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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OlVNER BI]II,DER DDt,CAf4'I'ION
<br />I hcr.b! r6.!n undcr n nrlly ol plrjlr, rhar I rnr.rcnu fm.r thc Conrrodo^ l,iccn\c Lns r(, rh\ irlt'NinB rcrvr (S..7011.5
<br />Busi,rcs Md Prolcssn,n Oxic) Atry Cny .r Coutrry shich rcquircs ! Pcnnir k, .otr(nr.l, alrs. inrPrnc dcnknish ur rFir rnv
<br />siruchrc. prfinr irr i\\t,rf,r, rl{r rcquncsllr opdE.nr ior slch P.dir b filcr\i8trcd ($.'Enr rhxr h.or shc s liccntd Iiu6urnr
<br />t) rhc novnons olrhe Conrxckn \ I-iLcn\.rl b$ (Chrnr$ 9. CnrnrrcNing wirh Sc.n.tr 7(X)O ol l)ivirion I of rht BusnEs\ and
<br />ltoltsrionsCodctorrhar trm(h. i\ cremDt licrefronrr rhc h3\i\ f(trrhc rllcecd crenDrtn, Anyvnn.rionolScclionT(r.ll5hla!
<br />ppl(anr f,tr rlDrnt suhjsls lhe !nIli.atrr t, dcivrlPcnrlryoffolnDrcrhan fivc huddr.d dollds(1150(D
<br />-1,
<br />rs osncr ol rhc pmpcny- or my crpbyec\ sirh wagc\ {s rlrn $t conr|En{ t'., sill do lhc work ..d rhc sltrrm i( mr
<br />inrcMcd .r ofiircd lor eL (Sa.7OJ4, Busin \s aM holt$ions Codc: -Ihc C('ntn.kr\ Liccn( Lrs does nor arply ro 0tr tqrcr ot
<br />rhc pmpcnt wh, hilds or in$ntrts rh.Nn-,Jd wh, &rs such $1,r* hinrclror h.^cll.r rhrcugh hh.t h.t owncmnlotcc\.
<br />Irovidcd rhar su.h impmvomn( n tu, ir{..d.d or.lIcEl lor eh lt no$c\tr. rh. hikiirA or i.{,o!c'tuir h s.ld ! irhin one )cr
<br />ofconplcrbn, rh. osftr Buildcr will ha$ rhc ttnicn orrn,vii! rlnlr hc o! sic did lrr t{ild or i Eorc thc PmFl, ror rh. PxrPo* of
<br />-1.
<br />r\ ou rcr ol rhc popcny. rf, cx.lus ivel, .ontGrins wirh licctr*d corkr.ros kr con(ruci rne lroFr I S.. 7o{. Buucs
<br />nnd A.fssbn Cudc ahcContracrtr s l-iccnsc l awd.c( nor rml!lo atrowocrofPror. y sho builds .r imProvcs rhcrcotr.
<br />rtrd sh. conrrcls ror soch E jdhwirh. Cotrlo.rn(s) liccnscd rurnrrm k,rhc (i, rrcrols l,i..nsc Lw)
<br />I xm.xcnnn tr c' Sccrnn, .ll. & l'.C knrlrN r$\rr
<br />D.rg O*ner wrrnxiri' conrpe,rslrrrx
<br />DEclntf,AIlO!
<br />I hdel,y aftm ud.r p.mltyofpcruryonc oithc following dclahlions:
<br />I hrtcaildwill nrainidn 0 Ccnificorc of Con*m tu scl nsurc foruortcB Compcnsaliotr.0s prcvidcdnnhySeiionlTO0oflhc
<br />Llbor Cod., for rh. p.rfoflmrcc of I hc tork for ehich th. Fnnl is hsued
<br />?Vm'. und *itt .nin,ni' *,rkr^ onpcnsalion insurancc- a\ rcqlncd by sccln'n 3?(lr of lfie Llbor Codc ror lhc pcdrmrcc or
<br />rhc work for whth this Fmir ir hsu.rl. My worlcrc' conqrnsal ion insuram. mEar and lDli.y nunbq ,cl
<br />.AYncricqn zvrich
<br />t YC loa,he(\O
<br />-t
<br />mnilyrh,r in rhc r.rl.rnmncc ollhc trort i, shich rhk prrnrir is issrcd. t \hsll nor.nIk,y my Dcson in any mlnntr
<br />tu sro bcco,m uh]ccr ro rhc worr.^ $mPctrstlnnr hws ofcalilornix. md aBN rh0t iil shorld t*omc suhr.l ro tlE
<br />wo*crl conrrcns0rion pi(,visn,trs ofsccrion lTmof lhc l:'inr Axi.,lshtrll. lonhwirh comply *nh
<br />'ho* nmvisions
<br />WARNIN(;: f{ilur. ro *curc worko\' .onlPcfudrn'n .otaragc is unl0wtnl and \hall su$Flt rrr cmln,Fr ro mmintl Fn.lri.! lnd
<br />cilil lin.s rp b onc hudrcd lhooun.l doun^ (SI(X).UX)). in lddirio! x) rh. cov of.onrrctrs.lion. dntugcs a\ Prorilcd lnr rhc
<br />\Alhf lfl76 lr Lrb{ c.dc. rnrr{Jftl rtr nry-.f.c\
<br />n",., 'l-28-2o?o n,,,.".iiftkffiJ,L( VAr3 a)
<br />DICIABAIION
<br />I hcrch, arltm uidrr l)..alry ofpcrjury rhlr I am licctr{rl oid.r rovirn{ ofChlPrc. s (onnrf,ncitr8 wilh SErt'n ?(ff) olDivnnm ]
<br />of lhc Busi.c\\ md Ps,te$mns codc. dt nryliccnsc n ir ruu r,nt d l cftccr
<br />(LO
<br />,rl -1R'7-oz"c"*-n*)4 Vi "/ Lnl3a@.t-
<br />rcNsrnugu()It![Nu&(i-e{iExq
<br />isucd (Scc. :11197- Cir C ).
<br />A.SIIIIANLDEIT,ABAIION
<br />I h.,rby dnm lndcr pcnalry ol perjury onc of$c follo*ins d*ldrdlions:
<br />D.mliriofl Permirs Ast dos Norincalion Frdcrrl Reguhlions tTn!.,1o, Pd6,
<br />-Rcqlircd
<br />L.rtcr of Norifi cotion
<br />-I
<br />cc ifythoi lhc f.dcr0l rcsulalioos me..di6g asiEslos Emovsla,c nol dlPlicabl.lo rhis !m,cc'
<br />Ey' ccniay rhlr I hdc rad rhii apdklrion and srole rhal lhe abole inromrion is coftcl I dst ro siryl, wilt all Cn v ind coxhrv
<br />;dinomcs and Srarc Llws Elding ro huildin8 conslru.lion. {id tEtby nurhoir rcplcsnrdilcs 6rrhis Cnt.d Cou.rvio cnld ulsn itE
<br />rh,!c mcnrn rd trotx,ly ior ins|Ecr i{nr Nrfrs.r
<br />rx,n, zlB\Drli.nr .
<br />^rcnr
<br />sirn ure )'
<br />*-,U""*-",rnr,,K O a^i({Varqc^ >
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsu latio n/E ne ro y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/aso nry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL 2 rt 74)Dtraa 1489
<br />Certificate of Occupancy I lr
<br />Notes, Remarks, Etc.
<br />-+
<br />Forms/Steel/Holdowns
<br />trndcar Nrm:-
<br />I
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