICIAB{IION
<br />I hcrct y afltm undcr Fnalr! ol Frjury rhd I rm li&isl ond.r Imvhion ol Chxprcr 9 (.onnn cirrs uirt Sst iJn ?00O or r)ivkion ll
<br />or lhc Ausim$ lnd Pntd*ions codc. and ry liccnsc i( in lull lnrcc,nd.ffccr'..-,'<-'IL-l \Jo \vb4
<br />CONSTTIICT!(N I TNDING ACSNCY
<br />thcEhyaflirmundcrltnrxyofPcrjurylh rhcrc n s cr,nnru.rirn kndinsasencr aoi (hc lc.fornurcc oirhc w.tk ior shich rhis Pcrhir i\
<br />i$ucdlS... 3097,Civ. C.)
<br />A.TTLICANLDEIIAAAIION
<br />I lE$y nfim undcr tEn.lry olpcrjry.m ol rhc followi.s d(laarioni
<br />Dcrrliiion P.rmirs sb.{os Notiiclrion Fdd$alR+ulrrions (Tillc 4r- l'an6)
<br />_Rcqrircd trn.r of Norifi colt
<br />-l.cnilyrhd
<br />rh.fcd.rrlrcSulrrio.s rcE(lingtr\h.{o\rcnrvrlrrc nnr lPPlic l.rorhis!('}cr
<br />'fyrhdr
<br />I h vc rcrd lhis urpl x d nrrc lhir rlr rtxrc i'rl,trn i{nr N(,flccr lx8rr
<br />i n.r\ rnd Srrl.l-r!s r.llli',! ro .otretuclio.. nd hcrchys horiT. r{tcrnraliv.s o
<br />otiovc nrnrioncd rn,rny ror iNpccr
<br />Appli.{nl or l!.nl Sia tt
<br />^r+
<br />a->
<br />h'6mnl, wirh all Cry3tuI counry
<br />fihh crland coun(y ro cnr$ uDotr rhc
<br />,J\r-\z_,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsulation a I
<br />Roof Sheathing / /<i/ut
<br />Shear Wall u
<br />Framinq
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Beport
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 2 -o./- Zo
<br />Certif icate of Occupancy
<br />Notes, Remarks, Etc
<br />Nl]
<br />.iv'l fin.<rD ro on. hutrdrcd rhoustrd
<br />"-,,- .,ti,,., I. c.,,. -"-.
<br />^",1['lA\2ow
<br />a--OL>c"",-"..k
<br />l
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