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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS <br />Set Backs <br />Formsi Steel/Holdowns <br />Erection Pads <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq I t5 D4 nrt a L-+rq <br />Shear Wall <br />Framino <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />Masonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif. <br />n <br />FINAL <br />Certificate ol Occu <br />, <br />()\\ tIk 8t lLt)tlR lr:t.( \R \t <br />l. rs .*ner ol ihc polsny, or ny cmployccs wirh tr1rcs 11 rhcn $b conltl.nglon, wil do rlE *dk e rhcdndmt R, <br />mr.nJcd droft.tul tai srk rSfr 7014. Busmrsand Pn asDNCi{d fhc O,.lm.itr s l-i.cnsc l-rq Jocl nor aml, b an o*ncr ol <br />rhcpn'Fny *lD bu ilJs or inw)vc\ ihsc,n. .Bl wlx' &r: n'ch u)rk hih{ll or hc^clt rlhi(N3hhs hcr own cmployccs. <br />pn,vidcJ rh.r such in,ft,Eftnh e rrn idcnticd .r ofiarll li)r qh. It, lDwckr. rlE h! Jine or itrWovcnnr tr n,Ll wirhr on. rd <br />ol(,nplcri,n, rlI Owncr Buill.r w]ll hrvr rh. burdcn ot pn)vn! rh! hc or shc dil n, tu lorinuov. rhc on{cn, turh.Elilr,(ol <br />l. ts owncr ol rhc t opdly. !m cx.lurvcly (onrra.ons wnh lEcnrJ contrrrs h (onnfld rlE pDFt (Scc ?Lra4. IrNrnds <br />d*l Pr,liiss i C(ic: Thc G)ntrncrtr's Lrccnsc Lrwd.cs norrlnlylli !nowncrolpro!.dyrho brilds or ihtntvcx th.rcon. <br />itul *[o contrurrs t)r su.h pn,r..( w h a A,nkicb(n liccns.J rtr6ur.r b rhc Cir ra.kn r Liccnsc Law) <br />I amcxcmpr ulcr Scctn, <br />\t()Rxt:ks' ('()III'uNsA uo\ <br />!.)!!! a!!!^ <br />.5 ptuvirleJ for by Set,on l7m .l lh. <br />th. rrhor Codc, lor th. p.rlolrrj,M ot <br />OI /-,1 2-O z-. <br />l.cnilyrhrrrIhcpcrturBxnc,,Irhcwo titr wl'(h rhN r.flnir A rs{rcJ. I shjll nol cD dyrtry <br />I <br />s, rrt,b.om suhj&r i,) rltr workc6' co m!.nsal nnr hes ol C,lilonria. an,l rsre <br />'haril <br />I rhoou h.d,rE suh]cd tolhc <br />work.6 ompcngr <br />'on F)v$idns or Sd$n l?0Oolrh. Llt$rCdc.l shnll. bnhw{hcofrPlyw hrlh*rovisrns <br />WAININGT f.ilrc to Burc *fic6 .ompensari,D.orcrrsc is unlawlul, rnJ drdll suhj.d an.mtl()ycr lo (ininll pcnahis &d <br />civ ,lNs up tu onc hundrcd lhousanJ 'ioll{s (5100.000), i, lJJ n,n b lhc con or.onqxnsarion. Jlmscs as pn,vilcd ,i,r rlt <br />Culc. inrcrc(.n,, arkrrcy r nc\ <br />Zoz-s D lhL <br />!!!EIsE!_Lqrr!r!croa!E$taar!!lN <br />I hcEby afinn utulcr l'cnall, oltcrury thal I am li{tren undcr lmvnio otCluprd 9 (onmnunS with S$tbn ?mO) o{Divtion l <br />of th. Ausincs rnd Ptulisions Code. ind myliccns is ir tull lirlr andclliur. <br />a6fV t> <br />Z-\)-<\,)frr,6 9ss <br />eoNgl!lcI]oN.LENllNc-dc <br />I hcEht alltm un'lcr rcnalryofFrjurythar rhcrc is r.onnrucrion Lndng.Scnuy ltr rhc pe,imraEe ol rhc work for *hich rhN lrrmi s <br />i$ucd (Scu..1097, Civ. ( ) <br />APPLICANT I)FCI,ARATION <br />I tErd,y lnim un ls pcnlh y of t rjoiy om ol rh. follown8 Jel*rr i,ni: <br />Ocmliron Pc,nrih-Ashcsros Notilicarnrn Fe,lenl Rcsllarions (Tirlc.t0, Pan6) <br />-Requncd <br />lJlrcrol Nniaruri,o <br />I.cnilyth!( I h!r. rcalt rht rpll'crL.n 'l {rrc l!tr rli{rn r\.on..r I n!r.c r().o0rtly wirl rll Ci! r Cotr0ry <br />oklinak.\rn'l Srarc llwsrhrmg k, bu'U rs uc rcp.cscnlarivcs olrhi\ Ciry and Cotrnry ('.nr$ qin Irr <br />ah)vc nrntioncd r)pcny li)r in\pccr o2-o <br />UFER Ground <br />Notes, Remarks, Etc. <br />I lNehy arftm undcr p.nalry or lc ury rrdr I m cr.mpr rit,m rh. c()ntrh6 Lrcn{ Llq tu (hc lollowiry rern,'r (scc ?oll.t <br />BusnrsunJ l']rofcsi.n Gtlc) An, C(y or Cirutrry whrh rc{urcs r Frnir t, condtu.r- alrc.. i6prdv., dcmolish ot ,qdt My' <br />(ruuxrc. nritr k) ils issurcc, ako r.quirs rhc atplf,3nr br \kh flmit h l,h a ilncd {arcmnr rhrt he or shc i\ lielrcJ purstranr <br />b rhc ti( visbns ot lhc Conrr..rni Licctrscd Lnw (Chaflcr 9. aonrmcnqnr *irh S..rido 7(XlO or Div*nrn I oi rhc ausincss !nd' <br />Pdasons Co'lc)or thll lE orslE i *cnrpr lhcr.,n,manJ rhc han\ irrh.JLscd.rcn{ .n. Any viobln,n olSccri,! 70.11.5 hy rny <br />rprl'canr ,i,r a pcm ruhjc.a rhc amli.. b . .rvll pcmky or nor mtrdhan lirc hundrql Jollan (5500). <br />(i c.li)rrhc p.rionmn..olrh. work lnr whirh tlr $nni ^,\tr.d. <br />L{nici\ A.ldrcs: <br />- <br />I ccn 'fy rh{r tlE LJ.ftl r+ulllDns ru3$ding islrdos rcnovallrc norslnlicahld t, rhi1!nu..t. <br />tt <br />I lLtl2z I